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Diarrhoea in pregnancy

by Peg Plumbo

question
I've had severe diarrhoea for two weeks. It lessens when I eat only dry toast and soup, but if I eat anything more substantial, I almost immediately have diarrhoea. 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 during pregnancy?

answer
Most often, diarrhoea in pregnancy can be as a result of the changing hormone levels - predominantly increased levels of progesterone. However, it is not a good idea to characterise this symptom as “normal” until other things have also been ruled out.

Malaria and other tropical parasitic diseases would be an unlikely cause unless, of course, you have recently been travelling outside the UK on holiday in some exotic far-off place. Seek your GP’s advice if this is a possibility.

Salmonella typhi used to be a problem before the advent of antibiotics. Non-typhoid salmonella can cause infection of a foetus by toxins crossing the placental barrier. The maternal symptoms generally would be diarrhoea with cramping, fever and abdominal pain. In other words, the symptoms of gastroenteritis. Salmonella can be cultured and identified quite easily from stool samples, and this might be necessary.

Giardia lamblia (Giardiasis) is also a frequent cause of diarrhoea. Infection is within the small intestine. A parasite that can be ingested from contaminated food. It is a worldwide disease, particularly common in children. 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 diarrhoea continues, sigmoidoscopy (an outpatient investigation of the large bowel) can be done quite safely, even during pregnancy. Conditions that can be diagnosed with this technique include reactivated or newly diagnosed inflammatory bowel disease, bleeding from internal haemorrhoids and other lesions in the colon (the large, lower bowel).

Continued diarrhoea is certainly an indication for stool culture at the very least. This is, of course, a concern because diarrhoea causes weakness, dehydration and incomplete absorption of nutritious agents into the system.

I wish you well and hope this resolves very quickly.

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