Pregnancy
Pregnant women frequently experience GI symptoms like nausea, vomiting, heartburn, and constipation due to higher than normal levels of estrogen and progesterone, and physical changes in the body associated with carrying a baby.
As the developing fetus increases in size it takes up more space in the abdominopelvic cavity and compresses on the intestines, contributing to these pregnancy related GI symptoms.
Additionally, progesterone, which is elevated in pregnancy, is associated with delayed or slowed muscle contractions, including intestinal contractions. Progesterone slows how quickly food is emptied from your stomach, contributing to nausea, vomiting, heartburn, and indigestion.
Pregnancy can cause new and/or temporary GI symptoms, and it can also worsen preexisting or underlying GI diseases like Gastroesophageal Reflux Disorder (or GERD), and Inflammatory Bowel Disease (IBD). GERD tends to be worsened by pregnancy due to delayed stomach emptying, hormonal fluctuations, and the increasing size of the baby pushing on your abdominal contents.
Food sensitivities like lactose intolerance may also be exacerbated by pregnancy.
Below, you’ll find some special considerations for women during pregnancy.
Hemorrhoids Associated with Pregnancy and Childbirth
Hemorrhoids are swollen veins in your anus and lower rectum similar to varicose veins.
Internal hemorrhoids are usually painless, but can cause symptoms like bright red blood with wiping and sometimes you’ll feel a bulge from your rectum. External hemorrhoidscan cause pain and discomfort, itching, and the sensation of incomplete emptying after bowel movements.
Common causes of hemorrhoids include:
- Straining associated with chronic constipation
- Chronic constipation or diarrhea
- Not going to the bathroom when you have to go (or holding it on a regularly basis)
- Being overweight or obese
- Heavy lifting, and
- Pregnancy
How does pregnancy contribute to the development of hemorrhoids?
When you’re pregnant, the baby puts extra pressure on your anus and rectum. It’s not unusual to develop hemorrhoids during or after pregnancy, especially following vaginal delivery. Hemorrhoids occur in 25% to 35% of pregnant women.
What are the Symptoms of Hemorrhoids?
Symptoms may include:
- Pain with bowel movements
- Bright red blood with wiping
- Swelling in the rectum or feeling a bulge
- Itching around the rectum
- The sensation of incomplete emptying after bowel movements
- Difficulty keeping clean after bowel movements
***ANY RECTAL BLEEDING SHOULD ALWAYS BE EVALUATED PROMPTLY AND AGGRESSIVELY BY A TRAINED GI PROFESSIONAL due to the rise in colorectal cancer in the younger populations.
How are hemorrhoids associated with pregnancy treated?
All hemorrhoids should be treated to prevent more serious complications, including inflammation, thrombosis, and prolapse, regardless of cause.
Hemorrhoids often resolve with conservative treatment approaches, like:
- Avoiding constipation,
- Following a high fiber diet to bulk your stools and make them easier to pass
- Keeping well hydrated
- Going when you have to go, and not holding it
- Following a good bowel routine
- Taking Sitz baths
- Using certain OTC or prescription medications if recommended and prescribed
- Taking stool softeners if recommended and prescribed
- Depending on the size, location, and severity of your hemorrhoids, it may take a few weeks for symptoms to resolve with conservative treatment approaches.
Sometimes hemorrhoids will form a blood clot and become “thrombosed”. Thrombosed hemorrhoids can be extremely painful. They are often treated with a minimally invasive in-office procedure that makes a small cut in the clot and drains it. Some hemorrhoids can become chronic and require more invasive treatment procedures like banding. At Hunterdon Digestive Health Specialists we use the CRH-O’Regan Disposable Hemorrhoid Banding System.
The CRH-O’Regan Disposable Hemorrhoid Banding System allows your hemorrhoids to be treated quickly and efficiently with little discomfort. Often you’re able to resume your normal activities that very same day.
The O’Regan method uses a small rubber band to cut off blood supply to the hemorrhoid. The banded tissue shrinks, and typically falls off along with the rubber band a few days after your treatment when you go to the bathroom. The treatment itself takes only a few minutes and can be performed in our office. Patients who have multiple hemorrhoids may require two or three treatments, which are scheduled a few weeks apart.
Inflammatory Bowel Disease (IBD) and Pregnancy
Women with IBD tend to have normal, healthy pregnancies; however they are more likely to have pregnancy complications than women without IBD, even in the setting of remission.
