Hi, I'm 20 weeks pregnant and really struggling with constipation. Is there anything I can do to help? I don't want to take laxatives but I'm really uncomfortable. Also I don't know if laxatives are safe when you pregnant?

Constipation during pregnancy is very common with up to 40% of women experiencing it. It can occur at any stage of pregnancy but is more common in the first and second trimester.

Diet, lifestyle, hormonal and mechanical changes can all contribute to constipation in pregnancy. Apart from the fact that constipation is uncomfortable, it also could cause more long term damage so it is important to seek help.

Changing your diet should be the first step in preventing or treating constipation in pregnancy. In general, your diet should be balanced and contain whole grains, fruits, and vegetables. The Food Standards Agency website, Eat Well, Be Well has lots of information on healthy eating (www.eatwell.gov.uk).

You should try to eat more high fibre foods, for example wholemeal bread and wholegrain cereals, beans and pulses (lentils, chick peas), fruit and vegetables. These foods should be gradually introduced into the diet, if you are not used to eating them, otherwise you may feel bloated and gassy.

To get enough fibre while pregnant you should aim to consume 18–30 g fibre per day (and then maintain this level for life). To achieve this you could try eating 4-6 portions of the foods per day from the list below:

• 3 tablespoons of muesli
• 5 tablespoons of bran flakes
• 3 tablespoons of allbran
• 2 slices of wholemeal bread
• 2 pitta breads
• 1 chapati
• 4 dried apricots
• 2 dried figs
• 8 prunes
• 2 bananas
• 15 berries (blackberries and raspberries)
• 2 spears of broccoli and 2 tablespoons of carrots
• 2 tablespoons of boiled spinach
• 2 tablespoons of frozen peas

When increasing your fibre intake it is really important to drink enough fluid, at least 2 litres per day. Without enough fluid extra fibre can make constipation worse, in fact many women find that increasing their intake of fluid is enough to ease constipation on its own.

Being active during your pregnancy can help to ease constipation, always build up your levels of activity slowly so as not to overdo it and listen to your body. Feeling faint or too hot means you should stop immediately. Exercises like going for a walk, doing some housework or swimming are ideal.

A combination of a diet with plenty of fibre and activity during pregnancy is not only a great way to prevent and treat constipation; it is also an excellent way to make sure you don't put on too much weight during pregnancy and, if continued after pregnancy will help to maintain your bowel health.

You should only use laxatives if you have tried all of the above and it hasn't worked. It would be best to speak to your GP or pharmacist about your particular symptoms, and then they can advise on a laxative that is safe for pregnancy, and is going to be the most effective for you.