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2512Constipation during pregnancy

Constipation is common during pregnancy, occurring in up to one-third of women. Constipation during pregnancy is probably caused by progesterone-related changes in both small bowel and colon motility, and by the increased absorption of water and electrolytes during pregnancy. The subjective experience of the pregnant woman (a feeling of fullness due to the growing uterus) certainly also plays a role. Therefore, before prescribing laxatives it must be determined whether there is, in fact, any constipation (hard, dry stool, painful, less than three times a week). Laxatives should only be used in pregnancy when dietary and physical measures have been unsuccessful. In this case, stool-bulking agents are the drugs of choice (Bonapace 1998).

2514 Hyperosmotic and saline laxatives

Saline laxatives are poorly absorbed as well they work in a similar way to lactulose, but use saline to create an increase in fluid accumulation. Isotonic solutions are recommended because hypertonic solutions have the disadvantage that they remove significant quantities of fluid from the body. The saits, which are most appropriate as saline laxatives, are sodium sulfate and magnesium sulfate potassium-sodium tartrate, magnesium citrate, potassium bitartrate, and potassium citrate are also used. Generally speaking, magnesium salts can inhibit contractions (see Chapters 2.8 and 2.14), but after oral ingestion as a laxative, with its limited systemic absorption, this effect is unlikely to occur. Recommendation. After stool-bulking agents, lactulose is the first-choice laxative in pregnancy. Lactitol, mannitol, and sorbitol, as well as the saline laxative sodium sulfate, can also be used as laxatives during pregnancy. However, sodium sulfate in higher doses and magnesium sulfate are...

Combating constipation

Progesterone, a hormone that circulates freely through your body during pregnancy, can slow down your digestive system and thus cause constipation. The extra iron from your prenatal vitamin only makes matters worse. Women who are on bed rest because of pregnancy complications are at particular risk of constipation because they're so inactive. flV You can counteract constipation by drinking plenty of fluids, by eating ade- JL quate fiber (in the form of fruits, vegetables, beans, bran, and other whole ir ll grains), and, if possible, by getting exercise every day. Keep in mind, however, that some women experience abdominal discomfort, bloating, or gas from eating too much of foods high in fiber. You may have to use a little trial and error to see which fiber-rich foods you tolerate best. If constipation bothers you, your practitioner may recommend a stool softener.

Constipation

V About half of all pregnant women complain of constipation. When you're pregnant, you may become constipated because the large amount of progesterone foil circulating in your bloodstream slows the activity of your digestive tract. The iron in prenatal vitamins may make matters worse. Try these suggestions to deal with the problem Take stool softeners. A stool softener, such as Colace (docusate sodium), isn't a laxative it just keeps the stool soft. Stool softeners are safe during pregnancy, and you may take them two to three times a day. Avoid laxatives because they can cause abdominal cramping and, occasionally, uterine contractions. For any person, pregnant or not, chronic laxative use should be avoided. If you're extremely constipated, though, and aren't at risk for preterm labor, you may want to talk to your practitioner about the short-term use of a very mild laxative, like a glycerin suppository or milk of magnesia. Exercise as regularly as you can. Exercise helps...

Common deficiences in pregnancy

The Kidneys will almost certainly be deficient, but try to ascertain from your case history whether the deficiency is predominately Yin or Yang. Treatment will centre on tonifying Kidney Yin and Yang conditions in women who have suffered recurrent miscarriages early on in pregnancy. They usually suffer from backache and are cold. Moxa cones can be used with care to tonify points such as BL-23, BL-20 and GV-4. If the woman suffers from constipation, use moxa and tonification. If there is oedema of the ankles, this is due to Kidney Yang deficiency use BL-23 and GV-4 (Mingmen).

2515 Diphenylmethanes

The diphenylmethane Phenolphthalein and its derivatives bisacodyl and sodium picosulfate have a laxative effect by stimulating the colon peristalsis hence they are stimulant laxatives. Up to 15 of Phenolphthalein is absorbed, and after glucuronidation is excreted in the urine (reddish coloring). Only about 5 of bisacodyl is absorbed. Recommendation. When constipation needs to be treated with medication and neither bulk nor osmotic laxatives like lactulose work effectively enough, bisacodyl is the drug of choice throughout the entire pregnancy.

