to just want a STRAIGHT ANSWER so I can stop worrying about Movicol in pg?

[emeraldgirl1]

I am getting totally conflicting advice and getting more and more worried and in a state.

I was diagnosed with slow-transit constipation last year which basically means I have very little peristalsis in my colon (nerve endings are 'faulty' IYSWIM). The ONLY thing that works for me is Movicol - I spent almost a year prior to diagnosis trying everything else, from prunes to bran to exercise to water to vegetables... also tried lactulose, Fybogel etc. Movicol was and is the only thing that makes my colon function. My gastroenterologist put me on a regime of Movicol twice a day and lactulose four times a day which worked fine until I got pregnant.

I am now almost 9 weeks and that regime is barely working any more. I have had to increase the movicol to 3 times a day and I am only just barely managing to keep 'moving' on that.

I knew movicol is 'not advised' during pregnancy but I really have no choice. But I had hoped I might be able to cut it down at some point, maybe to just once a day, but now that the hormones are kicking in, as I say, I am on 3 a day.

Gastro (who doesn't seem even remotely concerned about use of movicol in pregnancy which should reassure me but doesn't because he is quite gung-ho and I don't think knows anything about pregnancy stuff) is unconcerned about the movicol... Midwife is VERY concerned about the movicol and says she never recommends it. She did understand when I explained that this is a long-standing problem and that movicol is my only solution, but still pulled faces and said we'd have to keep an eye on it. I stupidly didn't ask her WHAT the problem with movicol is and now am imagining terrible damage being done to the baby and don't know what to do.

GP is vague and just says 'we'll keep an eye on it' - am not sure what that is meant to mean!!!

Does ANYONE have any advice about this, whether because they used Movicol in pregnancy or whether they have any medical knowledge? My impression was that movicol is not advised as a regular thing but if mother's health requires it then it is OK - but I am just so worried that in the amounts I am having to use atm I am harming the developing embryo in some way :(

This thread has worried me, then reassured me. I'm also on movicol for constipation and anal fissure, and 19 weeks. I've been on between 1 and 5 sachets a day since long before I was pregnant. Both my gp and obstetrician were fine with me having it.

bonzo - hi and thanks so so much for posting... like you I was worried and then reassured... Glad to hear you got the OK from your GP and your obstetrician, that makes me feel much better about taking it. I too have fluctuated (before pregnancy) with between around 1 and 4 sachets a day, I try to cut it down sometimes but it always ends up being a mistake. Right now I am still hoping that 3 sachets a day is only a temp thing and I can go back to my usual dose when hormones settle a bit, I hope so anyway!
I think things were also made worse by fact that for the last 2 weeks I have felt so sick that my usual high-fibre diet went out of the window; I have been living on ginger biscuits and dry white toast, NOT a good anti-constipation diet and nothing like what I normally eat (5-6 veg a day). I really can't face veg at the mo but think I will have to find a way to re-introduce some asap.

You're absolutely right, you want to do the best for your baby, but nobody will tell you what that is! It's very frustrating.

I'm now pregnant with DC2, but that's made things more complicated as DC1 was born 6 weeks early, so nobody's sure when I should stop certain meds to minimize withdrawal risks as I'm more likely to have another early baby.

While I appreciate totally that it's unethical to do trials on pregnant women, surely they could set up some kind of pregnancy medication register where meds and pregnancy outcomes were recorded? The scale of data should lead to some fairly certain indications.

I have no idea how to go about suggesting it though, or who to suggest it to, or how.

you'll find that no medicine will ever say 'yes! use in pregnancy, it's totally fine!' mainly because the drug companies can't do any trials in pregnant women (for obvious reasons), so they err on the side of caution..

I'd be very surprised if your midwife has the pharmacological background to answer questions for you about movicol, your gastroenterologist is the most experienced in this area, although if you think they don't have all the answers surrounding pregnancy, you could always ask to see a medical obstetrician (if they have them in your area)

thanks whyohwhydowebother - it hadnt actually occurred to me that virtually all medicines say not safe in pg... I feel much more reassured after reading this but may try to have a word with an obstetrician just to be absolutely sure that I can stop worrying. :)

And it is hard to do "tests" on pg women that are designed to see if it's safe. Sure, in ideal world you'd stop & use fibre etc. But the real world is that if you stay constipated you may lose control of your bowel contractions, get impacted etc, which could lead to surgery, colostomy bag etc. These scenarios hold more risk to you & baby.

When midwife gets all snooty, ask her what this is based on as your research & that of your specialist suggested this is the least risk for you & baby.

Thanks Jenny.
Mere thought of this getting worse is just too awful - I've suffered with such bad constipation before (until I got diagnosed) and it's frightening when you just don't go for days... weeks...

I have slow transit constipatipn too and I took movicol throughout my last pregnancy with no problems. I was advised to drink lots too my gp admitted that they didn't really know the effects but said it was so gentle she was. confident it would be fine .

