Diarrhea in pregnancy: How normal is it?
I've had severe diarrhea for two weeks. It lessens when I eat only dry toast and soup, but if I eat anything more substantial, I almost immediately have diarrhea. Otherwise, controlling what I eat doesn't seem to help. Could this be a parasite or bacterial infection? Is it related to high hormone levels in during pregnancy?Question:
Most often, diarrhea in pregnancy is a result of the changing hormone levels, predominantly increased levels of progesterone. However, it is not a good idea to characterize this symptom as normal until other things have been ruled out.
Malaria and other tropical parasitic diseases would be an unlikely cause if you have not been traveling outside the U.S.
Salmonella typhi used to be a problem before the advent of antibiotics. Non-typhoid salmonella can cause transplacental infection of a fetus; the maternal symptoms generally would be diarrhea with cramping, fever and abdominal pain -- gastroenteritis symptoms. Salmonella can be cultured from stool.
HELLP syndrome can cause varied symptomatology. Early symptoms/signs include:
- weakness and fatigue
- nausea and vomiting
- right upper quadrant and/or epigastric pain
- changes in vision
- increased tendency to bleed from minor trauma,
- diarrhea, and
- shoulder or neck pain.
This would most likely occur in the second and third trimesters and might be associated with elevated blood pressure, swelling and protein in the urine.
Giardia lamblia is also a frequent cause of diarrhea. Although water remains the most common mode of transmission of Giardia, there has been an increase in the number of person-to-person cases, especially related to children in day care, as well as an increase in food-borne cases. New antigen detection assays have improved the ability to diagnose Giardia in the stool.
If diarrhea continues, sigmoidoscopy can be done even during pregnancy. Conditions that can be diagnosed with this technique include reactivated or newly diagnosed inflammatory bowel disease, bleeding from internal hemorrhoids and other lesions in the colon.
Continued diarrhea is an indication for stool culture at the very least.
This is, of course, a concern because diarrhea causes weakness, dehydration and incomplete absorption of nutrients. If your obstetric care provider is not a help with this, perhaps an internist could provide a second opinion.
I wish you well and hope this resolves.