Constipation is the most common intestinal pathology during pregnancy.
You can read about what constipation is in the article “ Constipation ”.
Content
Causes
Constipation that occurs in women during pregnancy is a secondary symptom of various health disorders. In the first trimester of pregnancy, the cause of stool retention is increased production of progesterone, and in the later stages - compression of the colon by an enlarged uterus.
Today, constipation is the most common gastroenterological problem in pregnant women. Its frequency, according to various sources, varies from 17 to 50%. Most often, constipation occurs between the 17th and 36th weeks of pregnancy.
The main reasons for its development are:
- increased synthesis of progesterone, which has a relaxing effect not only on the muscles of the uterus, but also on other smooth muscle organs (urinary tract, gastrointestinal tract), which leads to a decrease in intestinal motor activity;
- the uterus gradually increasing in size begins to compress the abdominal organs;
- changes in food quality and taking various medications (progesterone, tocolytics);
- if a pregnant woman has to lie down for a long time, and normal intestinal motor function requires at least minimal physical activity.
Consequences
Prolonged colonic stasis is extremely undesirable and can lead to a number of disorders:
- activation of opportunistic microflora occurs, penetration of microbes and their toxins through the intestinal wall, which is a risk factor and cause of complications during pregnancy, childbirth and the postpartum period;
- disruption of the microflora of the colon can lead to disruption of the microflora of the vagina, which can cause ascending infection of the fetus and the development of various complications;
- threat of miscarriage, untimely rupture of amniotic fluid, endometritis;
- increased permeability of the intestinal wall and disruption of its barrier function , while its barrier function is not compensated even in the postpartum period.
In the absence of adequate treatment with a laxative, constipation may ultimately be one of the risk factors for purulent-septic complications in the postpartum period.
Symptoms
- With constipation, stool retention occurs,
- change in stool consistency,
- pain and discomfort in the abdomen, often in the left half,
- feeling of incomplete bowel movement.
With atonic constipation, feces are abundant, shaped, and sausage-shaped. Defecation occurs with great difficulty, is very painful due to tears in the mucous membrane of the anal canal, and there may be streaks of fresh blood on the surface of the stool.
With spastic constipation, stool takes the form of sheep feces (fragmented stool).
Constipation is often accompanied
- flatulence,
- feeling of pressure, expansion,
- spasmodic pain in the abdomen.
Long-term constipation often causes a feeling of fatigue, lethargy, and decreased performance.
Painful sensations can occur for no reason or after excitement or physical activity. Negative emotions can cause an attack of acute or exacerbation of persistent abdominal pain.
Sometimes the pain radiates to the lower back, perineum, anus, and genitals.
There are often complaints of nausea, a feeling of bitterness in the mouth, and difficulty passing gas.
Treatment
Therapy should be carried out strictly under the supervision of a physician.
When treating constipation in pregnant women, 4 basic principles are applied:
- following a special diet;
- assignment of motor mode;
- the use of herbal remedies and teas with a laxative effect;
- Only if these measures are ineffective is drug treatment prescribed.
What can you do at home?
Treatment of constipation in pregnant women should begin with non-drug measures. These include dietary nutrition. Therapeutic diet No. 3 for constipation, which was developed by the Institute of Nutrition, is prescribed.
It is necessary to normalize the water balance and follow the drinking regime recommended by the doctor in each specific case.
Correction of the psycho-emotional state plays an important role in the treatment of constipation in pregnant women.
Particular attention should be paid to women who enter pregnancy already experiencing constipation. Women who suffer from constipation before pregnancy and abuse medications in connection with this problem develop a certain lifestyle with the problem of constipation. During pregnancy, this lifestyle should be corrected by changing the correction regimen and adding products that do not affect the course of pregnancy.
As initial therapy, you can use preparations that regulate intestinal function and do not harm pregnancy. You can read about the composition of the infusions and methods of their preparation in the article “ Therapeutic herbal infusions for constipation during pregnancy .”
Laxatives during pregnancy
Only if the measures listed above are ineffective, the doctor can prescribe laxatives. At the same time, it is necessary to comply with the highest safety standards to ensure the normal development of the fetus.
The choice of drug during pregnancy should be done with great caution. For treatment, it is necessary to recommend drugs with a mild laxative effect, causing stools close in consistency to normal.