What does it mean to be a mother Changes for women

Kara came to see me for help with an eating disorder. She tended to diet and then binge on alcohol and food. She would use laxatives and vomit when she sobered up. In the course of our sessions Kara became pregnant. (She had been using the contraceptive pill, which is clearly not recommended as a contraceptive for women with such eating problems.) The father was her flatmate and they had had a 'fling' during a drinking binge. From what looked like a disastrous situation Kara was able to decide that she needed to take control of her life and sort out her problems in a different way. The pregnancy helped her to get some control over her eating problems. She struggled greatly but accepted the idea of eating regular meals and the binging decreased very quickly. Her flatmate helped her to cut down on her drinking but he was not keen on becoming a father. Kara suddenly decided to return home to her parents in Argentina and I did not see her again.

Taking Stock of What Youre Taking In

Sticking to a well-balanced, low-fat, high-fiber diet is important not only for your baby but also for your own health. Consuming adequate protein is also important because protein carries out many of the body's functions. The fiber in your diet helps to prevent or reduce constipation and hemorrhoids. By not consuming too much fat, you help keep your heart healthy and avoid putting on extra pounds that may be difficult to shed. Avoiding excessive weight gain also decreases your chances of developing stretch marks. To read more about stretch marks, see Chapter 7.

Endocrine Changes And Metabolic Adaptations

Macrosomia Fetal

Progesterone is required to sustain early embryonic growth. After the initial rapid rise in progesterone concentrations during the luteal phase, progesterone concentrations continue to rise for the remainder of pregnancy (Fig. 1) (7). Progesterone inhibits smooth muscle tone in the uterus, gastrointestinal tract, and renal collecting system. This results in a decrease in uterine contractions, but also increases esophageal reflux, delayed gastric emptying, constipation, gallbladder enlargement, and hydronephrosis. Progesterone inhibits the aldosterone effect on renal tubules, causing a decrease in tubular reabsorption of sodium.

Speaking of pregnancy competing truthclaims

Rowlandson

Free from other disorders and that labour, though painful, is almost always natural, and the event happy' (p. xxiv). Repeatedly, women are urged to trust themselves to nature so Denman confirms that 'in every thing which relates to the act of parturition Nature, not disturbed by disease, and unmolested by interruption, is fully competent to accomplish her own purpose'.10 However, as has been noted in the Introduction, 'nature' is a slippery ideological construction. Here, in a paradox which continued to structure antenatal care, the authoritative professionals can do little more than suggest faith in nature, that is, non-intervention, as a medical strategy. Other than this, the advice in these texts consisted of bland injunctions to eat a balanced diet and exercise moderately. Venesection (blood-letting) was still sometimes recommended, and much attention was paid to constipation.11 This latter was considered a serious matter, as it might lead women to use strong purgatives, which...

Rectus Abdominis Separation

Rectus Abdominis Separation With Hernia

Note the typical gastric peristalsis in a 10-day-old infant with pyloric stenosis. There was a history of projectile vomiting, constipation, and an olive was palpable. It is unusual for pyloric stenosis to present at this early age. Figure 2.16. Note the typical gastric peristalsis in a 10-day-old infant with pyloric stenosis. There was a history of projectile vomiting, constipation, and an olive was palpable. It is unusual for pyloric stenosis to present at this early age.

2516 Anthraquinone derivatives

Anthraquinone derivatives with a laxative action occur in a number of plants folia sennae, rhizoma rhei, cortex frangulae, and aloe. They have a laxative effect by directly stimulating colonic smooth muscles. Anthraquinone derivatives occur as glycosides. After the sugar portion is cleaved in the intestine, these agents are partially absorbed and excreted in the urine (colored ). Anthraquinone derivatives do not appear to be teratogenic. Reported experience is the most extensive with senna laxatives. No stimulating effect on uterine contractions or other side effects relevant to pregnancy were noted when senna laxatives were used in pregnancy (Anonymous 1992).

Exercise in Pregnancy

Exercise prepares you for the physical demands of labor and motherhood. It also helps to improve your posture and reduces backache, constipation and leg swelling. You will feel less tired and sleep better. You will also gain less body fat. If you are a diabetic in pregnancy, you will be able to control your blood sugar better with exercise.

Third trimester 28 to 40 weeks

Although some women may still be enjoying the traditional 'bloom' of pregnancy, many will be feeling very tired and uncomfortable. They may also be suffering from such minor problems and discomforts as breathlessness, insomnia, back ache, constipation, piles and heartburn.

