What causes severe bloating during pregnancy?

Question

Hello doctor,

I am 20 years old, and currently, I am pregnant. I have had constipation issues since birth, but with pregnancy, it has got worsen. In the beginning, I go every few days, but it will be super uncomfortable if it was more than three days. I also have a history of celiac disease and constipation.

I have a super bloated, sick feeling. So I would do an occasional enema and milk of magnesia. But as the pregnancy progressed and constipation got worse, it stopped working. I was told to do stool softeners and Miralax.

It just gets pretty bloated, and I have to use an enema. Eventually, I stopped being able to go on my own. Now for the past few weeks, I have had liquid stools. The doctor says it is not diarrhea because I am 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 preparation to try to cleanse me out.

I had bad gurgles and a 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 was not the only problem. They cannot do imaging on me because of the baby, but they said they could not rule out colon cancer. I have not had any bleeding, my laboratory work looks good, and the pain subsides once I go to the bathroom. But I still will get lower abdominal tenderness to touch off and on. My current medicatations are: Trazodone and multivitamin.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Since you have constipation since birth, there is a possibility of Hirschsprung disease. Second, you might have functional constipation or pelvic dyssynergia. The latter is most likely. The pelvic dyssynergia is basically an incardinated mechanism of passing stool. This can worsen in pregnancy due to pressure of the gravid uterus over the rectum and large bowel.

Since you already used laxatives which would only cause liquefaction of the stools and can lead to spurious diarrhea or false diarrhea. Colonoscopy is not recommended in the pregnancy unless absolutely necessary. You can do two things.

Increase the fiber in your diet, and increase the water intake in a day to 3 liters per day. Take vegetables and fruits.
Biofeedback therapy. This can be performed in the nearby physiotherapy department of the hospital.
Do not use a phosphate-based enema.

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

I hope this helps.

Thank you.