Pregnancy and IBS: A Comprehensive Doctor's Guide (The Do's And The Donot's)

You as a female,  are 2.5X more prone to develop IBS than males (reference). And the female sex hormones may play a central role in this women predominance.

During pregnancy, your “female hormones” greatly change, this may further impact your IBS or produce symptoms that are similar to IBS (reference).

Today, we will answer all your questions about pregnancy and IBS and We will provide the best tips for dealing with IBS and pregnancy.

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1- Differences between IBS and pregnancy symptoms.

Pregnancy symptoms in the early days can be confused with IBS symptoms. We will discuss the symptoms of early pregnancy and IBS symptoms and differences.

A- Symptoms of early pregnancy.

The following symptoms are not present in all women. Every woman is different; some don’t have symptoms at all, others have minimal symptoms and others have severe pregnancy symptoms.

Also, the symptoms of early pregnancy may mimic symptoms of early menstruation. So, The only way to confirm getting pregnant is by getting a pregnancy test.

In the early days of getting pregnant you may experience:[1]

• Mild cramps that are similar to menstrual cramps. It is located in the lower abdomen, not related to meals, and didn’t affect by defecation.
• Morning nausea.
• Breast tenderness or soreness.
• You may experience minimal spotting due to the implantation of the fertilized ovum in the uterus wall.
• Some dizziness and maybe fainting.
• Headache and fatigue
• Missed period.

B- Symptoms of IBS.

If you have IBS before pregnancy, the symptoms may aggravate after getting pregnant. IBS-flare ups. 

The typical symptoms of IBS are:

• Abdominal pain in the form of colics and cramps.
• The pain is located anywhere all over your abdomen, but most commonly around the umbilicus and at the lower left part of your abdomen.
• IBS pain is usually increased after meals.
• IBS pain is related to defecation (the pain may increase or decrease after defecation).
• You may experience diarrhea or constipation or both.
• Stool form may change with the onset of the IBS pain: the stool may become harder or lose according to the type of your IBS.
• Also, IBS may be associated with nausea, fatigue

C- Can IBS symptoms be mistaken for pregnancy?

Yes, IBS can be mistaken for pregnancy. This is because many IBS symptoms are similar to early pregnancy symptoms.

Abdominal cramps, nausea, and fatigue may be difficult to assess its cause; whether pregnancy or IBS.

If you are not sure about your symptoms, you can take a pregnancy test by a urine test strip. Or consult your doctor about performing a more accurate blood test (serum HCG).

2- Can pregnancy cause IBS symptoms?

I think you heard before about HG “Hyperemesis Gravidarum”. A condition that occurs in early pregnancy. The pregnant female suffers from severe and persistent vomiting. 

The definite cause of HG is unknown. It is thought to be due to an increased level of the pregnancy hormone Human Chorionic Gonadotropin (HCG) affecting your stomach.

HCG hormone greatly increases in the first 20 weeks of pregnancy. And it is not only the HCG hormone that increases during pregnancy But also there is a steady increase in progesterone and estrogen hormones as the pregnancy progresses.

the research about IBS and Pregnancy is still deficient, But these high hormones may play a key role in your IBS symptoms. 

Pregnancy is suggested to increase IBS symptoms as [2]:

• You may have more constipation with your pregnancy especially in the third trimester (about 11 to 38% increase).
• And also, you may experience more frequent stool (about 34% report increased stool frequency during pregnancy).

So, pregnancy hormones may affect your IBS and may cause more frequent flare-ups.

Another important cause that pregnancy may aggravate IBS symptoms is cutting off IBS medications. Most pregnant women cut off their IBS medication when they get pregnant. And this may cause more IBS flare-ups.

IBS and early pregnancy (first trimester).

The first trimester of pregnancy is the time for major changes inside your body. Your gut and your IBS are also affected. IBS may exacerbate in some pregnant females due to the above-mentioned factors:

• Hormonal changes occurring with pregnancy.
• Cutting off your effective IBS medications due to safety issues with pregnancy.

But studies showed that the first trimester has fewer IBS symptoms frequency (compared to the third trimester): 

The IBS symptom frequency according to each trimester are : [3]

• 17% in the first trimester.
• 19% in the second trimester.
• 33.9% in the third trimester.

