Multidisciplinary Obstetric Medicine Service (MOMS)
Gastrointestinal Issues During Pregnancy
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Gastrointestinal (GI) issues are some of the most common complaints during pregnancy. Some women may experience GI issues that develop after becoming pregnant. Gastrointestinal problems affect the gastrointestinal tract, primarily the esophagus, stomach, small intestine, large intestine and rectum, but can also affect other organs of digestion, including the liver, gallbladder, and pancreas. Some women may have chronic GI disorders prior to pregnancy that can worsen and require special consideration during pregnancy.
Some of the most common gastrointestinal issues women experience during pregnancy are nausea and vomiting, hyperemesis gravidarum, gastroesophageal reflux disease, gallstones, diarrhea, and constipation. Some women may have been diagnosed prior to pregnancy with GI disorders such as Crohn’s disease or ulcerative colitis. It is also possible to have had these underlying conditions but they had been undiagnosed until pregnancy made them more apparent.
What Are Some Symptoms of Gastrointestinal Issues During Pregnancy?
Because there is a wide range of gastrointestinal issues, the symptoms vary. Some of the most common gastrointestinal problems and their symptoms include the following.
Nausea and Vomiting
Nausea occurs in 91 percent of pregnant women in the first trimester, usually in the first 6 to 8 weeks, and can often be accompanied by vomiting. In mild cases, it is referred to as morning sickness. However, it can become severe and require treatment to manage.
Hyperemesis gravidarum is characterized by uncontrollable and severe nausea and vomiting that leads to fluid and electrolyte imbalance. Symptoms of hyperemesis gravidarum can include:
- Uncontrollable vomiting
- Severe and persistent nausea
- Weight loss
- Electrolyte imbalance
- Food aversions
- Decrease in urination
- Extreme fatigue
- Low blood pressure
- Rapid heart rate
Hyperemesis gravidarum occurs early in the first trimester of pregnancy, typically around weeks 4 to 10. Symptoms usually resolve by weeks 18 to 20. However, if your symptoms are severe, call your doctor. Many of the symptoms of hyperemesis gravidarum can adversely affect your pregnancy and health, and may require treatment.
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease (GERD) is common in pregnancy, typically during the first or second trimester. It affects the lower esophageal sphincter, the muscle between the esophagus and stomach, and causes heartburn or acid indigestion. Symptoms can include:
- Burning in the chest or throat
- Chest pain
- Regurgitation of food or acid
- Bitter or acidic taste in the mouth
- Difficulty swallowing
- Dry cough
- Hoarseness or sore throat
- Sensation of a lump in your throat
While GERD is not often a severe disorder and can be managed through lifestyle modification, if you experience it during your first pregnancy, it often recurs in later pregnancies.
Pregnancy is associated with an increased risk of gallstone formation. The risk for developing gallstones is highest in the second or third trimester and during the postpartum period. Gallstones occur when substances in bile, which is released into the intestines to aid in digestion, becomes too concentrated and forms a hard stone. Gallstones themselves may cause no signs or symptoms. However, if they become lodged in a bile duct or cause a blockage, they can cause noticeable symptoms, which include:
- Sudden and intensifying pain in the upper right portion of your abdomen
- Sudden and intensifying pain in the center of your abdomen, below your breastbone
- Back pain between your shoulder blades
- Pain in your right shoulder
- Persistent pain in any of the above areas that lasts for 30 minutes or longer
- Nausea or vomiting
- Other digestive problems, including bloating, indigestion, heartburn, and gas
Gallstones can cause serious complications. Call you doctor immediately if you experience any of the following symptoms:
- Abdominal pain so intense that you can't sit still or find a comfortable position
- Jaundice, or the yellowing of your skin and the whites of your eyes
- High fever with chills
Diarrhea is a common condition during pregnancy that causes loose or watery stools. It is most commonly caused by viruses or bacteria, but can also be caused by certain medications. Symptoms associated with diarrhea can include:
- Abdominal cramps or pain
- Urgent need to have a bowel movement
While diarrhea is common and generally not serious, you should call your doctor if you experience any of the following symptoms along with diarrhea:
- Blood or mucus in your stool
- Weight loss
This could be a sign of a more serious condition. If you experience diarrhea, make sure you are staying hydrated. Diarrhea can cause dehydration, which can lead to other health complications.