12101 Nutritional Assessment

The initial assessment takes into account the diet history of the woman as well as any symptoms or problems that might hinder adequate intake. Typical dietary, appetite, gastrointestinal symptoms (i.e., nausea, vomiting, diarrhea, and constipation), difficulty with chewing and swallowing, food allergies, ethnic and cultural food practices, and household food security should be considered and included in the assessment. Furthermore, all medications and supplements as well as complementary therapies should be investigated in order to determine possible drug-nutrient interactions.

Pharmacological Treatment

The choice of antidepressants will depend on the main presenting complaints and side-effect profiles for the individual patient. Tricyclic antidepressants are likely to be more effective in cases of diarrhoea and abdominal pain, due to its anticholinergic activity. A sedating tricyclic anti-depressant may be useful when there are associated sleep problems, whereas selective serotonin re-uptake inhibitors (SSRI) such as fluoxetine may help in cases that have constipation or bloating7. Anticholinergic medications such as diphenoxylate can be used to control pain and diarrhoea. Antidiarrhoeals like loperamide and cholestyramine are used if diarrhoea is a dominant symptom. Constipation may be treated with Lactulose.

8 Antipsychotic Medications In Pregnancy

With respect to side effects, in the second trimester ofpregnancy there is a physiological drop in blood pressure, which may add to the orthostatic hypotension effects of some antipsychotic drugs (clozapine, quetiapine). Constipation, which is common in pregnancy, may be worsened by medications with anticholinergic side effects (olanzapine, clozapine). The sedation induced by some antipsychotics (olanzapine, quetiapine, clozapine) must also be taken into consideration, especially after childbirth (39).

How Your Body Is Changing

Discomfort levels will be increasing now. You will only be a bI e to br ea th e sh a I I owl y du e to t h e si z e of yo u r a b d omen a nd th e way it is restricting your diaphragm. You may have h ea rtb u r n . As the weeks go by, the baby will engage or d rop i nto yo u r pe Ivi s a nd yo u r br ea th i ng sh ou I d g et ea si e r, bu t th e n you will need to urinate more often beca u s e th e ba by i s putti ng pr es su re on yo u r bl a dd er. You may have constipation and hemorrhoids.

167 iron deficiency anemia and pregnancy outcomes

During the first trimester of pregnancy in poor women improved birth weight, lowered the incidence of prematurity, but did not alter the incidence of SGA deliveries 38 . The timing and dose of supplementation, as well as the frequency of supplementation, are important considerations in interventions during pregnancy 7, 39 . Large and frequent doses of iron as usually prescribed in the United States (Table 16.3) are frequently associated with complaints of constipation, dark stool, and gastrointestinal (GI) upset. Alternative strategies include nondaily supplementation at a much lower dose, delayed release supplements, and forms of iron salts that are less irritating to the GI tract. Since it is unlikely that dietary intakes alone will meet the iron requirements during pregnancy, it is imperative that cost-effective supplementation vehicles be developed that avoid these side effects while maintaining a positive iron balance. A number of side effects occur with nearly all of these iron...

8 Maternal Opioid

Heroin is processed from morphine, a naturally occurring opiate extracted from poppy plants. It is sold illegally, often tied in the ends of small balloons. Common street names for heroin include smack, dope, H, China white, black tar, and junk. Heroin can be smoked, sniffed, or injected intravenously or intramuscularly. After an injection, the user experiences euphoria, relaxation, warmth, and an absence of anxiety. Because the duration of action is 4-6 h (72), users tend to use it two to three times a day. The signs of heroin use include drowsiness, itching, pinpoint pupils, loss of appetite, slowed breathing, and constipation. Death in chronic intravenous heroin users is often the result of overdose. Heroin users are also at risk for developing collapsed veins, endocarditis, abscesses, cellulitis, HIV, AIDS, and hepatitis (73).

4 Impact Of Eating Disorders On Pregnancy Course And Outcome

It has been reported that such patients gain less weight, have smaller babies than healthy women, and may have a higher risk ofpremature delivery (11,12,17). In the largest prospective study to date (20), women with a history of hospitalization for an eating disorder prior to pregnancy (n 302) were twice as likely to have LBW infants relative to controls (n 900). Furthermore, women with eating disorders were 70 more likely to have a premature delivery and 80 more likely to have a small-for-gestational-age baby than control mothers. The authors speculate that weight-controlling behaviors (e.g., dieting, vomiting) and compromised maternal blood flow of nutrients to the fetus may have contributed to impaired fetal growth. Moreover, undernourishment and or the use of laxatives and appetite suppressants may also have negatively affected birthweight, size, and timing of delivery.

