Gastrointestinal problems in pregnancy

Abstract 

Nausea and vomiting in pregnancy is common but only 5% of women develop hyperemesis gravidarum. They will lose weight and will need admission, intravenous rehydration, anti-emetics and vitamin supplementation. Peptic ulceration is less common in pregnancy. It may be diagnosed by endoscopy and treated with H2 antagonists if simple treatments fail. Constipation is common and if increased fluid intake and increased physical activity are not sufficient there are a number of suitable laxatives that can be used. Haemorrhoids are consequently also common and usually respond to treatment of constipation and local measures. Irritable bowel syndrome is not more common in pregnancy but its symptomatology may be more pronounced. Although antispasmodics and anticholinergics are contraindicated, peppermint oil is safe and effective. Dietary modification and supplementation of the diet with fibre is often helpful, although opiates and loperamide may be more helpful if diarrhoea predominates. Inflammatory bowel disease (IBS) (ulcerative colitis and Crohn's disease) may increase the incidence of miscarriage and relapse is more common in the first trimester and in the puerperium. In general, the risks of untreated disease are greater than the risks of the common medications used to treat IBS. Women must be encouraged to stay on effective medication. There is no identifiable adverse effects of steroid therapy, sulphasalazine or 5-ASA (e.g. mesalazine) in pregnancy. Folate supplementation is necessary with sulphasalazine therapy. New perianal disease is common after episiotomy, however Caesarean section is associated with recurrent disease and fistula formation, therefore Caesarean section is reserved for obstetric indications.

Keywords:  pregnancy , hyperemesis gravidarum , constipation , peptic ulceration , haemorrhoids , irritable bowel syndrome , inflammatory bowel disease

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