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Q. My constipation problem has gotten worse during pregnancy. Please help.

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Aug 17, 2020
I am 20 years old and currently pregnant. I’ve had constipation issues since birth, but with pregnancy, it’s gotten worse. In the beginning, I’d go every few days but be super uncomfortable if it was more than three. Super bloated sick feeling. So I would do an occasional enema, and milk of magnesia. But as the pregnancy progressed and constipation got worse, MOM stopped working. I was told to do stool softeners and Miralax, and nothing. I’d just get pretty bloated. And have to use an enema. Eventually I stopped being able to go on my own. Having to do an enema every 3 or 4 days or so. And it was all constipated hard lumps. But I’d feel immediate relief. Now for the past few weeks, I’ve had liquid stools. The drs say it’s not diarrhea because I’m not going multiple times a day, and having spasms. I can only get it out with the enema. So they thought it was a fecal impaction. They had me do a colonoscopy prep to try to cleanse me out. I had bad gurgles and distended stomach but still could not go on my own. When I did the enema, it cleared out some harder stools and the rest was liquid. But I am scared that wasn’t the only problem. They can’t do imaging on me because of the baby, but they said they can’t rule out colon cancer. I haven’t had any bleeding, my lab work looks good and pain subsides once I go to the bathroom. But I still will get lower abdominal tenderness to touch off and on, I have the constipation or liquid stools, and can’t go naturally. I’m worried what this could all mean and if it might be colon cancer

More details about the presenting complaint:
Constipation for whole life, stomach pains and severity of it more recent since pregnancy

Previous history of the same issue:
Celiac disease, and constipation whole life

Current medications:
Trazodone, and multi vitamin

Lab tests performed:
Normal blood tests

Dr. Ajeet Kumar Lohana

Medical Gastroenterology

Hello. I welcome you to icliniq.

Well there are few possibilities here.

Since you have constipation since birth, there is possibility of Hirschsprung disease.

The Second you might have functional constipation, or pelvic dyssynergia. The later is most likely. The pelvic dyssynergia is basically an incordinated mechanism of pooping. This can worse in pregancy due to pressure of gravid uterus over the rectum and large bowel. Since you already used laxatives which would only cause liquification of the stools and can lead to spurious diarrhea /false diarehea.

Colonoscopy is not recommeded in the pregnancy unless absolute neccessary. You can do two things.

  1. Increase the fiber in your diet, and increase the water intake in a day to 3 liter per day. take vegetable and fruits.
  2. Biofeedback therapy. This can be performed in near by physiotherapy dept. of hospital.
  3. Do not use phosphate based enema.
  4. also do not use MOM. both not suitable in preg.

You would need some testing but let the pregancy go on safely. Let me know if you have some basline investigations in the pregancy? like thyroid, complete blood count, and liver function tests? if already done, upload the tests. Otherwise it is wise to get them tested.

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