Constipation during pregnancy is a violation of the bowel, manifested by a delay in defecation or insufficient emptying, which often occurs in women at different gestation periods. Stool retention is accompanied by pain in the left iliac region, bloating. More rare defecation is caused by physiological changes in the woman’s body, gestational and intestinal pathology. Ultrasound methods, laboratory tests of blood and bowel movements are used to identify the causes of constipation. A change in eating habits and adequate physical activity helps to restore the normal frequency of stool.
Causes of constipation during pregnancy
A normal pregnancy
Fecal retention is a problem faced by two thirds of pregnant women. In the early stages, constipation is usually caused by hormonal restructuring, a change in the usual diet. In the second half of pregnancy, the difficulty of the act of defecation is more often associated with mechanical compression of the intestine by an enlarged uterus, a decrease in physical activity. Fecal retention in such situations is not a cause for concern and is easily corrected using non-drug methods. The causes of constipation during the physiological course of gestation are:
- An increase in the size of the uterus. In the second and third trimesters, the uterus rapidly increases in size, squeezes the intestinal loops, especially the blind and sigmoid intestines. This disrupts the normal passage of feces, increases the resorption of water with the formation of solid fecal masses, which hardly stand out during emptying. Constipation with enlargement of the uterus is accompanied by shortness of breath due to limited mobility of the diaphragm.
- Hormonal changes. In pregnant women, there is a predominance of progesterone effects. This hormone is critically necessary for the preservation of pregnancy, since it reduces the contractile activity of all smooth muscle organs — uterus, intestines, bladder. The suppression of peristaltic contractions leads to prolonged stagnation of feces in the intestine, chronic stool retention, discomfort in the left abdomen during defecation.
- Changes in eating habits. The diet of a pregnant woman can vary significantly. Appetite often increases in combination with a change in taste preferences. Constipation and other dyspeptic disorders can be caused by constant overeating, which significantly increases the load on the digestive system. In addition to fecal retention, discomfort and heaviness in the stomach occur after eating.
- Physical inactivity. Regular exercise and preserved abdominal muscle tone are very important for the normal functioning of the gastrointestinal tract. Women in late gestational periods are prone to inactivity, as it becomes more difficult for them to perform habitual actions. As a result, the motility of the colon slows down, the stool is absent for several days, the pregnant woman complains of other dyspeptic disorders.
- Reception of trace elements. To improve the processes of hematopoiesis and prevent disorders of the bone system, pregnant women are prescribed dietary supplements with iron and calcium. Drugs can inhibit the motility of the digestive and tract, so their side effect is constipation. When using drugs with iron, stool retention is combined with a change in the color of feces — due to the presence of metal salts, its color turns black.
- Emotional factors. Constipation during pregnancy can be potentiated by neuropsychological changes. Hormonal changes and the fear of impending childbirth often cause emotional lability, chronic stress. When the autonomic nervous system is involved in the process, sympathetic fibers are activated with inhibition of intestinal peristalsis and constipation.
Pathology of pregnancy
Various disorders of normal gestation provoke disorders of the digestive system, which may be associated with both the direct involvement of the gastrointestinal tract in early toxicosis, and with the neuropreflective mechanisms of stool retention. Constipation is often combined with other symptoms of dyspepsia — nausea, repeated vomiting, lack of appetite. If the symptom is constantly manifested, it is necessary to clarify its causes in order to determine further obstetric tactics. Most often constipation during pregnancy occurs against the background of the following pathological conditions:
- Toxicosis. Early toxicosis occurs in about 50-60% of pregnant women, but only in 10% they are characterized by a moderate or severe course. The main symptoms are various dyspeptic disorders, constipation often develops a second time against the background of severe dehydration of the body due to repeated vomiting and intense salivation. The situation is aggravated by a decrease in food intake, which provokes a sharp weight loss.
- Hypertonus of the uterus. The absence of defecation with an increase in the tone of the smooth muscle fibers of the uterine wall usually has a psychogenic origin. Violation of the stool is caused by conscious restriction in food intake and suppression of the urge to defecate, since pregnant women are afraid of the threat of miscarriage with intense straining during toilet visits. This condition, combined with physiological prerequisites, leads to chronic constipation.
- Gestosis. Slowing of intestinal motility in gestosis of the second half of pregnancy is caused by prolonged use of sedatives, diuretics, hypotensive and other drugs that are used to relieve negative symptoms. Constipation is also observed in the severe course of the disease, when pregnant women are transferred to parenteral nutrition and provide them with strict bed rest.
Stool retention immediately after childbirth is usually noted in the presence of complications (perineal ruptures, perineotomy) or during childbirth by caesarean section. In such situations, the norm is the absence of defecation for up to 2 days, in the future, the use of laxatives is recommended. Timely restoration of peristalsis and defecation ensure a normal rate of uterine contraction.
