What is diarrhea?
Diarrhea is the frequent excretion of feces at an abnormally high frequency and in liquid (or mostly liquid) form. During pregnancy, diarrhea can be due to inflammatory bowel disease (IBS; includes Crohn’s disease and ulcerative colitis), food poisoning, deficiencies of enzymes, or celiac disease. IBS is a common disorder of gastrointestinal function that can result from a variety of abnormalities that are generally minor, as they are not connected with any anatomic problems, inflammation, or other disease processes. Diarrhea also can be a side effect of several different types of medications, including antibiotics.
How common is diarrhea during pregnancy?
Most pregnant women will experience some kind of gastrointestinal discomfort during pregnancy. Occasional diarrhea is one of the most common types of gastrointestinal discomforts.
How is diarrhea diagnosed?
Diarrhea is not a medical condition, but rather a symptom. If your diarrhea is frequent enough, or lasts long enough, to be a problem, you would be sent to a specialist (a gastroenterologist) to evaluate you for several different diseases, such as IBD, serious gastrointestinal infections, genetic disorders affecting the digestive tract, and cancers. The various workups generally include blood tests and several types of imaging. Specialized tests may be conducted to determine if you have minor enzyme deficiencies, such as a lactose deficiency (inability to digest milk sugar), which is part of a larger category of intolerances called fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) intolerance, for which there are also tests. If it is suspected that you may have celiac disease, a condition resulting from an inappropriate reaction of your immune system to a set of proteins called gluten, you can be tested with a biopsy of your small intestine. The biopsy is obtained through a procedure called endoscopy.
Does diarrhea cause problems during pregnancy?
In addition to making you extremely uncomfortable, diarrhea can dehydrate you, which can lead to low blood pressure, fainting, and problems with the heartbeat. If your diarrhea is due to a food poisoning organism, such as Salmonella, there is a slight chance that the womb can become infected. Diarrhea also can aggravate hemorrhoids, which are provoked by pregnancy. Also, if your diarrhea comes at night, this could lead you to go to sleep later than planned. Combined with a schedule that requires you to wake early in the morning, this can lead to inadequate sleep.
Does diarrhea during pregnancy cause problems for the baby?
There is some concern that dehydration from diarrhea and disturbances in pH and electrolytes can affect the developing baby in negative ways. Fever, which can develop as a result of food poisoning, can cause problems for the baby. There is some concern that fever during pregnancy can increase a babys risk of having congenital defects involving the heart and other organs.
What to consider about taking medications when you are pregnant:
- The risks to yourself and your baby if you do not treat the diarrhea
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat diarrhea during pregnancy?
There is a multitude of conditions that can cause diarrhea, each of which has particular medical treatments. In the case of food poisoning, generally, the treatment for diarrhea is supportive. You need to stay hydrated by drinking plenty of liquids and obtain some nourishment though bland foods and broth. If you are unable to stay hydrated by drinking, you can be hospitalized and hydrated through fluids given intravenously. Usually, the only needed medication is acetaminophen or paracetamol to bring down your fever. In the case of IBS, treatment is symptom by symptoms, which can involve some medications. Cramping in the digestive tract is treated with medications called antispasmodics. Certain anti-depressant drugs, such as amitriptyline and fluoxetine may also be used. The way that these drugs fit in with pregnancy is that their safety for the developing baby has not been proven, but theres no clear indication that theyre harmful either, so they can be used in certain cases, namely when the patient shows that her symptoms improve dramatically with them.
The drug loperamide given for diarrhea is very safe for the developing baby because it is not absorbed from the intestines into the bloodstream, so there is no way that it can reach the baby in the first place. Some concern, however, surrounds an anti-diarrheal drug called alosetron, so if loperamide works for you this is the drug of choice against diarrhea. Theres another anti-diarrheal drug called eluxadoline, which works like loperamide, but its safety issues in pregnancy have not been studied widely.
Finally, laxatives also are used for IBS, particularly a type of laxative called an osmotic laxative. These work by drawing water into fiber to add bulk to stool, which helps both against diarrhea and constipation.
Who should NOT stop taking medication for diarrhea during pregnancy?
In most instances of diarrhea, medications are often not necessary but can make you more comfortable. This is the case with occasional bouts of diarrhea, and with IBS. On the other hand, if your diarrhea is due to IBD, there are a host of medications that will be part of a treatment plan, and its likely that your medications will have to continue.
What should I know about choosing a medication for my diarrhea during pregnancy?
You may find Pregistrys expert reports about the individual medications to treat diarrhea here. Additional information can also be found in the sources listed at the end of this report.
What should I know about taking a medication for my diarrhea when I am breastfeeding?
Some of the agents used in IBS, particularly loperamide and osmotic laxatives, are thought to be very safe as they never are absorbed from the mothers digestive tract.
What alternative therapies besides medications can I use to treat my diarrhea during pregnancy?
If your diarrhea is part of IBS, or due to an intolerance to FODMAPs, including lactose, dietary approaches can be helpful. Adequate intake of fiber and fluids, assessment of the effects of spicy or fatty food and reduction of these foods can alleviate symptoms, as can reductions in caffeine and alcohol. A diet low in FODMAPs
should be attempted for a minimum of 3-4 weeks under dietitian guidance. A low, or no, lactose diet also should be attempted. With the dietary approaches, its basically trial and error. Certain approaches work for some people and not others. In the case of IBS, symptoms also tend to improve with regular aerobic exercise, plus there are psychological therapies that can be helpful.
What can I do for myself and my baby when I have diarrhea during pregnancy?
Maintain adequate hydration by drinking plenty of liquids. See your doctor if you develop a fever or you find blood in your stool, as this can represent a condition more serious than IBS.
Resources for diarrhea in pregnancy:
For more information about diarrhea during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:
Mayo Clinic: Diarrhea: Symptoms and Causes
Cleveland Clinic: How to Prevent Diarrhea While You Take Antibiotics