Indigestion and Heartburn
Written by Dr.M.D.Mazumdar, MD
Like many other pregnant women, you may also sometimes suffer from a feeling of discomfort, fullness or bloating in the upper abdomen.
Sometimes feeling of fullness may be so severe that you may find it difficult to eat anything, even if you feel hungry.
These signs of indigestion are very common in pregnancy, more so in the later stages.
A woman who is not pregnant may produce 1 -3 pints of gas a day, mostly during digestion of the food she eats, and in some extent from air she swallows while eating.
In pregnant women, the production of gas in the gut is more than normal. This is because the rising levels of the hormone, progesterone during pregnancy causes relaxation of all the smooth muscles of the body, including that of the intestines.
The digestive process is slowed down and food tends to stagnate in the stomach and the intestines.
You may find that you are burping and passing more gas than when you were not pregnant. You may also become aware of tinkling and gurgling noises from your bowels when gas forces its way between the half digested food in your gut. This is more common after a large meal or a meal where you have taken a lot of fried or spicy food.
Indigestion is also often accompanied by heartburn, nausea and vomiting, although heartburn can occur alone too. You may find that there is a burning sensation from the lower part of your breastbone right up to your throat. There may also be acid reflux, that is, a rush of sour tasting fluid into your mouth.
Causes of Indigestion and Heartburn in Pregnancy
Progesterone The main cause of both indigestion and heartburn in pregnancy is the increase in the levels of the hormone progesterone. The high level of progesterone in the body at this time is needed to relax the uterus and help your baby to grow. Unfortunately, progesterone also causes relaxation of all the smooth muscles in your body, including that of the digestive tract. Movement of food through the stomach and intestines slows down. Food that normally moves out of your stomach in 3 hours can now remain there for more than 6 hours.
Metabolism of food in the stomach causes the production of gas resulting in the sense of bloating in the upper abdomen. Air swallowed during eating also moves out of the stomach less slowly and contributes to the belching and burping that you may suffer from while pregnant.
Relaxation of the sphincter between the stomach and the oesophagus - Relaxation of the sphincter occurs due to progesterone. It can cause food mixed with gastric juice to seep up from the stomach into the esophagus and then into the mouth. Gastric juice, being acidic, causes the burning feeling you get in your chest.
As the fetus increases in size in later pregnancy, the enlarging uterus pushes the stomach upwards towards your chest. This decreases the capacity of the stomach to hold a large quantity of food. And that is why you may feel full even after a small meal. The large uterus also crowds against your intestines, further slowing down your digestion.
Certain foods like beans, cabbages, cauliflowers and broccoli can cause more gas in some people. Although this may not cause much trouble during a non-pregnant state, the slow digestive processes in pregnancy can lead to bloating and flatulence.
Spicy and fried food can cause an increase in the acid production of the stomach.
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What you can do to Control Indigestion and Heartburn
Take small meals every two hours instead of three large ones in a day. This will help your stomach to become empty before the next meal. Chew thoroughly to help in digesting the food.
Do not eat solid and liquid food together. The solids mix with the liquids and sometimes floats on them, making digestion difficult. Drink liquids at least 1 hour after eating solid food.
Avoid spicy and fried foods as they stimulate acid production in the stomach.
Take frequent sips of cold water throughout the day to dilute the acid in your stomach. Ice-creams and cold custards are also helpful but do remember that these will increase the calories when you plan your diet.
Certain foods are suspected to cause more heartburn and gas than others - soft drinks with their high levels of dissolved gases, alcohol, caffeine in tea and coffee, citrus fruits like lemon, lime and oranges, tomatoes and tomato-based food like sauces and chutneys, vinegar and mustard. Smoking also stimulates gastric acid production.
Enzyme tablets or liquids are often helpful in increasing the rate of digestion of the food and cutting down on the sensation of bloating and indigestion you get after food.
Avoid lying down flat on your back immediately after a meal. All meals should be taken at least 1 hour before going to bed.
Sleep propped up on a number of pillows if acidity and bloating is severe. If this is too uncomfortable, sleep on your side rather than on your back. This will prevent the gastric juices from seeping upwards into the oesophagus.
Antacids can be taken to neutralize the acids. Antacids containing alluminium hydroxide, magnesium hydroxide, magnesium trisilicate and calcium carbonate should be preferred over those containing sodium carbonate (baking soda) as the sodium can cause retention of water in the body leading to swelling of the feet and ankles of some women.
Chewable tablets and liquids are more effective than tablets that have to be swallowed whole with water.
If the acid reflux is too severe, ask your doctor to prescribe H2 receptor antagonist pills (omeprazole, ranitidine). These can prevent acid production in your stomach.
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