Physiological adaptation to pregnancy – Digestive system
The gastrointestinal system is affected in several ways in pregnancy. The height of progesterone levels interfere with body fluid balance, increase blood cholesterol, and slow contraction of smooth muscles. Secretion of saliva becomes more and more acidic. Later, stomach acid decreases. Enlargement of the uterus suppresses the diaphragm, stomach, and intestine. In early pregnancy, some women experience nausea and vomiting. As pregnancy continues, they will get decreased stomach acid, slower stomach emptying and bloating.
Decreased peristalsis not only causes nausea but also constipation since more stool found in the intestine. Commonly, more water is absorbed the more it will harden. Constipation can also be caused by uterine pressure in the lower intestine at the beginning of the pregnancy and back at the end of pregnancy.
Pregnant women often complain about changes in the digestive system, such as in the amount of appetite and type of food consumed. Even, they will also have any problem with their tolerance to certain foods. Even though some changes may be influenced by socio-cultural factors, anatomical factors and the influence of hormones on the digestive tract can change the functions normally. There is the influenced digestive tract:
Many women experience changes in the digestive system immediately after conception. This condition may be due to the influence of the saliva hormone, and the sense of smell. Scientifically, saliva becomes more acidic during pregnancy. Although previous studies say, there is an increase in saliva production. However, another study argues that this situation is only a perception caused by a decrease in swallowing ability during the period of nausea vomiting.
Some women are noted to experience ptyalism (hyper saliva) which occurs during the day and ends at delivery. Under the influence of estrogen, the gums become more vascular, getting hyperplasia and edema. Decreased thickness of the gum epithelial surface contributes to the increased frequency of gum disease during pregnancy. Bleeding may occur when brushing or chewing. Fragile surfaces can cause inflammation of the gums.
It is estimated that 50-77% of women experience gum inflammation during their pregnancy. The case increases when there are other gum problems, mother’s age, and increased parity. For less than 2% of pregnant women, gum hyperplasia causes a fragile period to form, resembling a tumor called epulis. Epulis usually heals spontaneously after giving birth but may need to be incised during pregnancy. It takes place if there is a lot of bleeding and gum and tooth disease appears.
The lower esophageal sphincter weakens under the influence of progesterone. It causes smooth muscle relaxation. This muscle tension decrease is related to the occurrence of acid reflux from the stomach to the esophagus. Changes in the diaphragm will contribute more to causing problems by changing acutely the esophageal angle – gastric so that it further aggravates reflux.
The progesterone can reduce stomach muscle tension and motility. Also, it also decreases pyloric sphincter muscle tension, causes reflux of the contents of duodenal fluid into the stomach. Along with the pregnancy, the pressure on the stomach by an enlarged uterus can reduce the amount of food consumed without causing discomfort. Decreased acid production and pepsin may also slow the digestion. Although the effect of pregnancy on the secretion of stomach acid is not well understood.
- The large and small intestine
Smooth muscle relaxation causes a decrease in intestinal muscle tension and motility. Decreased motility is further affected by a decrease in motilitin, a peptide hormone. Decreases in muscle tension cause an extension of transit time that will progress along with the development of pregnancy. Research has shown that increases transit at the end of pregnancy is caused by inhibition of smooth muscle contraction in the intestine. Prolongation of transit time and coupled with Duodenum villous hypertrophy causes an increase in absorption capacity. We will find the increased absorption of iron, calcium, lysine, valine, glycine, proline, glucose, sodium, chloride and water. The effect of progesterone on the transport enzyme may cause a decrease in absorption of niacin, riboflavin, and vitamin B6.
Decreasing motility and prolonged transit time in the colon causes increased absorption of water. Later it increases the risk of constipation. An increase in Flatulence was also found. Along with the uterus, appendix, and cecum development, it is pushed up and laterally. This anatomical change is important to remember especially when the mother complains of acute abdominal pain and appendicitis.
Hemorrhoids usually occur during pregnancy. It is caused by relaxation of secondary blood vessel walls to increased progesterone, and suppression of veins by weight and enlarged uterine size. Try to push during defecation because constipation also plays a role in the emergence of hemorrhoids.
- Trimester I
In this stage, significant changes will occur in decreasing smooth muscle motility in the digestive tract. There is also decreasing the secretion of hydrochloric acid and pepsin in the stomach. Further, it causes symptoms of pyrosis. Symptoms caused by gastric acid reflexes to the lower esophagus as a result of changes in gastric position and decreased esophageal sphincter muscle tension. Nausea is caused by a decrease in hydrochloric acid and a decrease in motility, as well as constipation as a result of decreased bowel motility. Hypersalivation often occurs as compensation for nausea and vomiting that occurs, in some women. It is found (food cravings) that might be related to the individual’s perception of what can reduce nausea and vomiting. Epulis during pregnancy will appear, but after labor will decrease spontaneously.
- Trimester II
Constipation usually occurs because of the increased effect of the hormone progesterone. Also, flatulence also occurs due to the pressure of the uterus which enlarges in the abdominal cavity. Hemorrhoids are quite common in pregnancy as a result of constipation and increased pressure under the uterine veins including hemorrhoids. Feeling burned stomach occurs because of the acid return of gas into the lower esophagus.
- Trimester III
As the gestational age progresses, the stomach and intestines are displaced by the enlarged Uterus. Gastric emptying and small intestine transit time decrease in pregnancy due to hormonal or mechanical factors. This may be caused by progesterone and decreased levels of motilin, a hormone peptide known to have smooth muscle stimulation effects. Pirosis (heartburn) often occurs in pregnancy and may be caused by reflux of acidic secretions into the lower esophagus. The position of the stomach changes and the lower esophageal sphincter also decreases. Gums can occur hyperemic and soften, in Berta pregnancy can bleed even in mild edema. Focal vascular gum swelling or epulis has spontaneous regression after birth.