If a woman becomes pregnant during an IBD flare-up, her disease is more likely to remain active throughout her pregnancy. Having active disease during pregnancy can increase your risk of premature birth and low birth weight.
Certain medications use to treat IBD like methotrexate can cause abortion and congenital defects. These medications should be discontinued PRIOR to planning pregnancy. Folic acid supplementation, which helps to prevent spina bifida and other neural tube birth defects, is particularly important for women taking sulfasalazine, as sulfasalazine can inhibit your body from absorbing folic acid.
Again, if you have IBD and are taking methotrexate, sulfasalazine, or any other medications and are planning to become pregnancy please talk with our office BEFORE GETTING PREGNANT about alternative treatment options to avoid loss of pregnancy and/or congenital abnormalities.
Gallstones and Pregnancy
Gallstones are concentrated lumps of bile. Bile is made up of water, fat, cholesterol, bilirubin, and salts. It is made in the liver and stored in the gallbladder. It is normally released into your small intestine during digestion to help us breakdown and digest fats. If bile sits stagnant in the gallbladder for a prolonged period of time, or the gallbladder doesn’t squeeze properly or effectively, gallstones can form.
In general, women are twice as likely as men to develop gallstones. During pregnancy your risk becomes even higher due to high estrogen levels. High estrogen levels lead to a higher concentration of cholesterol in your bile. As well, movement of bile through your gallbladder is decreased. The longer bile sits stagnant in the gallbladder and ducts the more likely it is to clump and form stones.
What are the symptoms of gallbladder disease during pregnancy?
Symptoms may include:
- Nausea and/or vomiting
- Pain in the right upper abdomen
- Fever, chills, sweats
- Itching without an obvious rash, and
- Jaundice or a yellowing of the skin and whites of the eyes
Pregnancy may affect your sensitivity to abdominal pain. If you have any concerns relating to your pregnancy please contact your OBGYN or go to your nearest emergency department to avoid complications or poor outcomes for you and your developing baby. This information not meant to serve as a substitute for medical care! It is only for educational purposes and the accuracy of the content is not guaranteed!
How common is gallbladder disease during pregnancy?
Research shows roughly 5-8% of women will experience gallstones or sludge during pregnancy. Gallstones are more common in individuals who are overweight or obese, and in those who lose weight rapidly. The post-partum period can be a time of heightened risk for some individuals due to rapid weight loss.
Pelvic Floor Dysfunction
The muscle and nerves coordinating our bowel and bladder movements can be damaged and strained during pregnancy and childbirth, especially if your labor was long or difficult, leading to possible long-term problems including pelvic floor dysfunction.
Pregnancy is the most common cause of pelvic floor dysfunction, which can result in symptoms of urinary incontinence, pelvic organ prolapse, and fecal incontinence. For more information about Pelvic Floor Dysfunction please click here.
Liver Disease Associated with Pregnancy
Liver diseases unique to pregnancy include:
- Hyperemesis gravidarum
- Intrahepatic cholestasis of pregnancy
- Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, and
- Acute fatty liver of pregnancy
Hyperemesis gravidarum causes severe nausea, vomiting, weight loss, and sometimes dehydration. It is more severe than typical morning sickness and may require IV hydration, hospitalization, and tube feeding. Elevated liver function tests can occur in up to 50% of patients.
Intrahepatic Cholestasis of Pregnancy occurs when high levels of pregnancy hormones disrupt or stop the normal flow of bile from the liver and gallbladder, and bile builds up in the liver, impairing liver function.
HELLP syndrome is a life-threatening pregnancy complication with a high mortality rate that affects the blood and liver. HELLP an acronym that stands for:
- H (hemolysis, or the rupture, breakdown, or destruction of red blood cells)
- EL (elevated liver enzymes)
- LP (low platelet count)
Acute Fatty Liver of Pregnancy is a rare but serious condition associated with pregnancy where fat accumulates excessively in the liver resulting in liver damage. Liver failure, hemorrhage, kidney failure, and severe infections can occur if left untreated.
If you have a history of pregnancy related liver disease, other pregnancy related complications, or if you are currently pregnant, please be sure to notify our office! Knowing your entire medical history helps us to provide you with the most comprehensive, quality GI care possible.