Colitis during pregnancy

Colitis during pregnancy is not a very common pathology, but any disease during pregnancy poses a potential threat to the future baby. The body of a pregnant woman is more vulnerable than in any other situation, since a state of physiological immunosuppression occurs. Therefore, the violation of the normal barrier function of the intestine and the decrease in local protective reactions allows colitis to develop during pregnancy, especially if the woman has predisposing factors. But this condition does not pose a direct threat to the baby, therefore it is not an indication for termination of pregnancy, so there is no need to worry.

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Causes colitis in pregnancy

Pregnancy is a condition when a woman's body is rebuilt to a new level of metabolism, so all processes go a little differently. The digestive system during pregnancy, 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 a change in taste preferences, but also by increased reflux due to the enlarged uterus, which presses on the stomach and intestines. This is accompanied by complaints of nausea, vomiting, heartburn. Increased amounts of progesterone in the first half of pregnancy contribute to intestinal atony and a tendency to constipation.

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

Local immunity in the intestines also decreases due to compression of the lymph nodes, which facilitates easy penetration of pathogenic microorganisms and their reproduction. Thus, a pregnant woman has many predisposing factors associated with physiological characteristics. These factors contribute to the fact that a woman during pregnancy is more prone to developing gastrointestinal diseases.

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

The decrease in the barrier function of the intestinal lymphatic apparatus leads to the fact that the microorganism easily penetrates the enterocyte and multiplies, destroying the cell, which causes a local inflammatory reaction. The toxin produced by the microorganism causes general manifestations of intoxication syndrome.

Colitis during pregnancy can be caused by bacteria, both pathogenic - salmonella, shigella, enterococcus, bacteroides, and opportunistic - E. coli. Opportunistic microorganisms normally live in the human intestine, but with physiological immunosuppression during pregnancy due to a decrease in protective forces, these pathogens multiply in huge quantities and can cause colitis.

Also among the etiological factors of colitis development during pregnancy, viruses can be distinguished. Among viruses, the main pathogens are rotaviruses, coronaviruses, adenoviruses. They have a slightly different mechanism of action, which consists of penetrating the cell nucleus 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, an allergen causes a local inflammatory reaction, which manifests itself in inflammatory changes in the intestines.

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

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Symptoms colitis in pregnancy

Colitis during pregnancy can be either acute or chronic. Chronic colitis during pregnancy often develops against the background of an existing pathology of the gastrointestinal tract. That is, women who previously suffered from chronic enterocolitis or cholecystitis, chronic pancreatitis, have a higher risk of developing chronic colitis. 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 abdominal pain. Such symptoms are moderate and accompany the entire pregnancy, which is associated with a chronic source of inflammation in the intestine.

Acute colitis develops suddenly and is characterized by the severity of all symptoms. It most often occurs in the second half of pregnancy, when there is additional compression of the intestine by the enlarged uterus, which complicates the processes of normal secretory and evacuation functions. Depending on the topic of the lesion, acute enteritis is distinguished - inflammation of the small intestine, acute colitis - inflammatory disease of the large intestine. Combined pathologies are more common, since the digestive processes of the entire gastrointestinal tract are disrupted - gastroenterocolitis, enterocolitis.

The first signs of colitis are diffuse abdominal pain, sometimes in the upper abdomen. Such symptoms of colitis during pregnancy make you worry, since such pain may indicate a disorder in the fetus's condition. Therefore, such signs immediately make a woman seek help. These pains arise due to inflammation of the intestinal wall, increased blood supply and impaired venous outflow, which contributes to irritation of the intestinal nervous system and irradiation of pain. The pains are of a spastic nature, or dull, constant nature.

Symptoms of colitis during pregnancy are also dyspeptic manifestations that appear mainly in the second half of pregnancy. Then nausea, vomiting, stool disorders with a tendency to constipation appear - which cannot be explained by early gestosis. Digestive disorders that are accompanied by constipation are more typical for chronic colitis, and as for acute colitis, especially viral or bacterial etiology, it is characterized by diarrhea with different types of excrement, depending on the cause.

If the symptoms are pronounced, the deterioration of the condition is accompanied by prolonged vomiting, then a decrease in the body weight of the pregnant woman is possible.

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

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

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Complications and consequences

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

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Diagnostics colitis in pregnancy

Given the extensive clinical picture, but also pregnancy, it is necessary to carefully conduct diagnostics to establish the correct diagnosis and treatment tactics. It is necessary to exclude any complications from pregnancy - premature birth, placenta previa, premature placental abruption, fetal pathology.

The tests that are carried out to diagnose colitis during pregnancy can be divided into general and special. General clinical tests are a general blood test, urine test, and blood glucose test. In a general blood test, changes may be of an inflammatory nature - with bacterial colitis, the number of leukocytes increases, ESR, the formula shifts to the left. If colitis has a viral etiology, then relative lymphocytosis is observed. No changes are observed in the urine test, which allows excluding late gestosis.

Special laboratory research methods for colitis include coprogram, stool analysis for helminth eggs, and stool culture 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 examination in colitis in pregnant women, undigested food residues, steatorrhea, amylorrhea, as well as formed elements - leukocytes, erythrocytes, mucus can be detected. These changes allow to suspect a possible etiological factor - coprogram has its own characteristics, taking into account a certain type of microorganism.

