As the body undergoes significant anatomical, physiological and hormonal changes, these can all affect the function of the intestines, causing a range of symptoms from morning sickness and heartburn, to constipation and haemorrhoids (piles).
A pregnant woman can suffer an inflamed or rupture appendix, she can develop diverticulitis or, very rarely, show symptoms of colo-rectal cancer.
These conditions need to be dealt with speedily without risk to the growing baby. Existing GI conditions, such as inflammatory bowel disease, also need to be managed differently during pregnancy.
Typical GI problems during pregnancy
Almost all women will experience some gastrointestinal problems during pregnancy as their body radically changes. Here are some of the most common problems:
Nausea and sickness
As many as 90% of women will experience nausea in the first few months, and at least half of these will be physically sick. Although commonly known as morning sickness this can occur throughout the day. For most women, this is more of an uncomfortable inconvenience than a medical problem, however for a small number it can be far more serious. Intractable nausea, known as hyperemesis gravidarum, can lead to dehydration and malnutrition, which can have serious consequences for mother and baby unless it is clinically addressed.
Increased levels of the female sex hormones progesterone and oestrogen often cause constipation in pregnant women, with as many as 40% of pregnant women experiencing symptoms. Constipation occurs when these hormones relax the muscles in the bowel wall, increasing the time it takes food to pass through the bowels, resulting in an increased level of water absorption and hard, dry stools. Bowel function is also disrupted by the growing uterus pressing on the bowel wall in the later stages of pregnancy.
Constipation during pregnancy can lead to haemorrhoids, as the woman strains to pass constipated stools. As the weight of the baby grows, haemorrhoids are often exacerbated by the increased pressure on the rectum.
Advice on lifestyle management of constipation, with careful use of laxatives when necessary, can ease symptoms throughout pregnancy and prevent complications.
As much as 80% of women experience heartburn or gastroesophageal reflux disease (GERD) during pregnancy, although the frequency of symptoms eases as the pregnancy proceeds. This is caused by changes in the upper part of the digestive system.
Existing GI problems and pregnancy
As well as the GI problems caused by their pregnancy, many women have to contend with existing GI conditions, such as inflammatory bowel disease (IBD), which were in place before they became pregnant. These diseases need very careful management during pregnancy as many of the investigations, treatments and drugs used are not appropriate for a pregnant woman.
Inflammatory bowel disease (IBD)
In the case of IBD, women are advised to delay conception until their symptoms are in remission, since pregnancies that begin during the active phase of the disease have a lower chance of success. Even then, around a third of IBD sufferers will relapse during pregnancy. If the disease is active at conception around two thirds of patients will get considerably worse during their term.
Diverticulitis needs special care during pregnancy, since the inflammatory response of the gut to the disease can stimulate premature labour.
To complicate matters further, many of the main antibiotics used to treat diverticulitis in non-pregnant women cannot be used during pregnancy.
Diagnosing and treating GI problems during pregnancy
The main challenge for the gastroenterologist with a pregnant patient lies in the fact that many of the symptoms of GI diseases, such as altered bowel habits, bloating and nausea, are also common side-effects of pregnancy itself. At the same time, many of the standard investigations, such as colonoscopy, x-rays and exploratory surgery, which could be used to differentiate the two, carry significant risks if used during pregnancy.
Managing the gastrointestinal health of pregnant women, both in helping them to deal with the symptoms of pregnancy and in diagnosing and treating unrelated GI problems, takes a great deal of skill and experience.
The advantage of a female gastroenterologist
- A female gastroenterologist, especially one who has children of her own as Dr Wilson has, will always be better placed to understand and sympathise with pregnant patients.
- Gastrointestinal investigations during pregnancy combine two of the most sensitive and intimate areas of women’s health.
- Many women simply feel far more comfortable discussing their symptoms with another woman, and being examined by her if that’s necessary.