Colitis during pregnancy

Colitis in pregnancy - pathology is not very frequent, but any disease during pregnancy carries a potential threat to the future baby. The organism of a pregnant woman is more vulnerable than in any other situation, since a state of physiological immunosuppression occurs. Therefore, a violation of the normal barrier function of the intestine and a decrease in local protective reactions allows the development of colitis during pregnancy, especially if the woman has predisposing factors. But this condition does not pose a direct threat to the baby, so it is not an indication for abortion, so do not worry.

[1]

Causes of the colitis in pregnancy

Pregnancy is a condition where a woman's body is rebuilt to a new level of metabolism, so all the processes go a little differently. The digestive system during the gestation of a child due to the influence of hormones - prostaglandins - changes in such a way that hypotension of the gastrointestinal tract occurs. This is characterized not only by changes in taste, but also by increased reflux due to an enlarged uterus that presses on the stomach and intestines. This is accompanied by complaints of nausea, vomiting, heartburn. The increased amount of progesterone in the first half of pregnancy contributes to atony of the intestine and a tendency to constipation.

In addition, the detoxification function of the liver and the peristalsis of the bile ducts decrease, which aggravates the digestive process.

Also, local immunity in the intestines is reduced because of lymph node compression, which facilitates easy penetration of pathogens and their propagation. Thus, a pregnant woman has many predisposing factors associated with physiological characteristics. These factors contribute to the fact that a woman in pregnancy is more likely to develop diseases of the gastrointestinal tract.

In addition to these risk factors, the causes of colitis during pregnancy are infection by pathogenic microorganisms with the development of the inflammatory process of the intestinal mucosa.

Reduction of the barrier function of the lymphatic apparatus of the intestine leads to the fact that the microorganism easily penetrates into the enterocyte and multiplies, destroying the cell, which causes a local inflammatory reaction. The toxin that produces the microorganism causes common manifestations of intoxication syndrome.

The cause of colitis during pregnancy can be bacteria, as pathogenic - salmonella, shigella, enterococcus, bacteroides, and conditionally pathogenic - E. Coli. Conditionally pathogenic microorganisms normally live in the human intestine, but with physiological immunosuppression during pregnancy due to a decrease in protective forces, these pathogens multiply in large numbers and can cause colitis.

Also, among the etiological factors of the development of colitis during pregnancy, viruses can be identified. Among the viruses, the main pathogens are rotaviruses, coronaviruses, adenoviruses. They have a slightly different mechanism of action, which consists in penetrating the nucleus of the cell and destroying it with the development of symptoms without a pronounced inflammatory process.

Also, the cause of colitis during pregnancy can be an allergic factor, that is, the allergen causes a local inflammatory reaction, which manifests itself by inflammatory changes in the intestine.

The use of certain medications can also cause colitis, as a side effect, and a direct effect on the mucosa of the gastrointestinal tract.

[2], [3], [4], [5]

Symptoms of the colitis in pregnancy

Kolit during pregnancy can have both acute and chronic course. Chronic colitis during pregnancy often develops against the background of the existing pathology of the gastrointestinal tract. That is, in women who previously suffered from chronic enterocolitis or cholecystitis, chronic pancreatitis, the risk of developing chronic colitis is higher. As for the symptoms, the main manifestations of chronic colitis will be dyspeptic manifestations in the form of constipation or diarrhea, nausea, vomiting and diffuse pain in the abdomen. Such symptoms are moderately expressed and accompany the entire pregnancy, which is associated with a chronic hotbed of inflammation in the intestine.

Acute colitis develops suddenly and is characterized by the severity of all symptoms. It often occurs in the second half of pregnancy, when there is an additional compression of the intestine with an enlarged uterus, which complicates the processes of normal secretory and evacuation functions. Depending on the topic of the lesions, acute enteritis is distinguished - inflammation of the small intestine, acute colitis is an inflammatory disease of the large intestine. More often there are combined pathologies, because the digestive processes of the whole gastrointestinal tract are broken - gastroenterocolitis, enterocolitis.

The first signs of colitis are diffuse pain in the abdomen, sometimes in the upper half of the abdomen. Such symptoms of colitis during pregnancy allow you to worry, because such pain can indicate a violation of the fetus. Therefore such signs at once force the woman to address for the help. These pains are due to inflammation of the intestinal wall, increased blood supply and violation of venous outflow, which contributes to irritation of the nervous apparatus of the bowel and the irradiation of pain. Pain has a spastic character, or dull permanent character.

Symptoms of colitis during pregnancy are also dyspeptic manifestations, which appear mainly in the second half of pregnancy. Then there is nausea, vomiting, a stool disorder with a tendency to constipation - which can not be explained by early gestosis. Violation of digestive processes, which are accompanied by constipation, is more characteristic of chronic colitis, and as for acute colitis, especially viral or bacterial etiology, it is characterized by diarrhea with a different character of excrement, depending on the cause.

