Constipation during early pregnancy

In obstetrics and gynecology, more and more often we have to deal with such a delicate problem as constipation during early pregnancy. At the same time, most women either do not attach importance to this issue or are embarrassed to raise this issue. Many women do not believe that this is a problem about which you should consult a gynecologist. Nevertheless, it is worth talking about this and clarifying the main points for yourself.

Constipation as a sign of pregnancy

When analyzing clinical cases, practicing gynecologists note that in many women the earliest sign of pregnancy is not even delayed menstrual cycle, but constipation. This problem usually occurs 10-20 days after conception. Thus, a woman is still waiting for the next menstruation, and is not aware of the occurrence of pregnancy. But she may have constipation, which may indirectly indicate fertilization of the egg.

It is worth noting that the exact cause of this phenomenon is not fully understood. There are several assumptions that equally have a right to exist. This may be a violation of the hormonal regulation in the body, or rather, the adaptation of the hormonal system to the new needs of the body, work on maintaining pregnancy. Also under the hormonal changes and the gastrointestinal tract, including the liver, pancreas.

The normal functioning of all endocrine glands is impaired. Hormones and digestive enzymes are secreted worse, their activity is reduced, normal digestive processes are disturbed, and peristalsis and intestinal motility are also disturbed. This leads to stagnation of feces in the body, and also contributes to the narrowing of the intestinal space.

The second theory suggests that constipation may accompany adaptation processes in the pelvic organs. The beginning of pregnancy entails the restructuring of all organs and systems, including the digestive system. First, the changes concern the reproductive organs, the uterus expands and increases, the configuration and volume of the fallopian tubes change.

All this exerts additional pressure on the intestines, mechanical compression of the intestine occurs, as a result of which the feces cannot move freely along the intestines, and cannot be expelled. There is their stagnation in the rectum. This can have a number of negative consequences, ranging from intoxication and ending with various complications and diseases of the digestive tract.[1]

What is dangerous constipation in early pregnancy?

First of all, the danger of constipation lies in the fact that it is accompanied by stagnation of feces. Feces can not move freely through the intestine, since there are various kinds of obstacles in its path. These can be mechanical obstructions that occur due to compression of the intestine, dysregulation of hormones, and disturbance of the conductance and sensitivity of the receptors.

It should also be noted that the danger of constipation lies in the fact that during long-term stagnation fermentation and decay processes develop, which leads to the fact that rotting products accumulate in the body. As a result, toxins are formed, which have a toxic effect on the entire body. First of all, the gastrointestinal tract undergoes rotting, toxins are absorbed secondly, they enter the bloodstream, as a result of which toxins are transported throughout the body and cause intoxication.[2]

With the development of toxicosis, which occurs against the background of the restructuring of the body, the vital activity of a fertilized egg in the early stages, there is a combined effect of toxicosis and intoxication of feces. At the same time various infectious, inflammatory, purulent-inflammatory processes develop. Such intestinal diseases as colitis, enterocolitis, gastritis, enteritis may develop. Also, such processes are accompanied by the formation of secondary foci of infection. One of the complications may be dolichosigma, in which there is an expansion of the rectal canal, as well as bowel deformity. This may be accompanied by painful processes, the development of inflammation, intoxication. One of the unpleasant consequences is the loss of fecal masses.[3]

Epidemiology

According to statistics, about a third of women suffer from constipation in early pregnancy. At the same time, women often do not even know that a pregnancy has occurred, and still await the onset of another menstruation. In about 24% of cases with a long stagnation process, there is a long-term stagnation of feces, which is accompanied by dolichosigmoid (expansion, change in the shape and structure of the intestine as a result of its deformation under the influence of various factors, including mechanical ones).

In the absence of treatment, 98% of cases are accompanied by severe intoxication, the development of purulent-inflammatory, infectious diseases. With adequate treatment, only about 15% of cases are accompanied by the development of inflammatory and infectious processes.[4]

Causes of the constipation during early pregnancy

The main reason for the development of constipation is to delay the fecal masses and the impossibility of their removal outside. The reason is a violation of motility and intestinal motility. This may develop due to a decrease in intestinal tone, as well as with mechanical obstacles that arise in the path of movement of fecal masses. The reason may be hormonal alteration of the body, adaptation to the forthcoming pregnancy and childbirth of all the organs of the small pelvis, impaired enzymatic and hormonal activity in the body. Also, the reason may be in the expansion or displacement of the intestine.

