Diarrhea during pregnancy is a pathological condition during gestation, characterized by frequent discharge of unformed fecal masses. Stool disorder can proceed painlessly or be accompanied by belching, nausea, vomiting, unpleasant sensations in the mouth, abdominal pain, imperative urge to defecate, increased body temperature, weight loss, weakness, fatigue. To determine the cause of diarrhea, clinical, bacteriological, biochemical studies of feces, blood, probing, and rectoromanoscopy are carried out. Treatment is most often conservative – medications, diet adjustments.
Diarrhea – an increase in the frequency of defecation up to four or more times a day with the separation of liquid or mushy bowel movements, 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 system of the body. Sometimes diarrhea is the first symptom of a pathology that can complicate gestation. The frequency of diarrhea in obstetrics is 34%. Diarrhea is registered less frequently than constipation, age-related (after 35 years), as well as young (under 19 years) mothers are more susceptible to it. Usually there are forms with a mild course, ending in a rapid recovery. Severe forms pose a serious threat to the life of the mother and fetus. Inpatient treatment with intensive therapy is necessary for 1.5% of pregnant women suffering from diarrhea.
Most often, diarrhea during pregnancy is caused by physiological (arising during gestation, associated with this condition, which are a variant of the norm during this period) changes on the part of the digestive, endocrine, nervous system. Another common reason is diet errors. Diarrhea manifests itself as diseases that developed during gestation in women whose body could not adapt to increased stress, and those that arose before conception. There are the following sources of intestinal disorder in pregnant women:
- Non-communicable diseases of the digestive system. Diarrhea can 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. An addiction to coffee, excessive consumption of fatty (including nuts), spicy, spicy foods, sweets, pastries, as well as products containing a large amount of fiber (fruits, vegetables, cereals) can lead to diarrhea. In addition, diarrhea may be accompanied by hypovitaminosis of pregnant women, arising due to imbalance or scarcity of the diet.
- Food intolerance. The cause of diarrhea may be a food idiosyncrasy associated with a lack of enzyme production (for example, lactulose intolerance to whole milk) or an allergic reaction (more often to citrus fruits, berries, cereals, eggs, chocolate, legumes). At the same time, hypersensitivity 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 psychoemotional stress, neuropathy.
- Infections and infestations. Diarrhea is caused by acute intestinal infections – bacterial, viral, protozoal, affecting the digestive tract. Nonspecific infections may be a consequence of the growth of opportunistic flora against the background of a natural decrease in immune activity during pregnancy. Often diarrhea is accompanied by flu. Of the helminths, ascarids are most often involved in diarrhea.
- Taking medications. Iron preparations, magnesium salts, antibiotics, antacids, sugar substitutes, antidiabetic, laxatives, dietary supplements cause diarrhea, involving various mechanisms of gastrointestinal dysfunction.
Other, more rare causes of diarrhea in pregnant women include metabolic and endocrine diseases (diabetes mellitus, hyperthyroidism, amyloidosis), surgical pathologies (acute appendicitis, intestinal obstruction, embolism of mesenteric vessels). False diarrhea is sometimes accompanied by persistent constipation, which is often observed in pregnant women: prolonged stay of feces leads to irritation of the colon wall, increased secretion of mucus, excretion of liquid feces.
About nine liters of liquid enter the intestinal lumen every day, 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 fluid is absorbed by the small intestine, about 10% by the colon, only 1.1% (about 100 ml) is excreted in the feces. Diarrhea occurs with increased fluid intake (mostly due to excessive intestinal secretion) or as a result of a decrease in absorption capacity. Hypersecretion of the small intestine is associated with infection with pathogenic microorganisms, the intake of irritating laxatives. The secretion of the lower intestine is most often increased due to a decrease in the absorption of bile acids.