Constipation is having infrequent bowel movement, difficulty having bowel movements, or having hard to pass bowel movements. It is generally described as having fewer than three bowel movements a week. As your baby grows, pressure from the enlarging uterus on the rectum and lower part of the intestine may cause constipation. It may be worsened by high levels of progesterone, which can slow the muscle contractions in the intestine. Some of the symptoms of constipation include:
- Having lumpy, small or hard stools
- Straining to have bowel movements
- Feeling as if a blockage is preventing bowel movements
- Feeling as if you can't completely empty the bowel
- Bloating in the stomach, or stomach pain
While constipation is common and generally not serious, you should call your doctor if you experience any of the following symptoms:
- Blood in your stool
- Weight loss
- Severe pain with bowel movements
- Constipation that lasts more than 2 weeks
Constipation can also cause hemorrhoids -- which are swollen veins in or around the anus. Straining to have a bowel movement or passing hard stool can cause these veins to swell. However, pregnancy alone can cause hemorrhoids to develop, as a growing baby can put pressure on the lower rectum. Symptoms of hemorrhoids include:
- Bleeding during bowel movements, with bright red blood on your toilet tissue or in the toilet
- Itching or irritation at the opening of the rectum
- Pain or discomfort
- Swelling around the anus
- A lump near the anus, which may be sensitive or painful
Colitis and Irritable Bowel Syndrome (IBS)
There are several different types of colitis, a condition that causes an inflammation of the bowel. Different types include:
- Infectious colitis
- Ulcerative colitis
- Crohn's disease
- Ischemic colitis
- Radiation colitis
The symptoms can vary depending on the type. However, some common symptoms of colitis include:
- Diarrhea, with or without blood in the stool
- Rectal bleeding
- Abdominal cramps
- Urgent and frequent need to empty the bowels
IBS affects the large intestine and causes the colon muscle to contract more often than normal. Symptoms of IBS can include:
- Abdominal pain and cramps
- Excess gas
- Change in bowel habits such as harder, looser, or more urgent stools than normal
- Alternating constipation and diarrhea
These conditions are often diagnosed prior to becoming pregnant and may worsen during pregnancy. They can cause difficulty in becoming pregnant or cause complications during pregnancy. Speak with your doctor if you have these conditions and are pregnant or thinking about becoming pregnant. They can help you take measures and considerations to ensure a healthy pregnancy.
What Are Some Causes of Gastrointestinal Issues During Pregnancy?
While many gastrointestinal issues are very common, you may not have experienced any before becoming pregnant. Because they vary, the causes can vary as well. Some common causes or risk factors of gastrointestinal conditions during pregnancy can include:
- Changes in hormones
- GI motility disorders
- Certain medications
- Poor diet
- Thyroid disorders
- Physical internal changes as the uterus grows
- Lack of exercise or activity
- History of overusing laxatives
- Taking antacid medicines containing calcium or aluminum
- Viral or bacterial infection
- Food intolerance or allergy
How Can Gastrointestinal Issues During Pregnancy Be Treated?
Gastrointestinal issues are common during pregnancy and, for the most part, do not cause a serious health risk. However, if you experience any symptoms, you should inform your doctor. He or she will be able to help you manage your symptoms, monitor you for worsening symptoms and determine if additional treatment is required. Different gastrointestinal issues respond to different treatments, so your doctor will be able to suggest the best option for you.
Making changes at home can also help you manage your symptoms. Some of these changes include:
Eat a healthy diet: Changing what, how often, and how much you eat can help manage or relieve your GI symptoms. Depending on your issue, you may need to increase the amount of fiber in your diet, avoid sugary, processed foods, or limit the amount of caffeine and dairy in your intake. Ask to speak with a registered dietitian to determine an individualized healthy eating plan that would most benefit you.
Drink lots of fluids: Increase the amount of fluids you take in, including water, fruit juice and clear soups. Getting lots of fluids can help your digestion and keep your GI tract moving regularly. Certain GI issues can also cause you to become dehydrated, so taking in fluids is very important to avoid any additional health issues cause by dehydration.
Exercise: Regular exercise boosts blood circulation and brings more oxygen to organs, including the bowels, to help them move efficiently and smoothly. Aim for at least two and a half hours a week of moderate exercise, or 30 minutes a day, 5 days a week. Speak with your doctor to find the best workouts that would be safe and appropriate for you.
Medication: If your GI symptoms are severe, persistent, or unmanageable with lifestyle modification, your doctor may prescribe medication, which may include antacids, digestive enzymes, antidiarrheals, GI stimulants, and antiemetics, among others. Your doctor will prescribe you the safest medication at the most appropriate dosage.
When Should I see My Doctor for Gastrointestinal Issues During Pregnancy?
Even if you experience only mild symptoms of gastrointestinal issues, it is important to inform your doctor. He or she can recommend the best methods to manage those symptoms and can then monitor you throughout your pregnancy for worsening symptoms.
If your symptoms are severe, become severe, and are persistent or prolonged, call your doctor right away. You should call your doctor and seek immediate medical care if you experience:
- Vomiting blood
- Bloody or black stools
- Dramatic weight loss
- Severe discomfort that interferes with daily activities
- Episodes of choking
- Pain or difficulty when swallowing
- Extreme fatigue