Sometimes constipation is not directly related to the presence of pregnancy and occurs due to functional or organic diseases of the digestive tract. Fecal retention is often provoked by morphological changes in the structure of the colon, which slows down the passage of feces, affects their consistency. Difficulties in defecation can be caused by dysregulation of the autonomic nerve ganglia, which provide peristaltic contractions of smooth muscles. Constipation during pregnancy provokes concomitant diseases such as:
- Irritable bowel syndrome. IBS is a functional disorder that is caused by a violation of the innervation of the intestinal wall, an unbalanced diet, and emotional shocks. For the disease, a combination of constipation with false urge to empty, pain and discomfort on the left in the iliac region, decreased appetite is typical. The clinical picture is characterized by polymorphism and inconstancy of symptoms.
- Dysbiosis. Specific hormonal changes during pregnancy sometimes disrupt the normal digestion of food ingredients, causing a mild variant of malabsorption and maldigestion. Constipation with dysbiosis is accompanied by bloating, belching air or rotten. With significant maldigestion, there is a change in the color and consistency of fecal masses, discomfort and pulling pains along the course of the intestine.
- Dolichocolon. An increase in the length and diameter of individual sections of the intestinal tract (more often the colon and sigmoid colon) is combined with pronounced dyspeptic disorders. Women complain of prolonged constipation, severe flatulence, abdominal colic and spasms of various localization. Additional compression of the intestinal loops by the growing uterus during pregnancy leads to an aggravation of symptoms, the appearance of signs of intoxication.
- Hemorrhoids. An increase in the concentration of progesterone and the mechanical pressure of the enlarged uterus reduces the tone of the venous plexuses of the hemorrhoidal zone. In this case, constipation during pregnancy is a consequence of the conscious suppression of the urge to empty the intestines, since the act of defecation causes severe pain. With the progression of the disease, stool retention becomes chronic, persists even after treatment of hemorrhoids.
- Biliary dyskinesia. The effect of increased amounts of estrogens and progesterone often disrupts the functioning of the biliary system. A decrease in bile excretion due to hypomotor dyskinesia provokes the development of spastic constipation, which is characterized by difficult excretion of solid fragmented feces (“sheep” feces). Typically, the appearance of pulling pains in the right hypochondrium.
- Inflammatory bowel diseases. Pregnancy in rare cases exacerbates the course of such chronic diseases as ulcerative colitis and Crohn’s disease. In these pathologies, organic lesions of the mucous membrane and intramural vegetative plexuses become the cause of fecal mass retention. Constipation is combined with tenesmus, abdominal pain, discharge of mucus from the rectum with streaks of blood.
Since stool retention is more often caused by physiological features of the course of pregnancy or painful conditions associated with gestation, a gastroenterologist is engaged in examining women with complaints of constipation during pregnancy, provided that an obstetrician-gynecologist is constantly monitored and consulted. The study of the digestive system is always carried out in conjunction with a standard gynecological examination of a pregnant woman.
The diagnostic search should first of all be aimed at excluding natural and pathological causes associated with carrying a child. A woman is given a comprehensive examination using only those methods that do not harm the fetal body. The most valuable for clarifying the root cause of fecal retention in pregnant women are:
- Ultrasound examination. Ultrasound is the main diagnostic method that is used during pregnancy, because it is absolutely harmless to the body of the mother and child. Sonography allows you to visualize intestinal loops, detect non-specific signs of inflammatory processes or stretching of the intestine. In the third trimester, the diagnostic value of the method decreases, due to a significant increase in the uterus.
- Analysis of feces. Standard macroscopic and microscopic analysis of feces makes it possible to suspect the presence of pathologies of both the small and large intestines, which often lead to constipation. To exclude dysbiosis, a bacteriological analysis of feces is carried out. If organic lesions of the rectum or other parts of the colon are suspected, the Gregersen reaction to hidden blood in the feces is performed.
- Rectoromanoscopy. The method of visual inspection of the surface of the mucous membrane of the rectum is used to identify enlarged hemorrhoids, cracks, which are quite often found in pregnant women. In the first trimester, a study using a rectoromanoscope can be supplemented with sigmoscopy, at a later date this manipulation is undesirable due to the risk of exposure to the uterus.
- Biochemical blood testing. Laboratory tests help to exclude the pathology of the gastrointestinal tract and the biliary system. During pregnancy, a standard biochemical analysis is prescribed to measure the level of total protein, free and bound bilirubin, cholesterol, glucose. According to the indications, the concentrations of sex hormones in the blood are determined, the increase of which delays stool during gestation.
In 95% of cases, constipation during pregnancy is associated with physiological changes in the patient’s body, usually eliminated by correcting the diet and increasing physical activity. To normalize peristalsis, it is recommended to eat often and in small portions, avoiding feelings of hunger and excessive overeating. In order to increase the volume of feces and improve the passage of feces through the intestines, it is necessary to include fiber-rich foods in the diet — fresh vegetables and fruits, whole-grain bread.
Women are advised to perform feasible physical exercises, specially selected taking into account the duration of pregnancy, stimulating the work of smooth muscles and facilitating defecation. With constipation caused by nervous overstrain, psychotherapy methods help well. The use of herbal or synthetic laxatives without a doctor’s prescription is prohibited, since the drugs can harm the child’s body or cause an increase in uterine tone.