Tip: If you have recently returned from a vacation in an exotic country with nausea and diarrhea and find out you are pregnant, see your doctor as soon as possible.

Gastroenteritis

One common cause of diarrhea during pregnancy is gastroenteritis or stomach flu. It is caused by bacterial or viral infections: norovirus, rotavirus, E. coli, salmonella, which enter the body through contact with contaminated surfaces, dishes, food and water.

Gastroenteritis usually lasts about three days. However, severe illness is a health hazard, especially during pregnancy, as it can cause dehydration, electrolyte imbalance, and lead to preterm labor.

The main symptoms of gastroenteritis are diarrhea without blood, nausea and vomiting, stomach cramps and pain, slight fever, headache and muscle pain.

Take extra precautions to reduce your risk of getting sick: frequent handwashing and surface disinfection. If the expectant mother has small children, they are not recommended to use the same cutlery.

Risks of diarrhea during pregnancy

Usually diarrhea during pregnancy is not a cause for concern. However, you should consult a doctor if the following symptoms occur during this period:

• Diarrhea for more than two days;
• Blood or mucus stools;
• Sudden weight loss;
• Pain in the abdomen;
• Dehydration.

How to treat diarrhea during pregnancy

If you have diarrhea during pregnancy, drink plenty of fluids, avoid foods high in fat and sugar, avoid dairy products, and caffeinated drinks.

Dehydration is a serious risk, especially during pregnancy, so electrolyte balance should be restored first with fluids and simple foods:

Find out about your body's ability to break down lactose and gluten with the Atlas Microbiota Test.

Stomach pain and heartburn during pregnancy

Many women experience stomach pain during pregnancy, especially in the upper part of the stomach, as well as heartburn - a burning sensation in the chest and esophagus.

This is more common in the third trimester, after about 27 weeks. This is an unpleasant but natural phenomenon during pregnancy: the baby grows inside the uterus and presses on other organs, including the stomach. And hormones cause the muscles to relax, which causes acid from the stomach to enter the esophagus and irritate it. In addition, pain can be caused by problems with certain organs such as the gallbladder, or inflammation of the pancreas.

Symptoms of heartburn during pregnancy:

• Burning in chest and esophagus;
• Feeling of overeating, heaviness or bloating;
• Belching, including with acid and/or food particles;
• Nausea.

It is unlikely that you will be able to avoid cramps and heartburn during pregnancy. However, some tips can help reduce their frequency:

Nutrition : try to avoid overeating - eat easily digestible food in small portions; do not eat three hours before bedtime; watch your posture while eating - so the pressure on your stomach will be less.

Smoking and alcohol: In addition to known harms to mothers and babies, tobacco smoke also relaxes the muscles in the lower esophagus, allowing acid to enter the esophagus. And alcohol provokes heartburn and acid reflux.

Although stomach pain and heartburn often accompany pregnancy, abdominal pain, especially in the third trimester, should be taken seriously. It can be a sign of preterm labor or placental abruption, and puts mother and baby at risk.

If you experience severe abdominal pain during pregnancy that is accompanied by the following symptoms, seek medical attention as soon as possible:

Bloating, constipation and microbiota during pregnancy

Excessive gas and constipation during pregnancy can be caused by hormonal changes, such as increased production of progesterone. This hormone, essential for nourishing the uterus and fetus, relaxes the muscles of the body, including the muscles in the intestines, which slows down digestion and increases flatulence. A similar reaction of the body can be observed before each menstruation, when the production of progesterone increases.

Flatulence - bloating of the abdomen due to the accumulation of gases.

Here are a few simple rules that will help improve bowel movements and avoid constipation and bloating:

• If you don't usually eat a lot of fiber and indigestible foods like legumes, try to gradually introduce them into your diet;
• Avoid carbonated drinks and fatty foods;
• Move more;
• Drink plenty of fluids.

If bloating and constipation are accompanied by severe pain that lasts more than 30 minutes, or if you have been constipated for two or more weeks, see your doctor.

Gut microbiota and bacteria during pregnancy

A woman's body goes through many changes during pregnancy, and this can affect the microbiota, the bacterial ecosystem that lives in the gut. Trillions of microorganisms do important work for the whole body: they synthesize vitamins and essential acids, keep your intestines working and protect it from disease and inflammation.

The additional influx of female hormones that accompanies pregnancy alters gut function and affects the microbiota. This is good, because the bacterial community is constantly adjusting to external and internal conditions in order to keep up with the needs of the body.

To keep your gut bacteria running smoothly, they need your help. Provide them with healthy foods and plant fibers. Fruits, vegetables, whole grains, nuts, and seeds contain prebiotics, special substances that beneficial bacteria feed on. When properly balanced, the bacteria even increase your body's defenses against harmful microorganisms that can cause gastroenteritis during pregnancy.

