Diarrhea during pregnancy in the second trimester: causes and treatment

Causes and symptoms of diarrhea during pregnancy

Infectious.

The cause of intestinal dysfunction can be bacterial and viral infections (for example, norovirus or rotavirus). They are usually transmitted through the air or the fecal-oral route. Pathogenic microorganisms also often enter the gastrointestinal tract when consuming low-quality foods or contaminated water. Infectious diarrhea during pregnancy in the second and third trimester may be accompanied by fever, chills, nausea and vomiting, painful abdominal cramps, and general weakness. An admixture of mucus often appears in the stool.

Non-infectious.

This form of diarrhea can be caused by a variety of factors: changes in diet, frequent stress, disturbances in the processes of digestion and absorption, certain chronic diseases, and taking certain medications. In this case, the pregnant woman may be bothered by frequent bowel movements (sometimes with imperative, i.e., strong, irresistible urges), abdominal pain in the upper or lower section. With organic lesions of the colon, an admixture of blood sometimes appears in the stool. In later stages, disturbances in the frequency of bowel movements may be associated with fetal pressure on the gastrointestinal tract.

Up to contents

Causes

Despite the normalization of the pregnant woman’s well-being in the second trimester, the causes of diarrhea can be not only pathological, but also physiological. The presence of pathology always entails a number of complications harmful to the fetus and mother. Physiological causes are usually harmless, but they can have a negative effect on the body and cause great discomfort to the woman.

Physiological

A woman’s physiology in the second trimester of pregnancy undergoes changes associated with hormonal changes and mental disorders. In this regard, loose stool appears, which is secured with special means.

Physiological causes of diarrhea:

1. During hormonal changes in the blood fluid, the level of the hormone progesterone increases, which stimulates the secretion of gastric juice and relaxes intestinal motility.
2. Changes in psycho-emotional state due to hormones. In this case, there is excessive lability of the nervous system, which makes the woman irritable, whiny and even aggressive. The girl is subject to severe excitement, anxiety and stress, which leads to hyperactivity of nerve endings in the intestines and increased mobility. As a result of these chemical defense reactions, the body expels excess material and speeds up digestion, which contributes to diarrhea.
3. During pregnancy, a woman's diet changes and the amount of food consumed increases. Unfamiliar foods and overeating contribute to thinning stools. This is due to the fact that the stomach does not have time to digest food, and the process of its absorption slows down (when eating new food).
4. Decreased immunity, especially if the girl does not eat enough vitamins and microelements (need 2-3 times more than before pregnancy, since beneficial substances are redirected to the fetus).
5. In the second trimester, the fetus actively develops and grows, and therefore the uterus increases in size. As a result, unusual pressure occurs on the pelvic organs, which causes dyspeptic reactions.
6. Diarrhea occurs with uncontrolled and excessive consumption of vitamin-mineral complexes.

Pathological

If loose stools are present for a long time, and in addition unpleasant symptoms appear, then one can speculate about the pathological nature of the origin of diarrhea.

1. If a woman has a chronic disease that is aggravated by diarrhea because the body becomes weaker in the second trimester.
2. Poisoning with low-quality or expired food products, chemicals, etc. In this case, the person not only vomits, but also other symptoms appear - dizziness, pain, weakness.
3. Infection of the body with bacteria and viruses. The reason is non-compliance with hygiene rules, infection by a sick person, insufficient heat treatment of food, and the like.
4. Dysbacteriosis due to the use of antibacterial drugs, as a result of which the balance of bacteria in the microflora of the gastrointestinal tract is disrupted. Features of manifestation - flatulence, flatulence, pain, undigested food particles in the stool, frequent gas discharge.
5. Diseases of the gastrointestinal tract - pancreatitis, ulcerative colitis, gastritis, irritable bowel syndrome, etc. The main symptoms characteristic of all pathological disorders in the gastrointestinal tract: pain, spasms, flatulence, the formation of mucus or blood clots in the stool.
6. Infection with worms is manifested by itching in the anus, increased body temperature, alternating diarrhea and constipation, belching, weight loss, and increased appetite.

In addition to the above, diarrhea in the second trimester is caused by the following reasons (less commonly):

• Deficiency of important enzymes - diseases of the pancreas, urinary system and gall bladder;
• Allergic reaction to gluten and lactose;
• Flu with viral infections of the stomach and intestines;
• neoplasms of a malignant or benign nature;
• Overproduction of hormones, diabetes and other endocrine disorders;
• enteritis, enterocolitis;
• trauma, surgery;
• consumption of alcoholic beverages.

Diagnostic features

When diagnosing the disease that caused diarrhea, it is important to exclude surgical, urological and obstetric pathologies. To do this, an examination is required; if necessary, the doctor prescribes additional examination. Diarrhea in the early stages can be a manifestation of ectopic pregnancy, appendicitis, urinary tract infections, pyelonephritis, inflammatory bowel diseases, acute pancreatitis. That is why it is important to promptly establish the cause of intestinal dysfunction and select adequate therapy. Monitoring (monitoring) of the condition of the fetus at 37, 38 and 39 weeks of pregnancy is also mandatory.