Irritating laxatives (castor oil, Carlsbad salt, senna preparations) can cause reflex contractions of the uterus. There are drugs that require taking a large amount of liquid, which is also undesirable, since the load on the kidneys increases, which leads to an imbalance in water balance and the development of edema.
Self-medication with laxatives is unacceptable.
It is necessary to take into account various side effects, for example, senna preparations (senade, senadexin) are known to have a damaging effect on the fetus. Thus, the list of laxatives during pregnancy is narrowing. They must be safe for both the woman and the fetus, as well as for the normal development of pregnancy.
Currently, one of the most widely used laxatives in the world is the drug dulcolax , the active ingredient of which is the prodrug bisacodyl. When taken orally or rectally in an alkaline environment, hydrolysis occurs with the formation of an active metabolite - biphenol, which has an irritating effect on the colon mucosa.
The action of dulcolax is due to direct stimulation of nerve endings in the mucous membrane of the large intestine. It stimulates the excretion of water and electrolytes into the intestinal lumen, which leads to softening of stool, acceleration of peristalsis and reduction of evacuation time and, ultimately, to the act of defecation.
Dulcolax is absorbed to a minimal extent (no more than 5%) from the gastrointestinal tract. After the liver, the drug enters the enterohepatic circulation and is partially excreted by the kidneys.
The drug is available in tablets and suppositories and is prescribed:
- adults and children over 10 years old, 5-10 mg orally (1-2 tablets),
- children aged 4 to 10 years - 5 mg (1 tablet).
Conveniently, the drug is taken once a day at night, regardless of the time of meal. If necessary, you can take an additional 5 mg in the morning 30 minutes before breakfast.
One of the advantages of Dulcolax tablets is their enteric coating. The tablets should be swallowed without chewing. The drug should not be taken together with foods and medications that reduce acidity in the gastrointestinal tract (milk, antacids or PPIs) to avoid premature dissolution of the enteric coating and, as a result, ineffectiveness of the drug.
Dulcolax suppositories are administered rectally at 10 mg (1 suppository) per day. The effect of the suppositories begins in approximately 30 minutes.
The accumulated long-term experience of use has not revealed a negative effect of the drug on pregnancy.
Dulcolax is practically not absorbed from the intestines, it does not have embryotoxic or uterine stimulating effects, and does not pass into mother's milk. This drug is a Group B laxative (no evidence of risk) on the FDA safety classification and is one of the few laxatives approved for use in pregnant women.
In addition, currently the drug of choice for laxatives in pregnant women, which are approved by the FDA and approved for use, are also representatives of the group of osmotic laxatives - the synthetic disaccharide lactulose and the stool regulator macrogol, which have a mild laxative effect.
Lactulose is not absorbed or broken down, since there are no enzymes in the human body that could break it down. The mechanism of action of lactulose is close to the mechanism of action of dietary fiber contained in fruits, vegetables, and cereals on the intestines. During its pharmacological action, lactulose is decomposed by the microflora of the large intestine to short-chain fatty acids, leading to an increase in osmotic pressure, a decrease in pH and an increase in the biomass of saccharolytic bacteria.
An increase in the biomass of saccharolytic bacteria leads to an increase in intestinal contents, and this increases peristalsis. Thus, a gentle regulation of intestinal function is carried out and a laxative effect develops.
Lactulose ( Duphalac ) is taken 1-30 ml once a day in the morning with meals.
The dose is increased if the patient’s condition does not improve within 2 days of administration. Most often, after 2 days of use, depending on the needs of the pregnant woman, the dose can be reduced to 10-2 ml (maintenance dose).
Macrogol is an isosmotic laxative. It is not absorbed into the gastrointestinal tract, is not included in metabolism and is not destroyed by intestinal bacteria. Macrogol has the ability to retain water, which dilutes stool and facilitates the evacuation of intestinal contents, having an indirect effect on its peristalsis.
This drug does not penetrate the fetoplacental barrier, without having a negative effect on the tone of the myometrium, it has no toxic effect on the mother’s body and the fetus.
Macrogol is taken 1-2 sachets per day at a time (preferably in the morning), the contents of the sachet are pre-dissolved in water - 5.9 g per 100 ml (half a glass); the maximum daily dose is 11.8 g (2 sachets of 5.9 g).
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