Simple Lifestyle Changes Can Ease GI Upset During Pregnancy
By Marge Dwyer
Beth Israel Deaconess Medical Center Correspondent
Five weeks after learning she was pregnant, Leah Diskin began feeling "pretty wretched." She hoped it would soon pass but the nausea and stomach pains kept getting worse. "I remember sitting on the couch all night, feeling unbelievable pain inside, just waiting for morning to come so I could go to the doctor," recalls the Jamaica Plain woman.
When she went to see
Dr. Jacqueline Wolf, a gastroenterologist (digestive system specialist) in the Division of Gastroenterology at Beth Israel Deaconess Medical Center in Boston, Leah learned she had a rather extreme form of gastroesophageal reflux disease (GERD) or heartburn. She learned GERD, along with nausea, are among several gastrointestinal (GI) conditions common in pregnant women. For Leah, it occurred in both of her two pregnancies.
"I remember trying to sleep on all sorts of pillows. I had my bed propped up on blocks so my head was higher than my stomach," she recalls. She spent weeks lying on the couch, having her husband bring her meals. Her doctor recommended changes in her diet. Crackers helped the nausea but getting the right amount of fiber was a challenge. She tried several over-the-counter medications that didn't work, so Dr. Wolf prescribed several medications that helped.
"Luckily, as soon as I gave birth, the GERD went away. It was like magic," she says. Her two daughters, now 4 and 7, were not adversely affected in any way. Her strong desire to have children really helped her through the discomfort. "I really wanted children. I would have walked on hot coals for them," she says.
Pregnancy is a time of excitement and joy for many pregnant women, but it also can bring some annoying GI problems. Morning sickness, constipation, hemorrhoids and heartburn are on the list. Fortunately, most are temporary inconveniences on the road to having a healthy baby. In the meantime, your health provider can suggest simple changes in your diet and lifestyle that can help.
"During pregnancy the small and large intestines with the appendix get moved about by the expanding uterus," Dr. Wolf says. "While there are many things you can do at home to feel better, the bottom line is that you should talk to your doctor if your symptoms are increasing in severity."
Among the conditions that Dr. Wolf and her colleagues frequently see in pregnant women are:
Gastroesophageal reflux disease (GERD): "About 40-80 percent of pregnant women experience this condition in which stomach acid or bile backs up into the esophagus (the tube connecting your throat to your stomach). The result can be a burning sensation in the chest (heartburn), food backing up in your throat, an acid taste in your mouth, nausea or pain at the base of the breast bone. "The good news is that while symptoms can be severe, this condition rarely is associated with serious pregnancy complications. Usually within a few days of delivery it goes away," Dr. Wolf says. If GERD persists, it's important to follow up with your doctor.
It is unclear why one-third of pregnant women who experience GERD do so in the first four months of pregnancy, when the uterus is not pressuring other organs. Perhaps the "high pressure zone" in the esophagus that keeps food down in the stomach relaxes earlier in these women. "We don't completely understand why this happens. It may be due to hormonal changes or delayed emptying of the stomach," Dr. Wolf says.
Among simple changes that can help:
- Stay away from triggers like garlic, onions, alcohol, mints, coffee and other caffeine containing foods, including chocolate.
- Avoid fatty foods, like whole milk, that can delay stomach emptying.
- Eat smaller, more frequent meals.
- Don't eat within three to four hours of bedtime.
- Elevate the head of your bed.
- Bend your knees to pick something up off the floor instead of bending over.
If these tricks don't work, you can try over-the-counter antacids. Over the counter H2 blockers (acid reducers) like ranitidine and famotidine also are safe. If you're still having problems, your health provider may prescribe other medications.
Nausea and vomiting: About 70-80 percent of women develop nausea and vomiting (morning sickness) in the first trimester. It can occur at any time of the day - not just in the morning. For 90 percent of women it goes away by the 22nd week. "But that means it persists for 10 percent of all pregnant women," Dr. Wolf says.
Sometimes nausea is triggered by smells -like fish or garlic. "Some women eat only foods that appeal to them and end up with a limited diet," she says. But luckily this usually passes. Excessive vomiting, however, can be serious as it can deplete nutrition for the mother and baby. Intravenous (IV) nutrition and other interventions may be required.
As with GERD, you can manage nausea by eating small, frequent meals and avoiding fatty foods. "Studies have shown consuming ginger helps," Dr. Wolf says. One study showed Vitamin B6 helpful in small daily amounts. If you are having trouble holding down food, sports drinks and soups containing salt (sodium) may help. If that works, you can gradually add starches like pasta and crackers, then lean protein like fish or chicken.
Constipation: Difficulty having a bowel movement is common among pregnant women. Causes include not drinking enough fluids or eating too much or not enough of certain fibers. Pressure from the expanding uterus on the colon can make bowel movements more difficult. Increasing physical activity, however, can help keep the bowels moving.
How is constipation treated? First, add fluids and fiber to your diet in the form of flaxseed or over-the-counter products like guar, inulin, psyllium or methylcellulose. Propping your feet up (to straighten the colon) when you are on the toilet may help. If these measures don't work, your doctor may recommend certain laxatives, like mineral oil. It's important to check with your doctor before taking a laxative because some, such as castor oil, are unsafe for pregnant women.
Gas: This common complaint of pregnant women may be due to drinking more milk and being lactose intolerant. "If you reduce your intake of milk and add calcium and vitamin D or switch to soy milk, it may help," Dr. Wolf says. Avoiding gas-producing foods like legumes (beans, peas, lentils and more), or taking Beano before a meal can help. Staying away from products that contain protein gluten (such as wheat, barley and rye found in bread and other baked goods) also can bring relief to some women. Luckily, over-the-counter anti-gas products made from simethicone seem safe for women who are expecting.
Hemorrhoids: As a result of pushing during delivery, many women have the annoying condition of hemorrhoids. What to do? Dr. Wolf suggests:
- Keep the stools soft, using a topical numbing substance, a steroid cream or Tucks pads that contain witch hazel to shrink swelling.
- Soak in a warm tub.
- Avoid straining when going to the bathroom.
- Eat regular fiber.
- Add a small amount of mineral oil to your diet as long as you're not having GERD.
"Most hemorrhoids go away on their own and heal up. "We don't recommend doing anything if they heal up," she says.
Other GI conditions: For tips on dealing with Inflammatory Bowel Disease or Crohn's disease during pregnancy, click here. (link to Pregnancy and Crohn's disease story.)
To schedule a consultation with the experts in the Division of Gastroenterology at Beth Israel Deaconess Medical Center, call (617) 667-2135.
Above content provided by Beth Israel Deaconess Medical Center.
For advice about your medical care, consult your doctor.
Posted March 2009