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Vidya S. Kakhandki (Doctor)
Bagalkot, Karnataka
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| This descriptive study typifies the constant efforts of obstetricians and gynaecologists who practice in remote, resource-poor villages in India. Despite a lack of infrastructure and modern research facilities, findings can highlight potential patient benefits as here, derived from adhering to simple clinical measures. |
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Introduction
Constipation is a normal physiological change occurring in pregnancy, presumably as a result of altered progesterone and oestrogen levels which decrease intestinal transit. Nausea and vomiting are prominent symptoms in patients with disordered gastrointestinal motility.
Patients and Procedures
This study was done over a 1-year period. The sample consisted of 30 pregnant patients with excessive vomiting during the first trimester. None of these women had vomiting unrelated to pregnancy, e.g. on account of acute gastroenteritis, acute pyelonephritis, acute intestinal obstruction, twisted ovarian cyst, uraemia, cerebral tumours, etc. Likewise, none of the patients responded to routine treatment with antiemetics, intravenous fluids, or vitamin B12 injections. All, however, had a history of constipation and irregular bowel habit.
Patients were given a soap-water enema before being discharged for follow-up along with advice to take stool softeners, as well as plenty of fluids and fibre, and green leafy vegetables and fruits.
Results
The results were very encouraging in all patients. Immediately after receiving the soap-water enema, each one reported objective and subjective improvements in constipation (i.e. stool frequency and consistency). Their vomiting disappeared and some patients even experienced an enhanced appetite.
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Five patients were lost to follow-up. However, the remaining 25 were all totally relieved of their constipation/vomiting complaint once they had had the enema and strictly adhered to the medical advice. For example, 5 patients who did not properly comply with the medical advice remained symptomatic and therefore repeated the treatment (enema + advice) this time with strict adherence. All were subsequently relieved of their symptoms (table 1).
Conclusions
This study suggests that soap-water enema together with dietary modifications can, in the absence of drug intake, be useful in eradicating the nagging problem of constipation in pregnancy. This treatment is very simple, economical, and safe, since systemic therapy is not involved.
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Table 1. Results: total symptom relief of constipation/vomiting
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First visit
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Second visit |
Total |
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5/5b
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25/25 |
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aAll patients who had strictly adhered to dietary advice.
bAll patients who, at the time of the first follow-up visit, had not strictly adhered to dietary advice, but who repeated the treatment.
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