Pregnancy and Gastrointestinal Health: When to Consider Colonoscopy?

How can pregnant women check their gastrointestinal tract?

Hello Dr.
Chen, I would like to ask you a few questions: I have been experiencing intermittent lower abdominal pain for several years, which has become a long-term issue.
I often alternate between diarrhea and constipation.
My stools are usually not hard.
I underwent a health check-up at that time, and while I did not find blood in my stool, the hospital tests indicated the presence of blood.
After a follow-up examination, the symptoms disappeared.
The doctor diagnosed me with irritable bowel syndrome (IBS).
However, about six months ago, I experienced blood in my stool on one or two occasions, which was bright red, along with other bowel movements.
Occasionally, there is mucus, but this usually occurs only during difficult bowel movements.
My stools have a thin shape, and I often feel urgency with incomplete evacuation.
When I consulted the doctor again, I was still diagnosed with IBS, and the doctor believed that a colonoscopy was unnecessary.
I later sought a second opinion and had a CEA (carcinoembryonic antigen) test, which came back normal.
Two months ago, I consulted another doctor who performed a digital rectal examination and indicated that there were no hemorrhoids.
The doctor suggested that it might be intestinal inflammation.
Just as I was preparing for a colonoscopy, I discovered that I was pregnant...
Since then, I have made significant dietary adjustments, and so far, my bowel movements have been smooth, and I no longer experience rectal bleeding.
My stools have become slightly thicker and are no longer as thin as before.
However, I still have persistent lower abdominal pain and frequent urges to defecate.
Shortly after using the restroom, I still feel a lingering urge.
I often experience dull pain in the right lower abdomen near the cecum.
I would like to ask you a few questions: (1) Is my condition unusual? Is there a possibility of a malignant tumor? (2) Is it appropriate to perform a colonoscopy during early pregnancy? Are there alternative methods available? Or can I just have a sigmoidoscopy first? I have researched that the CEA level cannot be used as a diagnostic criterion, which makes me a bit anxious.
(3) If the digital rectal examination shows no hemorrhoids, could it still be internal hemorrhoids? I sincerely request your assistance in answering these questions, and I am very grateful.

Ms. Hsu, 30~39 year old female. Ask Date: 2009/03/29

Dr. Chen Shidian reply Gastroenterology and Hepatology

Dear Ms.
Hsu,
Currently, the situation is just a sensation of abnormal peristalsis.
Adjusting the medication is sufficient, and there is no urgency for a colonoscopy.
Changhua Hospital cares about your health.

Sincerely,
Chen Shidian

Reply Date: 2009/03/29

More Info

Pregnancy can significantly affect gastrointestinal health, and it is essential to approach any gastrointestinal symptoms with caution, especially when pregnant. Your concerns about your long-standing abdominal pain, alternating diarrhea and constipation, and the recent episodes of rectal bleeding are valid and warrant careful consideration.

1. Is your condition unusual? Could it be a malignant tumor?
Given your history of symptoms consistent with irritable bowel syndrome (IBS) and the recent episodes of bright red blood in your stool, it is understandable to be concerned about the possibility of a more serious condition, such as colorectal cancer. However, the fact that you have undergone multiple evaluations, including a normal CEA (Carcinoembryonic Antigen) test and a digital rectal examination that ruled out hemorrhoids, is reassuring. While IBS can cause significant discomfort and changes in bowel habits, it is generally not associated with malignancy. The presence of bright red blood typically suggests a lower gastrointestinal source, often related to hemorrhoids or anal fissures, but given your situation, it is crucial to monitor these symptoms closely. If the bleeding recurs or if you experience any new concerning symptoms, further evaluation would be warranted.

2. Is it appropriate to perform a colonoscopy during early pregnancy?
Generally, performing a colonoscopy during pregnancy is not recommended unless absolutely necessary. The procedure can pose risks, such as potential miscarriage or preterm labor, due to the pressure it may exert on the uterus. If your symptoms have improved with dietary adjustments and you are currently not experiencing significant issues, it may be prudent to postpone the colonoscopy until after delivery. Alternatives such as a flexible sigmoidoscopy or non-invasive imaging studies could be considered, but these should be discussed with your healthcare provider. It is essential to weigh the risks and benefits of any procedure during pregnancy, and your obstetrician or gastroenterologist can help guide this decision.

3. If there are no hemorrhoids, could it be internal hemorrhoids?
Internal hemorrhoids can sometimes be difficult to detect during a digital rectal examination, especially if they are not currently prolapsed. They can cause symptoms such as rectal bleeding and discomfort, particularly during bowel movements. If your symptoms persist or worsen, it may be worth discussing further evaluation with your healthcare provider. They may recommend a more thorough examination, such as an anoscopy, which can visualize the rectal area more clearly and help determine if internal hemorrhoids or other conditions are present.

In summary, while your symptoms are concerning, the current evidence suggests that they are more consistent with IBS or benign conditions rather than malignancy. It is crucial to maintain open communication with your healthcare providers, especially during pregnancy, to ensure that both your gastrointestinal health and the health of your baby are prioritized. Dietary modifications, hydration, and possibly the use of stool softeners may help alleviate your symptoms. If you experience any new or worsening symptoms, do not hesitate to seek medical attention.

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