Risk factors

At risk are people with impaired functional status of the gastrointestinal tract. First of all, these are people with low intestinal tone, with the development of various congenital and acquired defects and pathologies of the rectum, large and small intestines. At risk are patients suffering from frequent constipation, impaired motor function of the intestine. Also at risk are people with irregular stools, often suffering from various diseases of the digestive organs.

Patients who have a tendency to an irregular stool, as well as the need to constantly restrain the urge to defecate by willpower (for example, a person works in a public place, has to constantly suppress the urge of a bowel movement) form a separate risk group. [5]

Pathogenesis

The basis of pathogenesis is a violation of the normal functioning of the intestinal tract. The hormonal status of a person changes, respectively, this entails a violation of the synthesis of enzymes, hormones, mediators that cause inflammation and infection, contribute to a decrease in intestinal tone, prevent the penetration of infection in the body. Accordingly, fecal masses are moving slightly outward, and also can not leave the rectum. As a result, stagnant processes develop.

Symptoms of the constipation during early pregnancy

The development of constipation may indicate the inability to empty in the presence of the urge to defecate. This may develop pain, burning sensation in the intestine and rectum, sometimes there is a feeling of pressure, and even pain in the rectum. Also, the whole process may be accompanied by chills, a feverish state, which alternates with chills and an excessive decrease in temperature. Gradually, pain may develop in the ovaries, uterus, fallopian tubes, and other reproductive organs.[6]

The first precursors, which may indirectly indicate possible constipation, are abdominal distension, pain and pressure in the intestinal area, or in the rectal area. Also, there is a headache, discomfort, tension, pressure in the bladder, ovaries. Quite often a feeling of bloating develops, both in the abdomen and in the reproductive organs.

• Bloating, constipation in early pregnancy

This happens every second woman. This feature is that a woman may not know more about pregnancy, because the delay has not yet come. It is also worth noting that a lot of pregnancies are finally confirmed in the process of consulting a gastroenterologist, who accepts about abdominal bloating, pain, prolonged constipation.

• Hard stools in early pregnancy

Quite often, the onset of pregnancy is associated with such an unpleasant phenomenon as constipation. But it can and must be fought. Today, the pharmaceutical industry is represented by a variety of drugs that can solve this problem gently and without consequences. For example, during pregnancy, you can use drops gutalaks, buckthorn extract, festal, and many other means, including prescriptions for alternative medicine.

Complications and consequences

One of the most dangerous complications of constipation is intoxication, which develops as a result of stagnation of feces. The processes of fermentation, decay, this is accompanied by the release of gases, the spread of toxins throughout the body. As a result, new foci of infection may be formed, as well as poisoning of the whole organism. This is due to the fact that the decay products (toxins) can be absorbed through the blood, and penetrate into all other organs and systems. Also, a complication can be the deformation of the rectum of the sigmoid colon, the development of purulent-inflammatory bowel disease.

Various inflammatory infections, such as the intestines and the urogenital system, may gradually develop. The most dangerous is the excessive progression of infection, in which it enters the bloodstream, spreads and leads to bacteremia, sepsis. Sepsis is the most severe and dangerous form of the infectious process, which is reduced to infection of the blood, and requires complex treatment (antibiotic therapy).[7]

Diagnostics of the constipation during early pregnancy

In order to diagnose constipation and determine the causes of its occurrence, when the first signs of constipation appear, it is necessary to consult a doctor as soon as possible. Usually he conducts diagnosis by palpation, examination of the stomach, intestines. But before that, the doctor first asks the patient, collects general information about him, a history of life.[8]

Gastroenterologists rarely ask women about their last periods, so it’s not always so easy to guess that pregnancy was the cause of constipation. In addition, the delay has not yet arrived, therefore, even having information about when the last menstruation was, it is not always possible to determine the cause of the development of pathology. Most commonly suspected dolichosigmoid, intestinal obstruction, malabsorption, or just a violation of the normal intestinal motility, which leads to a delay in the body's fecal masses. Also, the reason may be a violation of the normal microbiocenosis, a violation of the motor activity of the ciliary epithelium, a violation of the normal state of the mucous membranes of the digestive tract, and even a violation of the activity of enzymes.