If the symptoms are pronounced, worsening is accompanied by a prolonged vomiting, then it is possible to reduce the weight of the pregnant woman.

As a manifestation of the general intoxication syndrome, especially in viral and bacterial colitis, symptoms of general weakness, fatigue, headache, pain and aching in the muscles, an increase in body temperature are expressed. These symptoms are more pronounced in bacterial infections.

These are the main symptoms that allow you to suspect colitis, and with the help of additional methods you can conduct differential diagnosis and accurately establish a clinical diagnosis.

[6]

Complications and consequences

The consequences of colitis during pregnancy are usually not expressed, since this condition does not have acute manifestations, which disrupt the vital functions of the fetus. Complications of acute colitis can be intestinal obstruction, critical dehydration, as well as infectious-toxic shock in bacterial colitis.

[7], [8], [9]

Diagnostics of the colitis in pregnancy

Given the detailed clinical picture, but at the same time, pregnancy, it is necessary to carefully diagnose to establish the correct diagnosis and treatment tactics. It is necessary to exclude any complications from pregnancy - premature birth, placenta previa, premature detachment of the placenta, pathology from the fetus.

Analyzes that conduct for the diagnosis of colitis during pregnancy can be divided into general and special. General clinical tests are a general analysis of blood, urine, a blood test for glucose. In a general blood test, the changes can have an inflammatory character - with bacterial colitis the number of leukocytes increases, the ESR changes, the formula shifts to the left. If colitis has a viral etiology, then there is a relative lymphocytosis. Changes in the analysis of urine are not observed, which allows to exclude late gestosis.

Special laboratory methods of investigation in colitis - this is coprogram, analysis of feces for eggs of worms, sowing feces on nutrient media.

Coprogram is a method of microscopic examination of feces, which allows to establish the degree of dyspeptic disorders and the function of the pancreas. In the results of this survey, in case of colitis in pregnant women, undigested remains of food, steatori, amylorea, and also regular elements - leukocytes, erythrocytes, mucus can be found. These changes allow to suspect a possible etiologic factor - the coprogram has its own peculiarities, considering a certain type of microorganism.

Analysis of feces for eggs of worms can exclude helminthic invasion and therefore is carried out without fail.

Sowing of feces on nutrient media is carried out in case of acute colitis with suspected bacterial damage. Then after a few days it is possible to identify the type of pathogen and to study its sensitivity to different antibiotics. In the case of viral colitis, rapid tests are performed.

If you can not identify the type of pathogen, then the exact method of diagnosis is a polymerase chain reaction. This method allows you to identify the DNA of a bacterium or a virus. That also allows you to accurately establish the diagnosis.

Instrumental diagnosis of colitis during pregnancy has limited application, since invasive methods are excluded to prevent complications. Restriction of instrumental methods of research is the conduct of those methods that allow the elimination of pathology from pregnancy. Carrying out a cardiotocogram allows you to determine the frequency of the fetal heart rate, the tone of the uterus, and also to exclude premature birth. Ultrasound is performed in the case of a difficult diagnosis of pain in order to exclude renal and hepatic colic.

[10], [11], [12], [13]

Differential diagnosis

Differential diagnosis of colitis during pregnancy should be carried out with other inflammatory diseases of the digestive organs - with acute and chronic cholecystitis, chronic pancreatitis, and late toxicosis.

To exclude pathology data allows correctly collected anamnesis and additional research methods that exclude this pathology.

The very course of pregnancy can be complicated by premature birth activity, placental abruption - which is accompanied by an identical pain syndrome, therefore requires differential diagnosis in the first place. Ultrasound and cardiotocography can eliminate the pathology of pregnancy.

These are the main diagnostic methods that allow you to establish an accurate diagnosis and calm a woman about the normal condition of the fetus.

Treatment of the colitis in pregnancy

In the complex treatment of colitis during pregnancy, both drug and non-drug methods should be considered.

It is very important for a pregnant woman to observe the correct regime of the day - with the alternation of outdoor activities, nature walks and sleep. Sleep should be no less than eight hours of night, and not less than two hours should occupy a day's sleep.

When colitis during pregnancy to maintain body weight and as an important stage of treatment must adhere to the diet. Since the processes of normal peretravlivaniya, suction and evacuation function are violated, it is necessary that the products are sparing.