59 Changes Of The Skeletal System During Pregnancy

Uterine Size Weeks

Peristalsis is slowed because of the production of the hormone progesterone, which decreases tone and mobility of smooth muscles. This slowing enhances the absorption of nutrients and slows the rate of secretion of hydrochloric acid and pepsin. Flare-up of peptic ulcers is uncommon in pregnancy. Slow emptying may increase nausea and heartburn (pyrosis). Relaxation of the cardiac sphincter may increase regurgitation and chance for heartburn. Movement through the large intestines is also slowed due to an increase in water consumption from this area. This increases the chance for constipation. (2) The patient should eat a well- balanced diet high in protein, iron, and calcium for fetal growth high fiber and fluids to prevent constipation.

Reflux Treatment Guidelines for Prescribed Medications in Nonpregnancy1

Tytgat, G.N., Heading, R.C., Muller-Lissner, S. etal. (2003) Contemporary understanding and management of reflux and constipation in the general population and pregnancy a consensus meeting. Alimentary Pharmacology and Therapeutics, 18 291-301. Reproduced with permission of Blackwell Publishing.

Congenital Hypothyroidism In Infants

Facial Puffiness Hypothyroidism

This 5-week-old infant with congenital hypothyroidism has generalized myxedema, dry skin, hoarse low-pitched cry, low body temperature, and constipation. Note the characteristic facies with enlarged tongue (macroglossia) and the protuberant abdomen (pot belly) with umbilical hernia. Figure 5.4. Typical facies of the same infant as in Figure 5.3 with congenital hypothy-roidism. Note the coarse facial features with the macroglossia and the mottling of the skin (cutis marmorata). At birth there are usually no abnormal signs the characteristic features of hypothyroidism develop at a few weeks to a few months of age. At the present time, neonatal screening has been invaluable in making an early diagnosis. The diagnosis must be considered in infants with persistent jaundice or constipation.

Breast Feeding Summary

Most reviewers acknowledge the presence of anthraquinones in breast milk and warn of the consequences for the nursing infant (2,3 and 4). A comprehensive review that describes the excretion of laxatives into human milk has been published (5). The authors state that little is actually known about the presence of these agents in breast milk. Two reports suggest an increased incidence of diarrhea in infants when nursing mothers are given cascara sagrada or senna for postpartum constipation (6,7). However, the American Academy of Pediatrics considers cascara to be compatible with breast feeding (8). 6. Tyson RM, Shrader EA, Perlman HH. Drugs transmitted through breast milk. Part I. Laxatives. J Pediatr 1937 11 824-32. 7. Greenleaf JO, Leonard HSD. Laxatives in the treatment of constipation in pregnant and breast-feeding mothers. Practitioner 1973 210 259-63.

Third trimester

During the final 3 months of pregnancy a baby grows faster than ever, doubling in size, laying down fat stores and putting on around an ounce (28 g) of weight a day. Nerve cells increase, the lungs and immune system mature, the digestive tract develops, bones are strengthened, and stores of fat, iron and calcium are laid down. Bones both lengthen and harden and there are crucial growth spurts in the brain. The mother needs approximately 200 extra calories a day, and the need for protein is at an all-time high (Ford 1994). Her blood volume has by now increased by 40 , and she may be suffering from minor problems and discomforts such as breathless-ness, insomnia, back ache, constipation, piles or heartburn.

Carbohydrates

Carbohydrates, which include starches, sugars and fibres, are the main providers of energy. They are best eaten unrefined, with 'nothing added and nothing taken away', as processing removes many vital nutrients as well as much of the fibre that can help prevent constipation.