The Atlas Microbiota Test will help you understand how to prepare your intestines for future pregnancy and reduce the risk of digestive problems.

☝️ Take note

Now you have all the necessary knowledge and tools to help you deal with digestive problems during pregnancy. They are quite varied and quite natural, but in some cases it is necessary to immediately seek medical help:

• Vomiting blood;
• Blood in stool;
• Diarrhea for more than two days;
• Constipation for more than two weeks;
• Sudden weight loss;
• Severe pain interfering with daily activities;
• Difficulty breathing;
• Pain when swallowing or difficulty swallowing;
• Excessive fatigue.

More articles on the causes of digestive problems in the blog:

• 7 foods that cause gas and bloating
• Lindsey J Wegrzyniak, Treatment of Hyperemesis Gravidarum, 2012
• Edwards A. et al., The Maternal Gut Microbiome During Pregnancy, 2018
• National Health and Safety (NHS), Vomiting and morning sickness in pregnancy
• Kudzai Kanhutu, Travel and pregnancy: an infectious diseases perspective, 2011
• CDC, Pregnant travelers
• U. S. Department of Health and Human Services, Agency for healthcare research and quality, Abdominal Pain in Early Pregnancy
• Robyn Horsager-Boehrer, M.D., UT Southwestern Medical Center, Should pregnant moms be concerned about gastroenteritis?, 2018
• International Foundation for Gastrointestinal Disorders, Pregnancy and Irritable Bowel Syndrome, 2016
• NHS Vomiting and morning sickness in pregnancy
• NHS, Severe vomiting in pregnancy
• Lindsey J Wegrzyniak et al., Treatment of Hyperemesis Gravidarum, 2012
• Karen Miles, Diarrhea during pregnancy, 2020
• Cleveland Clinic, Diarrhea
• You and your hormones, Progesterone
• Traci C. Johnson, MD, Pregnancy, Bloating, 2020

Diarrhea during pregnancy. What is Diarrhea During Pregnancy?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Diarrhea during pregnancy is a pathological condition during gestation, characterized by the rapid release of unformed feces. Disorder of the stool can proceed painlessly or be accompanied by belching, nausea, vomiting, discomfort in the mouth, abdominal pain, imperative urge to defecate, fever, weight loss, weakness, fatigue. To determine the cause of diarrhea, clinical, bacteriological, biochemical studies of feces, blood, probing, sigmoidoscopy are carried out. Treatment is most often conservative - medications, dietary adjustments.

ICD-10

K59.1 A09.0

• Causes
• Pathogenesis
• Classification
• Symptoms
• Complications
• Diagnostics
• Treatment
• Prognosis and prevention
• Prices for treatment

General

Diarrhea (diarrhea) - an increase in the frequency of bowel movements up to four or more times a day with the separation of liquid or mushy stools, the volume of which exceeds 200-300 ml. Diarrhea is not a separate disease, but one of the manifestations of a violation of the functions or anatomical structure of any organ or body system. Sometimes diarrhea is the first symptom of a pathology that can complicate gestation. The frequency of diarrhea in obstetrics is 34%. Diarrhea is recorded less frequently than constipation, it is more susceptible to age-related (after 35 years), as well as young (under 19years) mother. Usually there are forms with a mild course, ending in a quick recovery. Severe forms pose a serious threat to the life of the mother and fetus. Inpatient treatment with intensive care is necessary for 1.5% of pregnant women suffering from diarrhea.

diarrhea during pregnancy

Causes

Most often, diarrhea during pregnancy is caused by physiological (that occurred during gestation, associated with this condition, which is a variant of the norm during this period) changes in the digestive, endocrine, and nervous systems. Another common reason is dietary errors. Diarrhea is manifested by diseases that developed during gestation in women whose body could not adapt to increased stress, and that arose before conception. There are the following sources of intestinal upset in pregnant women:

• Non-communicable diseases of the digestive system. Diarrhea may be accompanied by a physiological decrease in gastric secretion during gestation, as well as pathologies: dysbiosis, cholestatic hepatosis of pregnant women, hypoacid gastritis, less often - ulcerative colitis, Crohn's disease, chronic pancreatitis, tumors.
• Features of the diet. Diarrhea can lead to addiction to coffee, excessive consumption of fatty (including nuts), spicy, spicy foods, sweets, pastries, as well as foods containing a large amount of fiber (fruits, vegetables, cereals). In addition, diarrhea may be accompanied by hypovitaminosis of pregnant women, which occurs due to an imbalance or scarcity of the diet.
• Food intolerance. The cause of diarrhea can be a food idiosyncrasy associated with a lack of enzyme production (for example, lactulose with intolerance to whole milk) or an allergic reaction (more often to citrus fruits, berries, cereals, eggs, chocolate, legumes). At the same time, hypersensitization often develops for the first time during the gestational period.
• Neurogenic factors. By the last trimester of pregnancy, the processes of excitation of the cerebral cortex begin to prevail over the mechanisms of inhibition, which increases the likelihood of developing irritable bowel syndrome. Other causes of neurogenic diarrhea are prolonged psycho-emotional stress, neuropathy.
• Infections and infestations. Diarrhea is caused by acute intestinal infections - bacterial, viral, protozoal, affecting the digestive tract. Nonspecific infections may be the result of the growth of opportunistic flora against the background of a natural decrease in immune activity during pregnancy. The flu is often accompanied by diarrhea. Of the helminths, roundworms are most often involved in diarrhea.
• Taking medications. Iron preparations, magnesium salts, antibiotics, antacids, sugar substitutes, antidiabetic, laxatives, dietary supplements cause diarrhea, using various mechanisms of gastrointestinal dysfunction.

