Constipation during pregnancy is a bowel disorder, manifested by delayed defecation or insufficient emptying, which often occurs in women at different gestational ages. Stool retention is accompanied by pain in the left iliac region, bloating. More rare defecation is due to physiological changes in the body of a woman, gestational and intestinal pathology. To identify the causes of constipation, ultrasound methods, laboratory tests of blood and feces are used. To restore the normal frequency of stool helps change eating habits, adequate physical activity.
Causes of constipation during pregnancy
Normal pregnancy
Fecal retention is a problem faced by two-thirds of pregnant women. In the early stages, constipation is usually caused by hormonal changes, a change in the usual diet. In the second half of pregnancy, the difficulty in 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:
- Enlargement of the uterus . In the second and third trimesters, the uterus rapidly increases in size, compresses the intestinal loops, especially the caecum and sigmoid colon. This disrupts the normal passage of feces, increases the resorption of water with the formation of solid fecal masses, which are difficult to excrete during emptying. Constipation with an increase in 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 critical for maintaining pregnancy, as it reduces the contractile activity of all smooth muscle organs - the uterus, intestines, and bladder. Inhibition of peristaltic contractions leads to prolonged stagnation of feces in the intestines, chronic stool retention, discomfort in the left abdomen during defecation.
- Changes in eating habits . The diet of a pregnant woman can vary significantly. Often, appetite 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 delaying feces, there is discomfort and heaviness in the stomach after eating.
- Physical inactivity. For the normal functioning of the gastrointestinal tract, regular physical activity and the preserved tone of the abdominal muscles are very important. Women in late gestation are prone to physical inactivity, as it becomes more difficult for them to perform their usual activities. 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.
- Micronutrient intake . To improve the processes of hematopoiesis and prevent disorders of the skeletal system, pregnant women are prescribed nutritional supplements with iron and calcium. The drugs are able to inhibit the motility of the digestive tract and tract, so their side effects are 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 becomes black.
- emotional factors . Constipation during pregnancy can be potentiated by neuropsychological changes. Hormonal changes and fear of the upcoming birth often cause emotional lability, chronic stress. When the autonomic nervous system is involved in the process, activation of sympathetic fibers occurs with inhibition of intestinal motility and constipation.
Pathology of pregnancy
Various violations 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 neuro-reflex mechanisms of stool retention. Constipation is often combined with other symptoms of dyspepsia - nausea, repeated vomiting, lack of appetite. If the symptom manifests itself constantly, to determine further obstetric tactics, it is necessary to clarify its causes. 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 moderate or severe course. The main symptoms are various dyspeptic disorders, constipation often develops a second time against the background of severe dehydration due to repeated vomiting and intense salivation. The situation is exacerbated by a decrease in food intake, which provokes a sharp weight loss.
- Hypertension of the uterus . The lack 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 due to a 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 while going to the toilet. This condition, combined with physiological prerequisites, leads to chronic constipation.
- Gestosis . Slowdown of intestinal motility in gestosis of the second half of pregnancy is caused by long-term use of sedatives, diuretics, antihypertensives 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 (ruptures of the perineum, perineotomy) or during childbirth by caesarean section. In such situations, the absence of bowel movements for up to 2 days is considered the norm, and the use of laxatives is recommended in the future. Timely restoration of peristalsis and defecation provide a normal rate of uterine contraction.
Bowel disease
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 and affects their consistency. Difficulties in defecation can be caused by dysregulation of the work of the autonomic nerve ganglia, which provide peristaltic contractions of smooth muscles. Constipation during pregnancy provokes such concomitant diseases as:
- Irritable Bowel Syndrome . IBS is a functional disorder, which is caused by a violation of the innervation of the intestinal wall, unbalanced nutrition, emotional upheavals. For the disease, a combination of constipation with false urge to empty, pain and discomfort on the left in the iliac region, and a decrease in appetite are typical. The clinical picture is characterized by polymorphism and inconstancy of symptoms.
- Dysbacteriosis . Specific changes in the hormonal background during pregnancy sometimes disrupt the normal digestion of food ingredients, causing a mild version of malabsorption and maldigestion. Constipation in dysbacteriosis is accompanied by bloating, belching with air or rotten. With significant maldigestion, there is a change in the color and consistency of feces, discomfort and pulling pains along the intestine.
- Dolichocolon . An increase in the length and diameter of individual sections of the intestinal tract (often the colon and sigmoid colon) is combined with severe 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 mechanical pressure of the enlarged uterus reduces the tone of the venous plexus of the hemorrhoidal zone. In this case, constipation during pregnancy is the result of a conscious suppression of the urge to empty the bowels, 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 action of increased amounts of estrogens and progesterone often disrupts the functioning of the biliary system. A decrease in bile secretion 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 disease . Pregnancy in rare cases exacerbates the course of chronic diseases such as ulcerative colitis and Crohn's disease. With these pathologies, organic lesions of the mucous membrane and intramural vegetative plexuses become the cause of delayed fecal masses. Constipation is associated with tenesmus, pain in the abdomen, discharge of mucus streaked with blood from the rectum.
Survey
Since stool retention is more often due to the physiological characteristics of the course of pregnancy or painful conditions that are associated with gestation, a gastroenterologist is involved in the examination of women with complaints of constipation during pregnancy, subject to constant monitoring and consultations of an obstetrician-gynecologist. The study of the state of the digestive system is always carried out in conjunction with a standard gynecological examination of a pregnant woman.
Diagnostic search should first of all be aimed at excluding natural and pathological causes associated with childbearing. A woman is given a comprehensive examination using only those methods that do not harm the body of the fetus. The most valuable for clarifying the root cause of fecal retention in pregnant women are:
- Ultrasound . Ultrasound is the main diagnostic method used during pregnancy, since 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.
- Fecal analysis . 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 dysbacteriosis, a bacteriological analysis of feces is performed. If organic lesions of the rectum or other parts of the colon are suspected, the Gregersen reaction to occult blood in the feces is performed.
- Sigmoidoscopy . The method of visual examination of the surface of the rectal mucosa is used to identify dilated hemorrhoids, cracks, which are often found in pregnant women. In the first trimester, a study using a sigmoidoscope can be supplemented by sigmoidoscopy; at a later date, this manipulation is undesirable because of the risk of affecting the uterus.
- Biochemical study of blood . 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, and glucose. According to the indications, the concentrations of sex hormones in the blood are determined, the increase of which delays the stool during gestation.
In most cases, constipation is eliminated after correcting the diet.
Symptomatic therapy
In 95% of cases, constipation during pregnancy is associated with physiological changes in the patient's body, usually eliminated by adjusting the diet and increasing physical activity. To normalize peristalsis, it is recommended to eat food often and in small portions, avoiding 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 foods rich in fiber in the diet - fresh vegetables and fruits, whole grain bread.
Women are advised to perform feasible physical exercises, specially selected for the duration of pregnancy, stimulating the work of smooth muscles and facilitating bowel movements. With constipation caused by nervous overexertion, methods of psychotherapy 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.