Up to contents

Why is diarrhea dangerous in the second trimester of pregnancy?

Diarrhea is always dangerous, and even more so in the second trimester of pregnancy, as there are a number of complications that can lead to the death of the fetus and mother.

For woman

What are the consequences for the mother:

1. In the early stages of the second trimester, there is a risk of pathological abnormalities in the functioning of the liver and pancreas.
2. Feeling worse, toxicity returns.
3. The swelling increases.
4. Due to contractions and increased peristalsis, the risk of miscarriage and premature birth increases.
5. Pregnancy is weakening.
6. Dehydration of the body is fraught with the leaching of useful substances from a woman’s body, as a result of which the immune system is weakened and the functionality of all internal organs is disrupted. Against this background, blood circulation slows down, which contributes to the formation of blood clots. Lack of fluid leads to failure of the central nervous system, problems with muscles, ligaments and joints. Violation of water-salt balance slows down metabolism.

As a result, women experience contractions, impaired coordination of movements, decreased mental performance, vitamin deficiency, decreased blood pressure, and increased heart rate. Consequences: heart disease, cardiovascular disease and death.

For the fetus

What can happen to the fetus with diarrhea in the second trimester:

• oxygen starvation (hypoxia);
• intrauterine trauma, umbilical cord entanglement (caused by a decrease in the amount of amniotic fluid);
• Delayed fetal development (due to deficiency of minerals and vitamins);
• Infection of the embryo, leading to future congenital anomalies and pathologies;
• Death of the fetus.

Consequences of diarrhea in the early stages

Prolonged diarrhea can lead to dehydration, a condition that is dangerous for both the expectant mother and the fetus. It is manifested by severe weakness, dry mucous membranes, and thirst. Severe dehydration may affect cardiac and respiratory function. Diarrhea can also, in some cases, increase the risk of miscarriage due to increased contractile activity of the uterus and can lead to disruption of uteroplacental blood flow.

Up to contents

Directions of treatment

The doctor must decide how to treat diarrhea, taking into account the woman’s condition, the cause of indigestion, the duration of pregnancy and other factors. Typically therapy includes the following areas.

Up to contents

When is hospital treatment required?

It is not always possible to treat a disease accompanied by diarrhea at home. In case of severe dehydration, risk of miscarriage, or severe concomitant diseases, the doctor may suggest that the pregnant woman go to the hospital. This measure allows for constant medical supervision, which in such cases is often simply necessary. Urgently seeking medical help and emergency hospitalization may be necessary if:

• severe abdominal pain of any localization;
• blood in stool;
• general lethargy.

The standard clinical indications for inpatient treatment are moderate to severe diarrhea accompanied by dehydration. It is also necessary to go to the hospital if therapy at home for 3-4 days does not produce results (the pregnant woman does not get better, symptoms persist).

Important! Even in an outpatient setting, treatment of conditions accompanied by diarrhea should be carried out under the supervision of a physician.

Up to contents

Alarming symptoms

If the diarrhea is not accompanied by other symptoms and it goes away within 2 days, don't worry. But there are a number of warning signs, and if they are present, you should visit a doctor:

• sudden urge to defecate;
• too much fluid, profuse and frequent diarrhea;
• pain in the lower abdomen during defecation;
• General malaise, weakness, drowsiness;
• the presence of foam, mucus, blood, purulent exudate or undigested food in the stool;
• unpleasant odor;
• high body temperature;
• abdominal cramps;
• Change in stool color.

Diet

When treating diarrhea, it is very important to adjust your diet to reduce the load on the digestive tract and help the body cope with the problem faster. In case of intestinal dysfunction, accompanied by frequent bowel movements, spicy, sour, and fatty foods are excluded from the diet. If you have an intestinal disorder, you should not consume whole milk, fresh fruits and vegetables, legumes, sweets, spices, or smoked snacks. Liquid, semi-liquid, pureed and steamed foods are allowed. They should be served warm, but not hot or cold. In the first days of infectious diarrhea, experts may recommend following a fasting diet. Then rice water and liquid porridge made from oatmeal or buckwheat are introduced into the diet.

Up to contents

Treatment

The therapeutic approach is based on preventing dehydration, restoring water, salt, vitamin and mineral balance, normalizing digestion, microflora, peristalsis and motility, eliminating unpleasant symptoms and causes of pathological diarrhea. Adjusts the diet, prescribes medications, uses folk remedies.