Then the doctor collects the history of the disease. Tell the doctor everything that you consider necessary, any assumptions about what could have provoked the cause of the development of constipation, no matter how ridiculous they may seem to you. The more information, the easier it will be to diagnose a doctor. Indeed, at first glance it seems that the appointment of a pregnancy test for a complaint of constipation is also a nonsense.

Usually, only after a complete examination and interrogation of the patient are necessary examinations appointed. Important diagnostic information can give and palpation, because it allows you to determine the degree of intestinal density, swelling, and, consequently, the stagnation of fecal masses.

If necessary, additional laboratory and instrumental methods of research can be assigned.

Analyzes

Traditionally prescribed clinical tests: blood, urine, feces. They allow you to assess the overall direction of the processes occurring in the body. By results of analyzes it is possible to judge a possible pathology. So, they may indicate an inflammatory, infectious, or allergic process. You can also roughly assume what the severity and neglect of the inflammatory process.

But few gastroenterologists dare to prescribe a pregnancy test if you consult him about constipation. At least, there must be good reasons for this. For example, a gastroenterologist may prescribe standard clinical tests first, and if a pregnancy is suspected by the results, only then can he prescribe such a test.

The definition of pregnancy in the early stages is prescribed for human HCG-human chorionic hormone, which is produced from the moment of fertilization until the formation of the placenta, that is, for about the first four weeks. After that, the placenta begins to gradually form, and hCG is no longer synthesized by the body. At this stage, it is already necessary to prescribe tests for progesterone (placental hormone of pregnancy). He continues to synthesize from 1 month, and up to the birth. At different times, its amount may not be the same. So, if signs are found in the blood that may indirectly indicate pregnancy (with a clinical study of blood), further studies can be conducted further in this direction.

Of interest is the fact that on a blood test the signs of pregnancy are similar to the signs of parasitic invasion. This is due to the fact that the embryo developing in the body is initially alien to the mother's body. Pregnancy can be assumed if the blood test shows a high content of eosinophils and elevated levels of histamine. But it can also indicate parasites, and an allergic process can also be suggested. To clarify the data designate a pregnancy test. If this option is excluded, prescribe allergy tests, analysis of the content of total and specific immunoglobulin E, at the level of histamine. An expanded immunogram may be required that will display the current state of the immune system.

If the pregnancy is confirmed, it will be useful to conduct bacteriological research, analysis for dysbacteriosis or microbiological screening, which will eliminate the likelihood of developing dysbacteriosis, infectious diseases. The fact is that constipation is accompanied by stagnation of fecal masses in the body, as a result of which festering develops, which is inseparable from the infectious process.

If an infectious disease is suspected, virological studies are prescribed, as well as bacteriological inoculation, which will allow differentiation of the viral disease from bacterial or fungal. Take smears, scraping. Also examine the blood or feces by microscopy, bacteriological culture, serological or virological studies. With a disease of unknown etiology, it is advisable to conduct a study on latent infections, parasitic diseases.

Instrumental diagnostics

Which diagnostic method the physician chooses depends on what is believed to be the cause of the disease. Usually appointed after a preliminary examination and interview of the patient, after a standard set of studies, when the doctor already has a presumptive diagnosis, or a suspected cause of pathology.

So, in case of suspected gastrointestinal disease, gastroscopy, radiography, ultrasound, colonoscopy may be required. You may also need magnetic resonance imaging, which allows you to assess the condition of internal organs and soft tissues, to identify possible pathologies in the very early stages of their formation. If there is reason to suspect pregnancy, it is advisable to appoint an ultrasound, because it is the main method of confirming or excluding pregnancy. In addition, it is the most secure method. Such a method as x-ray in case of suspicion of pregnancy should be excluded, since the risk of fetal exposure is great, which may adversely affect its further development, especially in the early stages.[9]

Differential diagnosis

First of all, it is necessary to determine which alleged cause of constipation: an inflammatory, infectious, allergic process, parasitic invasion, or pregnancy (perhaps another reason). For this, laboratory and instrumental diagnostics are carried out.