Other, more rare causes of diarrhea in pregnant women include metabolic endocrine diseases (diabetes mellitus, hyperthyroidism, amyloidosis), surgical pathologies (acute appendicitis, intestinal obstruction, mesenteric vascular embolism). False diarrhea is sometimes accompanied by persistent constipation, which is often observed in pregnant women: a prolonged stay of feces leads to irritation of the colon wall, increased secretion of mucus, and the release of liquid stools.

Pathogenesis

About nine liters of fluid enter the intestinal lumen daily, 22% of which is water obtained from food, the rest is formed as a result of the secretion of the digestive organs. About 89% of this liquid is absorbed by the small intestine, about 10% - by the large intestine, only 1.1% (about 100 ml) is excreted in the feces. Diarrhea occurs with increased fluid intake (mostly due to excess intestinal secretion) or as a result of a decrease in absorption capacity. Hypersecretion of the small intestine is associated with infection by pathogenic microorganisms, the use of irritant laxatives. The secretion of the lower intestine is most often increased due to a decrease in the absorption of bile acids.

Enzymatic deficiency and acceleration of the passage of contents leads to a disorder in the absorption capacity of the small intestine. At the same time, unabsorbed substances accumulate in its lumen, retaining water due to their osmotic action. Reduced absorption in the lower sections is a consequence of increased fluid intake from the ileum, damage to the epithelium, impaired motility of the colon, and a lack of bacteria that ferment carbohydrates. As a result of severe diarrhea, hypovolemia, acidosis, deficiency of nutrients, vitamins, microelements develop. Irritation of the colon leads to a reflex increase in the tone of the pregnant uterus, and the release of active substances associated with inflammation into the blood enhances the effect.

Classification

According to the form of the flow, acute and chronic diarrhea are distinguished. The acute form is characterized by vivid symptoms observed for no more than 3 weeks. The chronic course is characterized by a longer duration of manifestations and less pronounced symptoms. According to the pathogenetic mechanism that contributed to the development of the disorder, four types of diarrhea are distinguished:

• Secretory. This type of diarrhea develops with an increase in the secretion of fluid and electrolytes in the intestine due to damage by pathogenic microorganisms, their toxins, as well as an excess of bile acids.
• Hyperosmolar. Occurs due to the influx of water during the accumulation in the intestine of osmotically active substances (potassium and sodium ions, glucose) as a result of impaired digestion and absorption (with chronic pancreatitis, dysbiosis, enteritis, food intolerance, amyloidosis, obstruction of the biliary tract), intake of excessively salty or sweet food .
• Hyperexudative. Diarrheal syndrome is caused by sweating of exudate through the damaged mucosa in autoimmune, neoplastic diseases of the intestine, some infections (dysentery, salmonellosis, intestinal tuberculosis, campylobacteriosis).
• Motor (dyskinetic). The cause of diarrhea is an increase or decrease in the rate of chyme transit due to impaired intestinal motility. Hyperkinetic diarrhea is accompanied by nervous shocks, neuroses, neuropathies, hyperthyroidism, taking laxatives. The hypokinetic type is associated with small bowel obstruction.

Symptoms

Symptoms of diarrhea during pregnancy depend on the causes of diarrhea, its type, localization of the lesion, intensity of manifestation. Enteritis is manifested by abundant voluminous loose stools without impurities, bowel emptying is often "explosive" in nature. Colitis is characterized by sharp tenesmus (frequency up to 30 times a day), increased defecation with scanty mucous discharge, often mixed with pus and blood. A significant increase in stool in acute diarrhea leads to a rapid decline in strength, severe weakness. Chronic diarrhea is characterized by fatigue, weight loss.

