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Q. There was diarrhea followed by constipation in pregnant woman. Why?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Divya Banu M
This is a premium question & answer published on Aug 01, 2020

Hello doctor,

I am a 34-year-old woman, currently 22 weeks pregnant.

Yesterday, I had an episode of sudden diarrhea (with mild-moderate cramping). It was an isolated episode, I only went to the toilet once. Today I am completely constipated. However, I feel an unpleasant discomfort above my belly button, around the colon area. It is almost like a fullness/pain/indigestion feeling. The abdomen is also more swollen than usual in the upper side. Otherwise no fever, headache, muscle pain, etc.

I am a bit worried about listeria- can this be it? Or do the symptoms suggest a more benign cause? I know listeria is dangerous in pregnancy and that is why I worry. I normally stay away from uncooked food but a week ago I did eat a burger that was slightly pinkish on the inside. I also sometimes eat salads that I do not prepare (like from restaurants). I have done this for many years and never had any serious issues. I also do not have antibodies to Toxoplasma (tested twice during this pregnancy and testing every month), but I doubt it would have diarrhea and gastric discomfort as the main symptoms with that. Is that right?

Also, what should be my course of action? What should I eat/not eat? Should I test for Listeria antibodies or wait to see if I develop more symptoms or if this goes away? Please let me know your opinion.

Dr. Ajeet Kumar Lohana

Medical Gastroenterology
#

Hello,

Welcome to icliniq.com.

Well your concern is quite genuine, but I think given one day of diarrhea followed by constipation, and given no other systemic symptoms like muscle pain, fever, joint pains, favor against the diagnosis of listeriosis. But as you rightly pointed out the different foods from retailers, frozen meat, salads are well recognized source of Listeria infection. You should be very cautious about this next time. As such there are no limitation of foods you take, but just make sure whatever you take is well cooked, preferably home cooked; salads washed with plenty of water, and crockery washed with chlorine based cleaners. Most market available detergents/cleaners usually contain chlorine but you can check at the store as well.

Your symptoms most probably seem to be secondary to pregnancy induced physiological changes of the gastrointestinal tract. Since with excessive pressure of the gravid uterus, it can cause compression of almost every part of the GIT namely the stomach, small bowel, and large bowel. So it is not uncommon to have symptoms of indigestion, bloating, burps, constipation in pregnancy. The symptoms of diarrhea however are uncommon in pregnancy, but are also reported. The possible mechanism underlying diarrhea is bowel wall swelling due to accumulation of water- which is otherwise a common in pregnancy as you also have felt water collection over feet.

Yes you are right, toxoplasmosis does not cause that type of symptoms. Further, it is alright to have vitamin supplements in pregnancy, but magnesium, particularly as daily supplement should be avoided. This can cause some cramps and diarrhea because of its irritant action over bowel loops. I want you to share with all your blood reports that you have 1 week ago, just to do a second check, in order to be ensured that we are in right direction.


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Hi doctor,

Thank you for your helpful and detailed response. I have attached my latest blood test results. The cholesterol is now higher than my typical normal (170-180), but from what I understand it is related to being pregnant.

Dr. Ajeet Kumar Lohana

Medical Gastroenterology
#

Hello,

Welcome back to icliniq.com.

Thanks for providing me reports of the tests (attachment removed to protect patient identity). Yes, you are right. Your all blood tests are unremarkable. The cholesterol is expected to sway in pregnancy, but that is some thing that you can ignore for a while. Particularly since your earlier cholesterol levels within normal ranges.

Finally, you see I have been able to read Latin though. I could have not thought that ever in my life. I think you can just follow normal precautions that everybody should do. No added precautions except about foods and magnesium supplements which I already discussed with you.

For constipation you can temporarily use Miralax (Polyethylene glycol 3350) sachet 17 gm once with water whenever you feel constipation is causing you trouble. This is Class B laxative drug which is safe to be given in pregnancy. It has no reported adverse effects as of now in pregnancy. Take a good care of yourself. Let me know if you have any other concern in future, I will be glad to answer that.


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