Analysis of feces for worm eggs allows to exclude helminthic invasion and is therefore mandatory.

Fecal culture on nutrient media is performed in case of acute colitis with suspected bacterial infection. Then, after a few days, it is possible to identify the type of pathogen and study its sensitivity to various antibiotics. In case of viral colitis, express tests are performed.

If it is not possible to identify the type of pathogen, then the precise diagnostic method is the polymerase chain reaction. This method allows you to identify the DNA of bacteria or viruses. Which also allows you to establish an accurate diagnosis.

Instrumental diagnostics of colitis during pregnancy has limited application, since invasive methods are excluded to prevent complications. The limitation of instrumental methods of research is the implementation of those methods that allow to exclude pathology from the pregnancy. Conducting a cardiotocogram allows to establish the fetal heart rate, uterine tone, and also to exclude premature birth. Ultrasound examination is carried out in case of difficult diagnostics of pain syndrome in order to exclude renal and hepatic colic.

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Differential diagnosis

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

A properly collected anamnesis and additional research methods that exclude this pathology allow these pathologies to be excluded.

The course of pregnancy itself can be complicated by premature labor activity, placental abruption - which is accompanied by identical pain syndrome, therefore, differential diagnostics is required first of all. Ultrasound and cardiotocography allow to exclude pregnancy pathology.

These are the main diagnostic methods that allow an accurate diagnosis to be made and reassure the woman about the normal condition of the fetus.

Treatment colitis in pregnancy

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

It is very important for a pregnant woman to follow the correct daily routine - alternating active rest, walks in nature and sleep. Sleep should be at least eight hours at night, and at least two hours should be spent during the day.

In case of colitis during pregnancy, in order to maintain body weight and as an important stage of treatment, it is necessary to adhere to a diet. Since the processes of normal digestion, absorption and evacuation function are disrupted, it is necessary that the products are gentle.

Basic principles of the diet:

• It is better to eat food cooked, warm, not hot or cold, as this is an additional burden on the digestive tract.
• The caloric content of food should be minimal, without complex saturated fats and with limited dietary fiber, as they stimulate the motility of the gastrointestinal tract.
• Sour, salty, smoked foods – exclude completely.
• It is necessary to exclude "simple" carbohydrates - sweets, buns, cookies, candies. Fresh white bread should also be excluded, since it tends to form adhesions in the intestines.
• The diet needs to be supplemented with complex carbohydrates; the ideal option is oatmeal, which has an enveloping effect.
• It is necessary to consume protein daily in the form of boiled meat and fish, but legumes should be excluded.
• Dairy products should be limited as they cause fermentation.
• You need to drink in sufficient quantities, it is advisable to exclude juices with a high glucose level, since this also causes fermentation in the intestines. It is better to drink boiled fruit drinks, alkaline waters, warm tea.
• The amount of fruit should also be limited, as this is an additional burden on the gastrointestinal tract.

These are the basic principles of dietary nutrition, which are a mandatory component of the complex treatment of colitis during pregnancy.

Drug treatment has its limitations, since many medications are contraindicated during pregnancy.

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

If a woman has experienced severe vomiting and diarrhea, it is necessary to replenish the water balance orally, which is a pathogenetically important stage of treatment.

If the cause of colitis is a bacterial factor, then antibiotics are necessary for etiological 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 measures in case of complications.

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

Antispasmodic drugs, which reduce the tone of the uterus, are most often used as pain relievers.

No-shpa (Drotaverine) 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 in the same dose of 2 milliliters. Side effects of the drug are tachycardia, a feeling of a rush of heat to the face, increased sweating, dizziness, allergic reactions. No significant harm to the fetus is detected, since the drug does not penetrate the hematoplacental barrier. Contraindications for use are closed-angle glaucoma, prostatic hyperplasia. The drug is used for colitis in pregnant women to relieve intestinal spasm during pain syndrome. Dosage is 40 mg per dose. It can be taken as a tablet, but it is better to inject in the same dose, no more than 3 times a day.

Today, there are a huge number of sorbents, but some of them are preferred because they can be taken during pregnancy. Colitis of any genesis is accompanied by a violation of the excretory function of the intestine and the accumulation of a huge number of toxins and metabolic products, so the use of sorbents allows you to cleanse the intestine and restore normal flora.

Smecta is a natural sorbent that can 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.

Available in 3 gram sachets.

The drug can be used during pregnancy and lactation, since it is not absorbed, but excreted unchanged. Side effects are rare, allergic reactions may be observed. The drug is contraindicated in case of intestinal obstruction and hypersensitivity to it. Precautions - it should be taken at least 2 hours apart from other drugs, since it reduces their absorption.

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

In case of proven infectious genesis of colitis during pregnancy, antibiotics are a necessary component of treatment, but taking into account the possible negative impact on the fetus, it is necessary to select the type and dose. In pregnant women with colitis, intestinal antiseptics of the nitrofuran series, as well as antibiotics of the fluoroquinolone group, should not be prescribed, since they have a pronounced effect on fetal development. Preference is given to antibiotics of the cephalosporin group, which are relatively safe due to the lack of proven harmful effects on the child. Therefore, for bacterial colitis in pregnant women, cephalosporins are the drug of choice.