Secretory diarrhea is characterized by abundant light watery or frothy stools without severe abdominal pain, the disorder does not depend on diet, and is not stopped by fasting. Osmolar diarrhea is manifested by an abundant separation of feces containing particles of undigested food: light, pasty in case of pathologies of the hepatobiliary system and gray, with a rancid odor in case of pancreatic insufficiency; diarrhea usually resolves after fasting. The exudative type is characterized by an admixture of blood and pus in the feces. A distinctive feature of hyperkinetic diarrhea is a slight increase in the daily volume of liquefied yellow or greenish stools. With diarrhea caused by decreased motor function, mucus is usually present in the stool.

Diarrhea may be accompanied by other pathological manifestations. Fever accompanies infectious and autoimmune enterocolitis. Tachycardia, sweating is accompanied by a significant loss of water and electrolytes, hyperthyroidism, irritable bowel syndrome. The latter also proceeds with alternating diarrhea with constipation, epigastric discomfort; there may be intense pain, simulating a picture of an acute abdomen, characteristic of surgical pathologies. Epigastric discomfort is also observed with diarrhea associated with the pathology of the liver, pancreas, dysbiosis. Cholestatic diarrhea is accompanied by jaundice, and caused by autoimmune colitis, amyloidosis - inflammation of the joints. With diarrhea associated with Addison's disease, diabetes mellitus, skin pigmentation disorders are observed.

Complications

The most common and dangerous complication of diarrhea is miscarriage. In 30-44% of cases, the cause of spontaneous abortion is gastrointestinal diseases that occur with diarrhea. Severe diarrhea with a large loss of fluid poses a threat to the life of the patient due to the development of collapse and shock, often leading to death. For the mother and the unborn child, it is also not the intestinal disorder itself that can be dangerous, but its causes. So, the result of an intestinal infection can be purulent-inflammatory gynecological complications (the most formidable is obstetric sepsis) in a woman and intrauterine infection with the development of fetal pathology in the fetus.

Diagnostics

Diagnostic search is aimed at finding out the causes of diarrhea (alimentary factors, internal diseases, endocrine, neurological or obstetric pathology). Most often, to establish the root cause, it is enough to consult a therapist and an obstetrician-gynecologist: differential diagnosis is carried out on the basis of anamnesis data (information on the frequency and volume of defecation, the nature of the stool, dietary characteristics, the presence of general somatic diseases) and the results of an objective examination (identification and evaluation of concomitant symptoms). To clarify the diagnosis, narrow specialists (gastroenterologist, infectologist, endocrinologist) are involved and instrumental and laboratory research methods are used:

• Fecal analysis. Bacterial culture allows you to identify the pathogen in case of infection and choose an antibiotic for its treatment. According to the results of the coprogram, it is possible to confirm or exclude functional pathologies of the stomach, digestive glands, intestines, and also to suspect a violation of the integrity of the mucous membranes (by occult blood). A positive test result for helminth eggs indicates a helminthic invasion.
• Blood tests. Based on the results of the general clinical analysis, it is possible to establish the inflammatory, allergic nature of diarrhea, suggest malabsorption or malignancy. Biochemical research allows to reveal pathologies of the hepatobiliary system, pancreas, diabetes mellitus.
• Endoscopy. Sigmoidoscopy is performed to detect colitis, tumor changes. With the help of gastric and duodenal sounding, it is possible to detect a decrease in the pH of gastric juice, an increase in the concentration of bile acids, and violations of the exogenous function of the pancreas.

Treatment

Treatment of diarrhea during pregnancy is carried out under the supervision of an obstetrician-gynecologist. In mild cases, symptomatic and etiotropic therapy is prescribed, aimed at eliminating intoxication and correcting the water-salt balance: enterosorbents, oral rehydration solutions. Particular attention is paid to the diet: food should not irritate the mucous membranes of the gastrointestinal tract, increase peristalsis, or cause fermentation. Fresh pastries, cabbage, legumes, onions, garlic, spices, seasonings, strong broths, fried and stewed foods, carbonated drinks are excluded from the diet. With severe dehydration, intensive therapy is used. Specific treatment is prescribed for chronic, severe acute diarrhea and is selected depending on the underlying disease.

Prognosis and prevention

The prognosis depends on the cause of the intestinal disorder. With alimentary diarrhea, neurogenic diarrhea, easily occurring infections, recovery occurs quickly, complications do not develop. With advanced, progressive pathologies manifested by chronic diarrhea, severe infections, the prognosis worsens, especially for the fetus. Preventive measures include the identification and treatment of chronic internal diseases before pregnancy, regular visits to the antenatal clinic during the gestational period, hygiene, eating fresh, optimally balanced in vitamins, macro- and micronutrients food, avoiding uncontrolled intake of drugs, herbs, dietary supplements, fight against constipation.

You can share your medical history, what helped you in the treatment of diarrhea during pregnancy.

Sources

1. Acute diarrhea in obstetric practice / Uspenskaya Yu.B. - 2014.
2. Differential diagnosis of internal diseases / Hagglin R.

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