Basic principles of the diet :

• Food should be taken in boiled form, warm, not hot and not cold, as this is an additional load on the digestive tract.
• The caloric content of food should be the smallest, without complex saturated fats and with the restriction of dietary fiber, as they stimulate the motility of the gastrointestinal tract.
• Sour, salty, smoked products - to exclude completely.
• It is necessary to exclude "simple" carbohydrates - sweets, biscuits, cookies, sweets. Fresh white bread should also be excluded, since it has the property of forming adhesive processes in the intestine.
• The diet must be replenished with complex carbohydrates, the ideal option is oatmeal, which has an enveloping effect.
• It is necessary to eat protein daily in the form of boiled meat, fish, and legumes must be excluded.
• Dairy products should be limited, as they cause fermentation.
• To drink it is necessary in sufficient quantity, it is desirable to exclude juices with a high level of glucose, as it also causes fermentation in the intestine. It is better to take cooked fruit drinks, alkaline water, warm tea.
• The amount of fruit should also be limited, since this is an additional load on the digestive tract.

These are the main principles of dietary nutrition, which are an obligatory component of complex treatment of colitis during pregnancy.

Drug treatment has its limitations, since many drugs are contraindicated in pregnancy.

The basic principles of treating colitis during pregnancy should take into account the etiologic factor, as well as the severity of clinical symptoms.

If a woman experienced pronounced vomiting and diarrhea, it is necessary to replenish the water balance by the oral route, which is pathogenetically an important stage of treatment.

If the bacterial factor is the cause of colitis, the prescription of antibiotics is necessary for etiologic treatment, but preference should be given to those drugs that do not affect the fetus. At the same time, it is necessary to monitor the child's condition and be ready to take action in the event of complications.

Symptomatic treatment is mandatory and includes detoxification, adsorption, anti-inflammatory, and spasmolytic therapy.

As an anesthetic, most often used antispasmodics, which reduce the tone of the uterus.

But-spa (Drotaverin) is an antispasmodic drug widely used in surgery and gynecology. It is available in tablets in a dosage of 40 milligrams, as well as in ampoules at the same dose of 2 milliliters. Side effects of the drug - a tachycardia, a sensation of hot flushes to the face, increased sweating, dizziness, allergic reactions. Expressed harm to the fetus is not detected, because the medicine does not penetrate the hematoplacental barrier. Contraindications for use are closed-angle glaucoma, prostatic hyperplasia. The drug is used in colitis in a pregnant woman to relieve spasm of the intestine with pain. Dosage - 40 mg per reception. You can take as a pill, but it is better to inject in the same dose, no more than 3 times a day.

To date, there is a huge amount of sorbents, but some of them are preferred because of the possibility of taking during pregnancy. Colitis of any genesis is accompanied by a violation of the excretory function of the intestine and the accumulation of a large number of toxins and metabolic products, so the use of sorbents allows you to cleanse the intestines and resume normal flora.

Smecta is a naturally occurring sorbent that is able to adsorb viruses and bacteria, and also has a protective effect by stabilizing the mucous-bicarbonate barrier and increasing the amount of mucus. The drug reduces the symptoms of bloating and heartburn.

Produced in bags of 3 grams.

The drug can be used during pregnancy and lactation, because it is not absorbed, but is withdrawn in an unchanged form. Side effects occur rarely, allergic reactions may occur. The drug is contraindicated with intestinal obstruction and hypersensitivity to it. Precautions - should be taken with an interval of at least 2 hours with other medicines, because it reduces their absorption.

Dosage - 3 grams of substance (one sachet) should be diluted in half a glass of warm water and taken 3 times a day, the course - 5-7 days.

In the case of proven infectious genesis of colitis during pregnancy, the necessary component of treatment is the appointment of antibiotics, but considering the possible negative effects on the fetus, you must choose the type and dose. In pregnant women, colitis should not be prescribed intestinal antiseptics of the nitrofuran series, as well as antibiotics of the fluoroquinolones group, since they have a pronounced effect on fetal development. Preference is given to the antibiotic group of cephalosporins, which are relatively safe because of the lack of proven harmful effects on the child. Therefore, for bacterial colitis in pregnant women, the drug of choice is cephalosporins.

Cefepime is a beta-lactam antibiotic from the 4 th generation group of cephalosporins, which has a pronounced bactericidal effect on gram-positive and gram-negative microorganisms, that is, it covers a huge range of microbes. Produced in the form of powder for injection 1 gram. The drug is used in a dose of 1 gram per day, is administered intramuscularly or intravenously at intervals of 12 hours. The course of treatment is 7-10 days.

Contraindications to prescription are allergic reactions to penicillins or other beta-lactam antibiotics.

There was no adverse effect on the fetus during pregnancy. Side effects are possible on the part of the gastrointestinal tract, allergic manifestations, reactions of the nervous system in the form of headache, drowsiness, dizziness.

Antibacterial therapy for colitis during pregnancy should be carried out with strict control of the condition of the mother and fetus. It is important to conduct antibiotic sensitivity before the appointment of therapy and further guided by the results.

During treatment with antibiotics, and also considering the violation of normal intestinal biocenosis in colitis in pregnant women, it is necessary to prescribe probiotics in a complex therapy.