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

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

No negative impact on the fetus during pregnancy has been identified. Side effects are possible from the gastrointestinal tract, allergic reactions, nervous system reactions in the form of headache, drowsiness, dizziness.

Antibacterial therapy of colitis during pregnancy should be carried out with strict monitoring of the condition of the mother and fetus. It is important to conduct antibiotic sensitivity before prescribing therapy and then be guided by the results obtained.

During treatment with antibiotics, and also taking into account the disruption of the normal intestinal biocenosis during colitis in pregnant women, it is necessary to prescribe probiotics as part of complex therapy.

Linex is a drug that contains lactic acid bacteria and bifidobacteria and helps to normalize the intestinal flora and, in addition, has an antidiarrheal effect. It is available in the form of capsules of 1 gram. The drug has no pronounced side effects, can be used during pregnancy due to. Dosage - 2 capsules 3 times a day after meals, the course of treatment for colitis is not less than three days.

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

Physiotherapy treatment is recommended only during the period of remission, especially in chronic colitis, and cannot be used during the acute period of the disease.

Surgical treatment of colitis during pregnancy is not used; only surgical interventions are possible if severe complications arise.

Traditional treatment of colitis during pregnancy

Traditional methods of treating colitis are widely used by expectant mothers due to the minimal harm to the child. There are many treatment methods using both herbs and traditional and homeopathic medicines.

The main methods of folk treatment:

• The use of a natural remedy - mumiyo - is widely used in the treatment of colitis. This substance has a pronounced anti-inflammatory, regenerating, analgesic effect. To prepare the remedy, you need to dissolve 100 milligrams of mumiyo in a tablespoon of water and take it orally 2 times a day for seven days. Such a solution can suppress normal intestinal microflora, so it is necessary to take probiotics.
• Propolis tincture reduces inflammation of the intestinal wall, promotes epithelial regeneration and has a bactericidal effect. To prepare 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, after which it is used internally by a tablespoon 2 times a day.
• Sea buckthorn oil enemas promote healing of the intestinal mucosa. To prepare enemas, you need simple sea buckthorn oil, which can be purchased at a pharmacy. During pregnancy, you should consult a doctor before using such enemas, as this depends on the period of pregnancy.

Herbal treatment also has its advantages, since herbal medicine, in addition to its local action, has a general calming effect.

1. Chamomile infusion, which is prepared from three tablespoons of chamomile leaves, which are brewed in a liter of boiled water. Before taking, add a spoonful of honey and take half a glass 3 times a day.
2. St. John's wort leaves are infused in a liter of boiled water and taken half a glass 3-4 times a day.
3. Sage in the amount of 2 tablespoons is brewed in boiled water and infused, after which it is taken half a glass 2-3 times a day.
4. Blueberry leaves or fruits are infused in boiled water for about 8 hours, then filtered and taken one glass 3 times a day.

Homeopathic remedies are widely used for colitis during pregnancy, especially in cases of chronic colitis. The main drugs are:

• Mucosa compositum is a homeopathic remedy that has a regenerative, antispasmodic, anti-inflammatory effect. The drug also has a mucolytic effect and can enhance intestinal motility. It is available in the form of an injection solution in a dose of 2.2 ml. Dosage - 2.2 ml intramuscularly or subcutaneously, in acute conditions once a day, and in chronic colitis once a week. It is not contraindicated in pregnancy, side effects may be in the form of allergic reactions.
• Traumeel S is a complex homeopathic remedy that is available in the form of tablets and injections. It has anti-inflammatory and regenerative effects. Dosage in the acute period is 1 ampoule of 2.2 ml per day, later or for chronic colitis, take 1 tablet 3 times a day.
• Nux vomica-Homaccord is a combined homeopathic preparation that has an anti-inflammatory effect on the intestinal mucosa. It is available in drops, the dosage is 10 drops per tablespoon of water 3 times a day. Side effects include allergic rash.
• Viburcol is a homeopathic drug that has analgesic, anti-inflammatory, antispasmodic, and sedative effects. It is available in the form of rectal suppositories. Use one suppository 2-3 times a day. It can be taken during pregnancy, side effects are not common in the form of allergic reactions.

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Prevention

Prevention of colitis during pregnancy is, first of all, treatment of chronic colitis before pregnancy. During pregnancy, it is necessary to adhere to the rules of proper nutrition, which ensure normal caloric content of food and the completeness of food products with a balanced composition of microelements. It is necessary to limit products that cause fermentation and are strong stimulants of intestinal motility.

Preventive measures must also be taken in the form of avoiding contact with infectious patients and hygiene measures - washing hands and food before use.

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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 life-threatening and does not require termination of pregnancy.

Colitis during pregnancy is not a cause for concern, since it is not severe and in case of timely correct treatment tactics the prognosis is positive. It is necessary to promptly consult a doctor if any symptoms from the gastrointestinal tract appear.

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