Frequent bowel movements (more than three times a day) with passage of loose, watery, or unformed stools of more than 200 grams per day is known as diarrhea. It should be taken seriously in a pregnant woman, especially if it continues for more than two days. The causes may be varied but it is important to guard against the danger of dehydration, for which treatment should be initiated promptly.
Causes of Diarrhea During Pregnancy
As in the non-pregnant state, diarrhea may occur in pregnant women due to the following reasons :
- Viral infections – most cases of diarrhea are caused by viral infections, such as rotavirus, norovirus, or adenovirus. The symptoms are generally mild and usually settle on their own.
- Bacterial infections – more serious types of diarrhea are caused by bacterial infections or food poisoning caused by contaminated food or water. Bacterial infection may be caused by Campylobacter, Salmonella, Shigella or Escherichia coli (E. coli).
- Parasitic infections – diarrhea may be caused by Giardia lamblia, Entameba histolytica, or Cryptosporidium which enter the digestive system through contaminated food or drinks.
- Food intolerances such as lactose intolerance or gluten intolerance.
- Exacerbation of inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis.
- Reaction to medicines such as antibiotics and antacids.
- Irritable bowel syndrome.
Diarrhea during pregnancy could also occur due to the following causes :
- Diarrhea during late pregnancy could be an indication that labor is about to ensue.
- Regular laxative intake to treat constipation in pregnancy (often due to iron supplements).
- Hormonal changes associated with pregnancy could affect the gastrointestinal system and cause diarrhea in some women.
- Dietary changes in a pregnant woman, such as intake of more fruits and vegetables and other high fiber diet.
- Unusual cravings and eating indigestible foods and other unusual substances (pica) during pregnancy.
- Excessive water intake may change the stool consistency in some women.
Dangers of Diarrhea During Pregnancy
While most cases of diarrhea do resolve on their own, diarrhea during pregnancy should not be taken lightly if it persists beyond two days or if there are other associated symptoms such as fever, vomiting, abdominal cramping or signs of dehydration (excessive thirst, dryness of mouth, dry skin or decreased urine output). Persistent and severe diarrhea may lead to :
- Dehydration – when there is excessive loss of fluid and electrolytes from the body, either due to severe diarrhea alone, or diarrhea and vomiting together, dehydration can occur. Dehydration may become a cause for concern for the health of the fetus.
- Weight loss.
- Pre-term labor.
Treatment of Diarrhea During Pregnancy
In most cases, the diarrhea resolves on its own without any specific treatment. Preventing and treating dehydration is essential.
- Plenty of fluids should be given by orally. Oral rehydration solutions (ORS) may be given but caffeine, alcohol and dairy products are to be avoided.
- Intravenous fluids may need to be given in case of severe diarrhea, especially if there is associated vomiting which cannot be controlled.
- The BRAT diet involves returning to solid foods by consuming mashed bananas, rice, grated or stewed apples or apple sauce and toast. If these foods are well tolerated without any vomiting, a bland diet should be commenced immediately containing mixed vegetables, meat and fiber. Yogurt should be used with caution as secondary lactose intolerance may arise after some instances of gastroenteritis.
- Medicines should be used with caution in pregnancy. Use of anti-diarrheals is controversial but if necessary, loperamide may be used safely even in the first trimester of pregnancy. Drugs containing diphenoxylate with atropine, and bismuth subsalicylate are not recommended in pregnancy.
- Treatment of the underlying cause is essential.
- Probiotics containing Saccharomyces boulardii and Lactobacillus casei may be helpful in restoring the normal intestinal flora. Live culture yogurt should be avoided for the reasons mention above.