922Bulimia Nervosa

Individuals with BN engage in binge eating episodes, followed by compensatory behaviors to prevent any increases in body weight. Purging behaviors include self-induced vomiting or self-prescribed use of enemas, laxatives, or diuretics. Nonpurging behaviors include fasting and excessive exercise. While clinically diagnosed BN occurs in approximately 5 of the female population, up to 20 of women have reported bulimic behaviors in their lifetimes 6, 7 . Clinical features of BN include Russell's sign, dental enamel erosion, dental caries, and enlargement of the parotid glands in those who use self-induced vomiting as a purging behavior. Use of enemas, laxatives, and diuretics as well as vomiting can lead to electrolyte imbalances, cardiac dysfunction, and other neurologic disorders. Gastrointestinal symptoms may range from constipation to esophageal or gastric rupture. In those who engage in nonpurging behaviors, electrolyte imbalances, renal and cardiac dysfunction, and gastrointestinal...

Bowel problems

Constipation can be very debilitating for a pregnant woman. It is common during pregnancy because of the relaxation of plain muscle by progesterone. This causes general sluggishness and decreased peristalsis of the colon. The Chinese viewpoint is that constipation is due to a Blood deficiency, especially if this is a pre-existing blood deficiency. It may also be due to Qi stagnation, which is common in the first 3 months because of the growing fetus. Another contributory factor may be if the mother is suffering from morning sickness and is not drinking the amount she should. Treating constipation during pregnancy is difficult because no abdominal points should be used.

Soiling Encopresis

If your child feels pressure to learn to use the potty and isn't ready yet, soiling (also called encopresis) may result. Soiling means involuntarily passing bowel movement into the diaper or underpants. If this happens, assure your child that it's not his fault, and back off toilet teaching for a while. Soiling is frequently a symptom of chronic constipation (see the section on constipation earlier in this chapter), with uncontrollable leakage of looser stool occurring around a large mass of hard stool that has collected in your child's lower intestine. If soiling persists, consult your child's doctor.

Dietary Management

Keeping a dietary history may also reveal problem areas that can be addressed by altering habits. A fibre-rich diet may be advised when the stool requires 'bulking out' or constipation is present, although for some patients this can make their symptoms worse. Caffeine, alcohol, fat and sorbitol-rich foods (e.g. ice cream, chewing gum, honey and jam) are known to aggravate IBS and should be taken in moderation2.

Ann Reed Mangels

Summary A vegetarian diet, defined as an eating style that avoids meat, fish, and poultry, can be healthful and nutritionally adequate for a pregnant woman. Some vegetarians, called vegans, avoid dairy products and eggs as well as meat, fish, and poultry. Vegan diets can also be healthful and nutritionally adequate for pregnancy. Vegetarian diets can provide numerous long-term health benefits including a lower risk of cardiovascular disease, some forms of cancer, and hypertension. Key nutrients for vegetarian pregnancy include protein, iron, zinc, calcium, vitamin D, vitamin B12, iodine, and omega-3 fatty acids. Vegetarian women should also be counseled to follow standard weight gain recommendations. A vegetarian or vegan diet can meet requirements for all of these nutrients although in some instances, fortified foods or supplements can be especially useful in meeting recommendations. The nutrient content of supplements targeted to pregnant vegetarians should be evaluated to make sure...

4210 Antitussives

In a 1-week-old infant after a single maternal dose of 30 mg codeine (Smith 1982). in another case, following a 60-mg single maternal dose, a maximum ot 455 ng I in milk was measured (Findlay 1981). Mathematically, for the infant this means a maximum of 7 of the weight-related maternal dosage. Here, and also in other studies, breastfed infants showed no symptoms when the daily maternal dosage remained under 240 mg, as recommended by some authors (Mcny 1993). As an antitussive, and for sporadic analgesic use, this amount is not reached by any means. Recently, fatal consequences were reported in a newborn whose mother was prescribed 60 mg codeine twice daily, with 1000 mg paracetamol, for episiotomy pain following birth. She reduced the dosage by half from day 2 because she experienced somnolence and constipation. The full-term healthy male infant showed intermittent periods of difficulty with breastfeeding and lethargy starting on day 7. On day 12, he had gray skin and his milk intake...

EBowel Elimination

(2) Patients who have a tendency toward constipation become noticeably more irregular during pregnancy because of (3) To prevent or to relieve constipation, you should encourage the patient to eat a diet high in fiber, maintain an adequate fluid intake, and to exercise--especially walking.

Lead Poisoning

Symptoms and Diagnosis Symptoms of lead poisoning, if they occur, can resemble those of other illnesses, making the condition difficult to detect. Some early signs include fatigue or overactivity, irritability, loss of appetite, weight loss, difficulty sleeping, and constipation.

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Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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