Diarrhea
Most cases of diarrhea that occur during pregnancy are caused by the same pathogens or digestive factors that occur in non-pregnant women, which include food poisoning, stomach viruses (gastroenteritis), or digestive disorders that women had prior to pregnancy.
Treatment for diarrhea during pregnancy is also very similar to the general population, but the threshold for seeking medical care is lower. Pregnancy requires a significant amount of extra body fluid, and any loss of this fluid in a short amount of time can cause dehydration and electrolyte imbalance that can affect the health of both mother and baby.
Pregnant women should call their HCP anytime they experience diarrhea, especially with accompanying symptoms such as fever, abdominal pain, cramps, nausea, vomiting, or signs of dehydration (described below).
Note: Although some women may experience diarrhea prior to the start of labor – which could be the result of prostaglandin production – evidence for this is inconsistent. There is very little research to explain gastrointestinal symptoms in early labor, and not all women who go into spontaneous labor experience this symptom.
Background
Diarrhea is a normally short-lived condition in which bowel movements (stool) are frequent, loose, and watery.
Diarrhea during pregnancy is mostly caused by the same illnesses that affect non-pregnant women, to include food poisoning or gastrointestinal (GI) diseases/disorders (“stomach bugs”).
There are very few pregnancy-specific factors that can cause diarrhea. Normally, pregnant women who have diarrhea either contracted food poisoning, a gastrointestinal illness, or are experiencing symptoms related to GI conditions they had prior to pregnancy.
Additionally, pregnancy-related changes in the body usually predispose women to constipation, not diarrhea.
Some women may, however, experience diarrhea near the start of labor, as diarrhea is associated with the production of prostaglandins. However, not all women will experience diarrhea prior to, or during labor; further, the digestive tract tends to slow down during labor.
It is also possible for some women to experience digestive distress due to prenatal vitamins; if this occurs, which should talk to their HCP about either switching brands,or switching formulations.
Bacterial and viral infections commonly trigger diarrhea by causing inflammation in the stomach and intestines (gastroenteritis). These inflamed cells cannot absorb water which leads to loose stool.
Examples of these illnesses include norovirus and rotavirus, as well as various bacteria (E. coli, salmonella) and parasites. Viruses that affect the stomach and intestines are usually erroneously referred to as the “stomach flu". Influenza is a respiratory infection, and rarely cause diarrhea in adults.
Certain antibiotics can cause diarrhea; antibiotics change the type of bacteria in the gut, and this process can sometimes inflame the intestines (usually within 4 to 10 days of starting the medication).
With viruses, food poisoning, or antibiotic use, diarrhea only lasts a couple days (acute). Chronic diarrhea may last for weeks, and indicates another potential underlying disorder such as inflammatory bowel disease, irritable bowel syndrome, Crohn's disease, ulcerative colitis, celiac disease, microscopic colitis, or food allergies.
Most women with these digestive disorders are aware of these conditions prior to pregnancy. However, it is unclear how many women or how often women experience these disorders for the first time during pregnancy, or whether these symptoms would be temporary (goes away after delivery) or permanent.
Note: While lactose intolerance can cause diarrhea, some women who usually need to avoid dairy have reported an improvement in their symptoms during pregnancy (read Dairy).
Signs and Symptoms
Mild cases of diarrhea can cause bloating, gas, abdominal cramps, abdominal pain, loose and watery stool, and strong urges to have bowel movements. Depending on the type of infection or cause, fever, nausea, and/or vomiting may also be present. Severe cases of diarrhea may also include blood and/or mucus in the stool (depending on the cause).
Complications
Dehydration and electrolyte imbalance are the two biggest complications of diarrhea for any individual; these complications may be more severe during pregnancy.
Diarrhea can quickly cause dehydration. Common signs of dehydration include:
Dry mouth/skin
Little to no urine (or very dark, concentrated urine),
Weakness
Sunken eyes or cheeks
Rapid heart rate
Confusion
Irritability
Skin turgor and capillary refill are two methods HCPs may use to quickly determine if an individual is dehydrated during a physical assessment, and some individuals may perform these tests on themselves.
Skin turgor, or skin “tenting” is performed by pinching the skin on the forearm between two fingers and observing how quickly the skin returns to normal (back to flat). Any delay in a return to normal can indicate dehydration. It is recommended these physical signs should not be used alone to determine dehydration, but together with the additional signs and symptoms described above.
Non-pregnant individuals are advised to call their HCP if diarrhea lasts longer than 2 days or signs of dehydration are present. However, pregnant women may become dehydrated quicker and require faster treatment. Women should call their HCP immediately if they have a fever, vomiting, abdominal pain, bloody stool, and/or signs of dehydration. Women with severe diarrhea should not wait two days before calling their HCP if they are also experiencing these symptoms.
Treatment
Most bouts of diarrhea will resolve within a few days with simple fluid replacement:
Plain water
Low-sugar juices
Sports drinks
Broths
Coconut water
Note: High-sugar fluids can make diarrhea worse, while caffeine may worsen dehydration as it can promote fluid release from the body. Solid foods can be added gradually; the types of foods that can be tolerated may vary based on the cause of the diarrhea. HCPs may recommend anti-diarrheal medications or antibiotics in very specific cases.
Pregnant women should never take any over-the-counter medications without calling their HCP as some of these medications can worsen diarrhea, depending on the cause.
An HCP may request a stool sample in severe or chronic cases of diarrhea to determine a potential cause or type of infection.
Women with severe diarrhea enough to visit the emergency department may require intravenous fluids, electrolytes, and/or anti-nausea medication.
Action
Women need to call their HCP if they experience any of the warning signs of dehydration described above.
Women should also call their HCP immediately if they have a fever, or are experiencing vomiting, abdominal pain, or bloody stool.
Low-fiber foods can help relieve diarrhea and ease women back into a normal diet: potatoes, rice, noodles, bananas, applesauce, smooth peanut butter, white bread, chicken or turkey without the skin, lean ground beef, fish, yogurt (some women may need to avoid dairy with a diarrheal illness).
The BRAT diet (bananas, rice, applesauce, and toast) is included in the above. This diet is often recommend because these types of foods are easily broken down and digested, which lets the intestines rest, but also provides an individual the ability to eat without making their illness worse.
Women should avoid greasy, fatty, or fried foods; raw vegetables and fruits; strong spices; and whole-grain cereals and breads (harder to digest).
Women should read Food Safety to learn the proper way to purchase, store, and cook foods to avoid bacterial illness, which usually results in diarrhea and/or vomiting.
To avoid gastrointestinal illnesses caused by different viruses, washing hands often (for at least 20 seconds) is the single best step for avoiding infection.
As stomach viruses are common, especially in families with young children, cleaning and disinfecting sinks, faucets, toilets, and door knobs are also good preventative steps.
Resources
Problems of the Digestive System (American College of Obstetricians and Gynecologists)
Symptoms & Causes of Diarrhea (The National Institute of Diabetes and Digestive and Kidney Diseases)
Diarrheal Diseases – Acute and Chronic (American College of Gastroenterology)