Then it is necessary to differentiate among themselves diseases and conditions that can cause constipation. Here mainly instrumental methods are used, consultations of other specialists may be required.[10]

Treatment of the constipation during early pregnancy

With the appearance of constipation, it is necessary to treat it, because the accumulation of feces provokes the development of intoxication, stagnation, which is unacceptable. It is recommended to build an optimal diet, pick up products that best meet the individual needs of the body.

If proper nutrition does not solve the problem, you should try alternative remedies, homeopathy, which will allow you to gently get rid of the problem. And only in the absence of the effect of these methods, it is possible to resort to the use of more stringent methods (pharmaceutical preparations). Also, in the absence of effect, you can try an enema, including on the basis of plant extracts. Well helps oil (olive, sunflower, castor), applied inside. Need to provide plenty of drink.[11]

Remedies for constipation in early pregnancy

Duphalac is the mildest, safest and well-known anti-constipation drug. It is a reliable treatment and prevention of constipation. The drug is based on herbal ingredients, so it can be used even during pregnancy. Before you begin treatment, you need to carefully read the instructions carefully. There are almost no side effects, so it can be taken as needed, as indicated in the instructions.[12]

Another drug is mukofalk. It comes in the form of packaged powder. At the same time one bag is designed for one reception. Side effects are rare. Usually the whole package is dissolved in a glass of water (warm), drunk after dinner. The maximum dosage is 4 sachets per day.[13]

Duspatalin Retard is also a laxative that is applied 200 mg in 2 divided doses, approximately 20 minutes before a meal. You should also drink plenty of water. Available in the form of capsules that are swallowed without revealing.[14]

Vitamins

In the event that constipation is accompanied by purulent, infectious processes (stagnation), vitamins are better excluded because they act as stimulants and nutrient medium of the bacterial flora, respectively, the infection will only progress. Also, vitamins, enhance fermentation, cause bloating, pain, cramps, and festering. The only vitamin that can be - vitamin C, because it on the contrary, has antiseptic, antioxidant properties, removes toxins, neutralizes metabolic by-products and free radicals.

If the infectious process has been stopped, and it is only necessary to ensure good intestinal motility, vitamins can be given. It is recommended to take vitamins in the following daily concentrations:

• Vitamin PP - 60 mg
• Vitamin A - 240 mg
• Vitamin E - 45 mg
• Vitamin C - 1000 mg.

Physiotherapy

Physiotherapy to eliminate congestion in the intestine is rarely used, and it is ineffective. With severe stagnation, which are accompanied by the development of purulent-inflammatory processes, purgation of the rectum is performed, and, if necessary, intestinal lavage, or gastric lavage. But it happens mechanically. For further treatment and restoration of intestinal motor function, electrophoresis and hydromassage baths may be required.[15]

A positive effect has a massage chair or massage bed. It has a vibrational and thermal effect, which allows to eliminate stagnation, break up deposits, stimulate muscles (increase contractile activity). Sometimes they carry out treatment with ultrasound, microcurrents, waves of different lengths. Electrophoresis is used, with the help of which drugs are injected directly into the damaged tissue. The depth of their penetration is regulated by microcurrents.

Alternative treatment

The most famous method of treating constipation, which has long been used in alternative medicine, is the juice of fresh potatoes, it is necessary to squeeze and drink during the day. Recommended daily about a glass of juice. But in fact, there are no restrictions. It all depends on the well-being, the individual characteristics of the organism. Usually, for a complete normalization of the stool, at least 10 days of treatment is necessary.[16]

Dandelion juice has also always been used to treat constipation. At the same time there are various ways to prepare a dandelion. Can be used as a decoction, in the form of syrup, infusion. Especially well proved infusion of dandelion roots, which is prepared on the basis of cold water.[17]