I was prescribed movicol during my recent pregnancy from about 24 - 30 weeks as I was very badly constipated due to taking iron supplements. My consultant was clear that it wouldn't pose any risk to the baby and would provide great relief to me (as it did). Two week old DS seems quite content, happy and healthy

Hope that helps reassure you.

I wouldn't worry about this. I was prescribed movicol (as well as loads of other drugs and various different laxatives) by the hospital earlier in this pregnancy. I had severe hyperemesis which itself causes constipation, added to which I was on the max dose of a nasty antisickness drug which essentially paralyses your colon. My constipation was so bad that the only thing that worked was either the 'impaction' dose of movicol (I think it was 8 or 10 sachets at once in a litre of water) or an enema. They did an enema in hospital and sent me home with the movicol. They seemed unconcerned with these pretty extreme measures and in hospital they were clear that the severe constipation needed sorting out, whatever it took. Hope that helps.

Couple of things:

1. Are you referred to a consultant obstetrician? If not then you need to be - he/she can discuss your management with gastro and decide best course of action.

2. One of your local hospital pharmacies will be able to give a report on the use of movicol in pregnancy though I think it will be a bland 'if the benefits outweigh the risks' and 'there are no definitive studies to say it is safe etc, etc...' I do not think you will get a definitive answer.

3. Peristalsis is reduced in pregnancy and iron supplements could make it worse hence the comments that it might get worse... sorry to say.

4. Laxatives have always been viewed with caution in pregnancy because anything that stimulates the gut could, theoretically stimulate the uterus in later stages as they lie close together and cause irritable uterus (where it tightens and causes period-type pains) or even prem labour.... however I would argue that your use of movicol returns your gut movement to normal and that the problems occur when we medicate an impacted constipation by overstimulating peristalsis.
   Constipation IS treated in pregnancy but gently and your normal every day edication is more than would offer to the average pregnant women. However the average pregnant woman does not have the gastro problems you have.

I think it's important yo stay on top of your constipation to avoid needing to have enemas, etc and as such I would go with the gastro advice at this stage but give the pharmacy a call just to make sure there is no specific caution in pregnancy.

james thankyou. we are mostly taking movicol and know it to be effective. The link you have provided is to information provided on the box. It only says to speak to your doctor before taking it in pregnancy. No information about it being harmful in pregnancy.

"it can cause a problem to the embryo if taken in excess". Please can you direct me to further information on this, as this in my opinion would rather rule it out as being a "nice" laxative in pregnancy. What are the problems and how much is excess?

Phoned doctor. Absolutely fine to use during pregnancy. Doesn't enter blood stream and totally harmless. Just make sure you drink plenty of water.

Movicol is SAFE to use during pregnancy - I phoned the doctor and asked. It doesn't enter your blood stream. Just drink plenty of water. annakwriter.wordpress.com

I had it in this pregnancy, prescribed by an obstetrician and I assume they knew what they were doing. In your situation I absolutely would take it - midwives really don't know much about drugs compared to drs.

I did not take movical but had to take tramadol for fibromylagia which effects have not been proven in pregnancy.
My GP and consultant and most of the midwifes saw that I had to take it as was in so much pain. One midwive went batshit crazy and me and told me my baby would have withdrawal and be behind developmentally etc.
My DS was born fine no withdrawal and all and he is ahead of all his targets.
Listen to your doctor not your midwife when it comes to medication

Haven't read the whole thread so not sure if someone else has suggested this already but the UK Teratology information service is a DoH funded service that gives advice on the safety of drugs in pregnancy. They have an information sheet for macrogols (Movicol)www.medicinesinpregnancy.org/Medicine--pregnancy/Macrogols/

Zombie thread from 2012.
Even elephant pregnancies don't last this long.

Ahhhh did not notice it's a zombie thread. Annoying

I may be making this up but I'm pretty sure I went to the GP's a few weeks ago (cold sores on and up nose,pharmacist refused to sell me the cream) and because I was wanting meds he checks some fairly new data base done by who ever it is that collates all e yellow reporting cards and other stuff inc the reporting systems surrounds baby related issues when the mother has been on medication, but this is specific to pregnancy.

But I cannot for the life of me remember what he called it.

Fuck that's annoying

Here is a leaflet on treatments for constipation in pregnancy. Hope it helps. www.medicinesinpregnancy.org/medicine--pregnancy/treating-constipation-during-pregnancy/

Also, UKTIS (where I work) have set up a registry to collect information about pregnancy outcomes from women who have used medicines (and also women who haven't) . If anyone is interested in participating, please see www.medicinesinpregnancy.org

The whole point of movicol is that it is kept in the gut, and not absorbed into the body. So your baby should be fine. The leaflet will indeed say it isn't advised. Drugs companies are scared rigid of testing anything formally in pregnancy, so the trials will have been in non pregnant people, so they are not going to officially say it's fine. But movicol has been around for a good few years now, and is used incredibly commonly. So if it had a significant effect on babies it ought to have become very apparent. It hasn't. So noone can say it's 100% safe, but I'd be gobsmacked if your baby was affected.