What various digestive problems do women face during pregnancy?
There are several of them. Hyperemesis Gravidarum is the most common digestive problem, which in simple language is excessive vomiting. It may start in the first three months of the pregnancy and sometimes continue till the baby is delivered.
In addition, there is Gastroesophageal Reflux disease which affects the muscular sphincter between esophagus and the stomach. The problem may occur for the first time as pregnancy begins or it may be a pre-existing condition which could worsen during pregnancy. Other digestive conditions include Acid Peptic disease during which there is excessive acid secretion. It is seen even during non-pregnant state. However, pregnancy may exacerbate the issue due to hormonal changes.
At times, expecting mothers come with an emergency case – that of blood vomiting. This usually occurs when there is a tear in the lining of the junction of the stomach and esophagus or the food pipe or a bleeding ulcer in stomach intestine where emergency endoscopy treatment is done to stop the bleeding.
Women also suffer from lower Gastro Intestinal problems like sudden onset of constipation, hemorrhoids, and anal fissures. Many pregnant women who stress out during pregnancy suffer from inflammatory bowel disease. The problem is characterized by ulcers in the large and small intestine. These were problems in the Gastrointestinal Lumen.
During pregnancy, the Liver, Pancreas and Gall Bladder also show some changes. The Gallbladder becomes sluggish. The liquid that is stored in it can turn into stones and these stones may slip into the tube next to the Gallbladder, called the Bile Duct that opens into the intestine. It may lead to severe jaundice with fever and abdomen pain. It’s a rare and an emergency case in which emergency ERCP is done to save both the baby and mother. I have 20 years of experience in these procedures and also have written many publications on this.
There are some conditions during which the patient could develop a Viral Hepatitis. It could worsen and become a permanent condition if not treated on time, especially Viral Hepatitis E
Benign Recurrent Intrahepatic Cholestasis is a condition which if shows up during first pregnancy may also occur in the second pregnancy.
Why do these conditions appear?
What really happens is that when the baby is growing, the baby’s weight increases, say it grows to 2.6 kgs. The secretions also add weight. So a pregnant woman carries in her abdomen a weight close to 3.5 kgs as she approaches term. This weight in the abdomen creates a sensation and causes pressure on the surrounding organs. As the uterus also increases in itsheight, it presses the stomach causing Acid Peptic disease or GERD. There are a lot of physical changes in the body just as there are hormonal changes.
Are these problems common across all pregnant women or are seen only during certain conditions?
Hyperemesis Gravidarum and Gastroesophageal Reflux are common problems. Others are seen only in 20 per cent of the cases. These conditions are unique to some people and are caused because of genetic component.
These problems last all through the term or only for a few months?
Depends. Vomiting is worse during the first few months and settles down later on in 60 per cent of the cases. So, there is no fixed term. Some problems worsen, some settle down.
How to cope with these problems during pregnancy?
Visit the doctor. When such cases come to gastroenterologists like us, we suggest lighter medicine so as the baby and the mother are not affected adversely.
Can lifestyle changes also cause digestive issues in expecting mothers?
It can. Eating junk food may lead to worsening of the problems. Eating out very often may also lead to bacterial contamination. If one doesn’t eat and sleep on time, it could lead to indigestion. Smoking and consuming alcohol are an absolute no.
What advice would you give to expecting mothers?
Eat a balanced diet, on time. Exercise moderately and do expose yourself to the sun. Remember, pregnancy is not a disease, it’s a state of being which one must enjoy. (Writer is Director & HOD of Interventional Gastroenterology and Liver Diseases at Continental Hospitals)