Enzymatic insufficiency and acceleration of the passage of the contents leads to a disorder of the absorption capacity of the small intestine. At the same time, unabsorbed substances accumulate in its lumen, which retain water due to their osmotic action. Decreased absorption in the lower parts is a consequence of increased fluid intake from the ileum, epithelial damage, impaired motility of the colon, lack of bacteria fermenting carbohydrates. As a result of severe diarrhea, hypovolemia, acidosis, deficiency of nutrients, vitamins, trace elements develops. Irritation of the colon leads to a reflex increase in the tone of the pregnant uterus, and the release into the blood of active substances associated with inflammation enhances the effect.
According to the form of the course, 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, there are four types of diarrhea during pregnancy:
- Secretory. This type of diarrhea develops with increased 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. It occurs due to the influx of water when osmotically active substances (potassium and sodium ions, glucose) accumulate in the intestine as a result of impaired digestion and absorption (with chronic pancreatitis, dysbiosis, enteritis, food intolerance, amyloidosis, obstruction of the bile ducts), taking excessively salty or sweet food.
- Hyperexudative. Diarrheal syndrome is caused by sweating exudate through the damaged mucosa in autoimmune, tumor 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 transit of chyme due to impaired intestinal motility. Hyperkinetic diarrhea is accompanied by nervous shocks, neuroses, neuropathies, hyperthyroidism, laxatives. The hypokinetic type is associated with obstruction of the small intestine.
The 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 volumetric liquid stool 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 with an admixture of pus and blood. A significant increase in stool with acute diarrhea leads to a rapid decline in strength, pronounced weakness. Chronic diarrhea is characterized by rapid fatigue, weight loss.
Secretory diarrhea is characterized by abundant light watery or foamy stools without pronounced abdominal pain, the disorder does not depend on diet, it is not stopped by starvation. Osmolar diarrhea is manifested by copious separation of feces containing undigested food particles: light, dough-like with pathologies of the hepatobiliary system and gray, with a rancid odor with pancreatic insufficiency; after fasting, diarrhea usually passes. 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 stool of a yellow or greenish hue. With diarrhea caused by a decrease in motor function, mucus is usually present in the feces.
Diarrhea during pregnancy 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; intense pain may occur, simulating a picture of an acute abdomen, characteristic of surgical pathologies. Epigastric discomfort is also observed in diarrhea associated with 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.
The most common and dangerous complication of diarrhea during pregnancy is miscarriage. In 30-44% of cases, the cause of spontaneous termination of pregnancy is gastrointestinal diseases that occur with diarrhea. Severe diarrhea with a large loss of fluid, poses a threat to the patient’s life due to the development of collapse and shock, often leading to death. For the mother and the unborn child, not the intestinal disorder itself, but its causes may also be dangerous. So, the result of intestinal infection can be purulent-inflammatory gynecological complications (the most formidable is maternal sepsis) in a woman and intrauterine infection with the development of fetal pathology in the fetus.
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 about the frequency and volume of defecation, the nature of stool, the features of the diet, 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:
- Stool tests. 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, as well as to suspect a violation of the integrity of the mucous membranes (by hidden blood). A positive test result for helminth eggs indicates a helminth invasion.
- Blood tests. According to the results of a general clinical analysis, it is possible to establish the inflammatory, allergic nature of diarrhea, suggest a malabsorption or malignant neoplasm. Biochemical examination allows to identify pathologies of the hepatobiliary system, pancreas, diabetes mellitus.
- Endoscopic examinations. Rectoromanoscopy is performed to detect colitis, tumor changes. With the help of gastric and duodenal probing, it is possible to detect a decrease in the pH of gastric juice, an increase in the concentration of bile acids, violations of the exogenous function of the pancreas.
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. Special attention is paid to the diet: food should not irritate the gastrointestinal mucosa, increase peristalsis, cause fermentation. Fresh pastries, cabbage, legumes, onions, garlic, spices, seasonings, strong broths, fried and stewed dishes, 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, primarily for the fetus. Preventive measures include the detection and treatment of chronic internal diseases before pregnancy, regular visits to the antenatal clinic during the gestational period, compliance with hygiene rules, the use of fresh, optimally balanced vitamins, macro- and microelements of food, the exclusion of uncontrolled intake of medications, herbs, dietary supplements, the fight against constipation.