You can also recommend aloe juice to eliminate constipation. Choose the fattest piece, squeeze the juice, give the opportunity to brew for about 10-15 minutes, then drink. You can drink up to 100 ml of juice per day.[18]

Herbal medicine

It has long been used for the treatment of constipation buckthorn alder. Previously, it was a means of alternative medicine, but later the roots of buckthorn were allowed for use in official medicine. Today, various preparations made on the basis of buckthorn have found wide application. Available extracts and infusions of buckthorn. Also available buckthorn in the form of pharmaceutical raw materials. Industrial version is used according to the instructions. As for the broth - it can be prepared at home independently and as simply as possible: pour a glass of boiling water with a tablespoon of buckthorn root, cover with a lid, insist for an hour, drink half a glass twice a day.[19]

One of the most effective means of treating constipation is fennel decoction. It also eliminates toxins, relieves inflammation, normalizes the condition of the mucous membranes, resulting in improved motility and peristalsis. The broth is prepared at the rate of 0.5 teaspoons of dill per cup of boiling water. Insist 30 minutes, drink in small sips. [20], [21]You can give even with colic newborns.[22]

Black elderberry flowers have also proven to be an effective anti-inflammatory agent, a normalizing stool remedy. It is used as a decoction or infusion. Drink a tablespoon every 1.5-2 hours. [23]The plant is poisonous, so you need to ensure that there is no overdose.[24]

Anise fruits are used as a decoction. To prepare, take 2 teaspoons of broth for a glass of water, pour boiling water on it, give an opportunity to brew for 20-30 minutes, drink a third of a glass 2-3 times a day.[25]

Homeopathy

Homeopathic remedies should be used with caution, while taking precautions. The main measure - be sure to consult a doctor. Self-medication is always dangerous, especially during pregnancy. Indeed, in the event of complications, you risk not only your life and health, but also the life of a child. At first glance it may seem that homeopathy is safe. So, homeopathic remedies have significantly fewer complications and side effects. But among homeopathic remedies, many of these that are not combined with other drugs and components, or cause an abortive effect, cause miscarriages, premature birth, edema, allergic reactions, toxicosis.[26]

• The tool number 1.

A mixture of licorice root and herb violets in equal shares is used to treat abdominal pain, which occurs as a result of prolonged constipation.

• The tool №2.

With spasms and flatulence against the background of constipation, a decoction of birch leaves is used (a tablespoon per cup of boiling water).

• The tool №3.

Buckthorn bark (2 tablespoons per liter of water) can be used as an enema agent.

• The tool №4.

An infusion of aniseed fruit and buckthorn bark (3 tablespoons of each product for a glass of vodka or alcohol), drink one-third of a glass a day every day for a month for chronic constipation.

Surgery

During pregnancy, surgery is not performed. If it is possible to postpone, all operations are postponed for the period after delivery. The exceptions are cases of acute pathology. For example, with long-term constipation, inflammation may develop, fermentation occurs. If it is impossible to empty more than 5-7 days, it may be necessary to wash, cleanse the intestines, and possibly also surgery to remove a part of the intestine. This is necessary to prevent sepsis (blood poisoning), peritonitis (inflammation and inflammation of the abdominal cavity).

Prevention

At the heart of prevention lies in the first place, timely diagnosis. It is important to identify the pathology at an early stage of its formation and take the necessary measures. This will prevent the progression of the disease. You need to keep track of food, drink enough water, comply with the daily regimen and diet.[27]

When constipation occurs, you need to take medication in a timely manner. Also important is a high level of mobility, physical activity. Means of hatha yoga, physiotherapy exercises also have an arsenal of tools to ensure the prevention of constipation. Also a reliable means of prevention is massage (visceral, massage of the abdominal cavity). Stimulation of biological points, means of alternative medicine also has a positive effect.[28]

Forecast

If it is timely to determine the cause and carry out the necessary treatment, the prognosis will be favorable. Constipation during early pregnancy can be completely and completely eliminated, and nothing will spoil the remaining months of pregnancy, the birth of a baby and the joy of motherhood. If, however, the diagnosis and treatment is delayed, the prognosis can be unpredictable. You can run a serious pathology of internal organs, get peritonitis, sepsis, and even death or fetal death.