Linex is a drug that contains lactic acid bacteria and bifidobacteria and contributes to the normalization of the intestinal flora and also has antidiarrheal action. Available in the form of capsules 1 gram. The drug has no significant side effects, it can be used during pregnancy because of. Dosage - 2 capsules 3 times a day after meals, treatment for colitis for at least three days.

An important step in the complex treatment of colitis during pregnancy is the use of vitamins, since absorption of nutrients is impaired and the body needs additional sources of vitamins. It is recommended to take vitamins of group B in injectable form, and even better complex vitamin preparations for pregnant women - Elevit, Pregnavit, Complivit.

Physiotherapy is recommended only during the period of remission, especially with chronic colitis, can not be used in the acute period of the disease.

Surgical treatment of colitis during pregnancy is not used, only surgical interventions are possible in the event of serious complications.

Alternative treatment of colitis in pregnancy

Alternative methods of treating colitis are widely used by future mothers because of minimal harm to the child. There are many treatments with the use of both herbs and alternative remedies and homeopathic medicines.

Basic methods of alternative treatment:

• The use of natural remedy - mummy - is widely used in the treatment of colitis. This substance has a pronounced anti-inflammatory, regenerating, analgesic effect. To prepare the preparation, you need to dissolve 100 milligrams of mumiy in a tablespoon of water and take it 2 times a day for seven days. Such a solution can inhibit the normal intestinal microflora, so it is necessary to take probiotics.
• Tincture of propolis reduces inflammation of the intestinal wall, promotes the regeneration of the epithelium and has a bactericidal effect. To make the tincture, 10 grams of propolis should be boiled in boiled water for about 20 minutes, this solution should be infused for at least an hour, then applied inward on a tablespoon 2 times a day.
• Clears from sea buckthorn oil promote the healing of the intestinal mucosa. For the preparation of enemas you need a simple sea buckthorn oil, which can be bought at the pharmacy. During pregnancy, it is necessary to consult a doctor before using such enemas, since it depends on the period of pregnancy.

Herbal treatment also has its advantages, as phytotherapy in addition to local action has a general soothing effect.

1. Infusion of chamomile, which is prepared from three tablespoons of chamomile leaves, which are brewed in a liter of boiled water. Before taking a spoon of honey and take half a cup 3 times a day.
2. St. John's wort leaves insist on a liter of boiled water and take half a cup 3-4 times a day.
3. Sage in the amount of 2 tablespoons is brewed in boiled water and insisted, then take half a glass 2-3 times a day.
4. Leaves or fruits of blueberry insist in boiled water for about 8 hours, then filter and take a glass 3 times a day.

Homeopathic remedies are widely used in colitis during pregnancy, especially in the case of chronic colitis. The basic preparations:

• Mucosa compositum is a homeopathic remedy that has a regenerative, antispasmodic, anti-inflammatory effect. Also, the drug has a mucolytic effect and is capable of enhancing intestinal motility. It is available in the form of a solution for injection in a dose of 2.2 ml. Dosage - 2.2 ml intramuscularly or subcutaneously, with acute conditions once a day, and with chronic colitis once a week. It is not contraindicated in pregnancy, side effects can be in the form of allergic manifestations.
• Traumeel S is a complex homeopathic remedy, which is available in the form of tablets and injections. Has anti-inflammatory, regenerating effect. Dosage in acute period - 1 ampoule 2.2 ml per day, later or for chronic colitis take 1 tablet 3 times a day.
• Nux vomica-Homaccord - a combined homeopathic preparation, has an anti-inflammatory effect on the intestinal mucosa. Produced in drops, dosage - 10 drops per tablespoon of water 3 times a day. Side effects in the form of an allergic rash.
• Viburkol is a homeopathic preparation that has analgesic, anti-inflammatory, antispasmodic, soothing effect. Produced in the form of rectal suppositories. Apply one suppository 2-3 times a day. Possible reception during pregnancy, side effects are not frequent in the form of allergic reactions.

[14], [15]

Prevention

Preventing colitis during pregnancy is, first of all, the treatment of chronic colitis even before the onset of pregnancy. When pregnancy is necessary to adhere to the rules of proper nutrition, which ensure a normal caloric intake of food and the full value of food from a balanced composition of trace elements. It is necessary to limit products that cause fermentation and are strong stimulants of intestinal motility.

Preventive measures should also be observed in the form of avoiding contact with infectious patients and hygienic measures - hand washing and food before use.

[16], [17], [18], [19]

Forecast

The prognosis for colitis in pregnant women is favorable for recovery, for the life of the mother and child, since the condition is not threatening and does not require the termination of pregnancy.

Kolit during pregnancy is not a cause for concern, since it has a mild course and in the case of timely correct treatment, the prognosis is positive. It is necessary to consult a doctor in time when there are any symptoms from the gastrointestinal tract.

[20], [21], [22], [23], [24]