Digestive system undergoes changes in pregnancy

Some women are fortunate enough to breeze through their pregnancies; ‘glowing’ and feeling fabulous. Unfortunately, that is not true for everyone. The list of pregnancy complaints is long but each is, for the most part, a mild and quite normal part of pregnancy.  

There are good reasons for the many discomforts you may experience. In addition to the physical stress of simply carrying a growing baby, some pregnancy hormones change the way your body works. The levels of two hormones in particular - progesterone and relaxin - gradually increase during your pregnancy. 

They work to make your muscles, ligaments and vessels soften so they can stretch. They allow your stomach, intestines, bladder and many other organs in your body to move and accommodate your baby. It is the softening and stretching of these parts that also cause many of the changes and discomforts women experience in pregnancy.

Because the risks of most medications in pregnancy are not known, they are generally not recommended as the first line of treatment for mild discomforts. It’s good to know then, there are some effective, non-medical options available. Good nutrition, hygiene and regular gentle exercise will go a long way to prevent or alleviate many of these symptoms.

This article looks at the following changes that affect your digestive system:

• bleeding gums
• constipation
• haemorrhoids (piles)
• indigestion or heartburn
• nausea.

Also read about the aches and pains associated with pregnancy and about how pregnancy affects your skin.

Bleeding gums

Bleeding gums can have a number of causes. The most common - pregnancy gingivitis - is caused by hormonal changes that affect the blood vessels, making them more spongy and prone to leaking. It used to be said that a woman loses a tooth for every child she had. Luckily, that is not true these days, as long as you use good basic dental hygiene practices. It is important to address bleeding gums promptly with regular gentle brushing and daily flossing. 

Left alone, gingivitis can progress to a more serious condition called periodontitis, which affects the underlying bone and supportive tissue. It is this that would cause you to lose a tooth. In addition, women with periodontitis have been found to be more likely to have their baby prematurely. 

Watch the everybody Human Atlas Movie on Gingivitis.

Bleeding gums could also be caused by anaemia (low iron levels in your blood) - a common complaint in pregnancy - or, rarely, other blood disorders such as von Willebrand's disease, which makes you prone to bleeding because of your blood not clotting properly.

Another possible reason for bleeding gums could be the presence of a benign (non-cancerous) skin growth called a pyogenic granuloma. Starting small and growing to an average of 2cm in diametre, this red, brown or blue-black growth is rare. It generally disappears once the baby is born. If not, it is possible to have it removed. 

• Good oral hygiene practices are very important in pregnancy - brush and floss regularly.
• Maintain a diet rich in iron and vitamin C.
• See your dentist if regular brushing and flossing do not resolve the problem.
• See your lead maternity carer (LMC) or GP if you think you may have any underlying condition that is causing your bleeding gums.
• A GP or dermatologist can advise you on the best approach with a pyogenic granuloma.

Constipation

The hormone progesterone slows the digestion, and this naturally slows the rate at which you eliminate waste from your bowel. In addition, your intestine is being compressed by your growing baby, which can affect its efficiency.

• Eat little and often.
• Eat plenty of fruit and vegetables.
• Drink plenty of fluids.
• Take regular, gentle exercise to help increase the rate at which you process and use food, and to help keep your bowel moving.  Visit PharmacyLive for more information and treatment options.

Haemorrhoids (piles)

Haemorrhoids are veins in the anus that form a ‘balloon’ in which blood pools (they’re just a form of varicose vein). This is caused by the poorer blood return that goes with the lower blood pressure, and softening veins during pregnancy, and compression from the baby's head on the pelvic and leg veins. Haemorrhoids are made worse by constipation.

• Minimise constipation (see above).
• Avoid deep squatting positions, which place pressure on haemorrhoids and make them worse.
• Do regular, gentle exercise to improve your circulation.
  

Watch the everybody Human Atlas Movie on Haemorrhoids.

Indigestion or heartburn

The valve (sphincter) at the top of the stomach becomes softer and a little less tight due to the effect of the pregnancy hormones. That, coupled with the added upward pressure of a growing baby, means that stomach acids rise back up into the oesophagus (the tube that runs from your throat down to your stomach), causing a burning feeling (heartburn) in the chest. 

• Avoid foods that bring symptoms on (eg, spicy or fatty foods).
• Eat little and often.
• Separate drinks from meals - try drinking warm water.
• Try to remain upright for half an hour or more after a meal.
• If the heartburn continues to be a problem, check with your LMC, pharmacist or GP what antacids you can safely take during pregnancy. Go to PharmacyLive for more information and treatment options.
  

Nausea

Early in pregnancy, nausea can be seen as a mixed blessing; a sign that a hormone called human chorionic gonadotrophin (hCG) is present and is keeping your baby growing until the placenta has grown and takes over. Once the placenta is established, most women find their nausea eases or disappears altogether. 

Some unlucky women experience nausea throughout their pregnancy. A small number may suffer nausea and vomiting that is so severe they lose weight and become dehydrated. This condition is called hyperemesis gravidarum. If your nausea and vomiting are serious, you should see your LMC or your GP. 

• Nausea can be made worse by low blood sugar levels - so eat starchy and protein-rich foods little and often.
• Avoid fatty foods or those with smells that make you feel nauseous.
• Eat something bland and starchy before getting up in the morning.
• Nausea also worsens with fatigue, so rest frequently.
• Get regular gentle exercise.
• Some women find ginger or peppermint tea helps.
• Try sea-sickness bands or acupuncture.

Join the everybody Communities forums to discuss the ups and downs of pregnancy with other New Zealand mums-to-be.

Original material provided by Jo Lawrence-King, Childbirth Educator, edited by everybody and reviewed in March 2009 by Dr Tom Whimbrow, FRANZCOG.