Drugs

The doctor must prescribe specific treatment depending on the cause of diarrhea (in each case, different groups of drugs are used). To eliminate diarrhea and associated symptoms, the following measures are used:

1. Enterosorbents are necessary to restore digestion. In the second trimester, drugs such as activated carbon, Enterosgel, Smecta are allowed, which additionally remove toxins from the body.
2. To normalize disturbed microflora, pro and prebiotics are used: Linek-s, Bifidumbacterin, Acipol.
3. To relieve vomiting and nausea, drugs based on the substance domperidone are prescribed: Motilak, Motilium, Passazhix, Motizhekt.
4. For the same purpose, drugs based on metoclopramide are used: Perinorm, Reglan, Cerucal, Metamol.
5. In order to strengthen the immune system, immunomodulatory drugs are used, which additionally have antiviral properties: Cytovir, Isoprinosine, Cycloferon.
6. Antibiotics are not prescribed to suppress pathogens (only in cases where the benefits of taking them outweigh the risks), but antiseptic drugs can be used: Stopdiar, Ecofuril, Ersefuril, Enterofuril.
7. If the body temperature is high, aspirin or paracetamol will suffice.

Restoring water-salt balance

The procedure for restoring water-salt balance is to treat dehydration of the body, since dehydration leads to the most dire consequences. This is the first thing you should do (even at home).

In the second trimester of pregnancy, the following solutions are most often used:

1. Regidron. The product based on chlorine, potassium and glucose is completely harmless to the fetus. An additional effect is the elimination of muscle weakness, restoration of psycho-emotional background and electrolyte balance.
2. Normohydron normalizes metabolism and relieves pain.
3. Reozolan is used during pregnancy because it contains only salt compounds that eliminate nausea and vomiting.

Rehydration solutions should be taken throughout the day, 1 tbsp every 7-10 minutes. Before preparing the liquid, warm the water slightly to above room temperature.

If you don’t have such products at hand, you can use the recipe of our ancestors and prepare a saline solution:

2

• Add 2 tablespoons of sugar to 1 liter of boiled warm water;
• add 1 tablespoon table salt (if you are using extra salt, add a little less);
• Take half a glass several times a day (usually after each bowel movement).

You can drink no more than 2 liters of solution per day.

2

2

Diet

The diet of a pregnant woman with diarrhea should be based on easily digestible animal protein, since the diet is required sparingly. The following rules must be strictly adhered to:

• Small meals - 6-7 times a day;
• Food should not be hot or too cold;
• The food is mostly boiled or steamed;
• Fried and fatty foods should be avoided;
• on the first day of diarrhea, it is better to refuse food, but this is undesirable for the fetus, so a woman should eat food in minimal quantities;
• on the second day, porridge is introduced into the diet;
• With successful treatment, the woman can eat fruits and low-fat dairy products.

What is prohibited:

2

• Boiled meat broths;
• Fatty meat, fish;
• raw eggs;
• strong coffee, tea;
• cake;
• freshly baked white bread;
• sweets;
• cold cuts, sausages;
• canned food;
• semi-finished products;
• raw fruits and vegetables;
• sauces, pickles.

What you can eat:

2

• Cooked lean meat or fish;
• oatmeal - rice, wheat, oatmeal;
• Vegetable soup;
• From fruits - bananas, pears, quince, pomegranates;
• crackers and unsweetened cookies, such as graham crackers;
• baked jacket potatoes;
• heat-treated pumpkin.

Folk remedies

Traditional medicine preparations do not harm the body; on the contrary, they saturate the body with useful substances, as they are prepared from components of natural origin. In the second trimester of pregnancy, when the fetus is not yet fully formed, prescriptions should be handled with extreme caution and only after obtaining the doctor's consent.

2

2

What is allowed for use:

2

1. A decoction of rose hips strengthens the immune system and binds stool. Brew in the usual way, like regular tea.
2. Blackberry leaves also contain a huge amount of vitamins. For a glass of boiling water you need 1-2 tablespoons of dried water.
3. Peppermint tea - a few leaves of the herb per 200 ml of water.
4. Potato starch is used. You will need a glass of boiled warm water, 1 tablespoon of starch. Mix the mixture thoroughly and drink throughout the day.
5. Boil blueberry, pear and banana jelly.
6. Rice water is the best option. Take 2-3 tablespoons of rice cereal per liter of water, cook for 20-25 minutes and let it brew. Then strain and drink 100 ml of infusion throughout the day.

Is it possible to use IMODIUM® Express in early pregnancy?

IMODIUM® Express is an antidiarrheal drug in the form of lozenges. The active substance of the drug is loperamide, which has no data on its teratogenic or embryotoxic effects. However, the drug cannot be used at any stage of pregnancy. According to the instructions, use is not allowed in the first trimester and during breastfeeding1. In the second and third trimesters, IMODIUM® Express can only be taken on the recommendation of a doctor1. An antidiarrhea drug is prescribed only if the expected benefit to the woman outweighs the risk to the fetus. Before use, you should consult a specialist and read the instructions.

The information in this article is for reference only and does not replace professional advice from a doctor. To make a diagnosis and prescribe treatment, consult a qualified specialist.

1 According to the instructions for medical use of the drug IMODIUM® Express.

* Among products based on Loperamide. Based on sales in money for February 2021 - January 2021, according to IQVIA (from English IQVIA).