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In the same study, the frequency of symptoms in non-pregnant women was 13%. This means that IBS symptoms in the first trimester may become slightly higher than before pregnancy (not in all females).

However, the difference was not big between pregnant and non-pregnant women.

IBS and late pregnancy (third trimester).

IBS may become worse during the third trimester. In this trimester progesterone and estrogen levels are greatest. Progesterone hormone is known to slow things down inside your colon. However, both IBS-constipation and IBS-Diarrhea can occur during the third trimester.

In the third trimester, your baby grows and the amount of amniotic fluid increases. This may cause IBS to get worse. Due to mechanical compression on your Gut and diaphragm, IBS bloating may also increase.

Also, you may get stressed in your late pregnancy as the delivery and arrival of your new baby become near. Stress can play a role in your IBS.

The most important concern is IBS-Constipation that worsens during the third trimester. You can relieve IBS constipation by the use of bulking agents and others (discussed later in this article).

MORE:9 Types of Lower Stomach Pain During Pregnancy Third Trimester.

3- Can IBS prevent you from getting pregnant?

Currently, there is no scientific evidence that IBS can affect your fertility. IBS is categorized as a “functional disorder”. The term “functional” denotes that we couldn’t find a definite lesion or defect in your gut causing the IBS.

IBS is a “psychosomatic” disease. It occurs more frequently with people who are more sensitive to pain. Also, it is related to chronic stress. 

IBS Itself can’t prevent you from getting pregnant. The only link between IBS and infertility is chronic stress and depression.

Chronic stress and depression in females can lead to a condition called Functional Hypothalamic Amenorrhea (FHA). FHA causes a disturbance in your menstrual period and this may lead to fertility problems. [4]

IBS itself is not known to prevent you from getting pregnant. But the same “stress” that led to IBS may lead to problems with fertility.

So…

You don’t have to worry about getting pregnant while you have IBS. this “worrying” puts you in stress. And IBS itself doesn’t lead to infertility.

5- Can IBS affect or harm pregnancy?

IBS is not known to cause problems during pregnancy. You just have to stick to safe medications that don’t cause harm to your baby (discussed below).

Worth mentioning that some studies addressed a small increase in the risk of miscarriage and ectopic pregnancy.

A large study [5] included about 100,000 pregnant women in the UK. Out of the 100k women, about 26k were diagnosed with IBS before pregnancy. 

The study found a moderately increased risk of miscarriage and ectopic pregnancy. But there was no risk of pre-eclampsia nor stillbirth.

Although the large number of study subjects, the evidence is still weak and the risk is small. 

But you have to discuss your IBS with both your obstetrician and your gastroenterologist.

Another concern about IBS and your pregnancy is severe IBS-diarrhea and IBS-constipation.

When IBS-Diarrhea gets out of your control may cause your dehydration which can affect your baby. Also, with severe IBS-Constipation, your pelvic muscles and uterus may become affected with constipation.

Consult your doctor when the symptoms of IBS become severe. Drink plenty of water with severe diarrhea and take safe bulking agents for constipation.

6- IBS relief during pregnancy (most effective tips).

Relieving IBS during pregnancy is quite a bit more challenging for you and your doctor. Some IBS medications are contraindicated during pregnancy.

I will mention the most effective tips to help you to cope with IBS during your pregnancy.what to do with IBS-D and IBS-C during pregnancy. And also, some details you should know about IBS medications and pregnancy.

(1) Avoid excess gas in your colon

Your colon is oversensitive to gas. With IBS and pregnancy, the condition may become more severe. This is because your abdomen is already distended with your baby. So your colon becomes even more sensitive, especially in the third trimester.

Avoid gas-producing foods like beans, onions, celery, carrots, and raisins.

Also avoid bananas, apricots, prunes, brussels sprouts, and carbonated beverages.

Some faulty habits can cause you more gas in your colon like:

• Eating and swallowing food quickly (that makes you swallow air with food).
• Chewing gums.
• Smoking.
• Not moving after you eat will decrease your colon motility and causes more gas.

(2) Avoid FODMAP foods and fruits: 

FODMAPs are a group of carbohydrates with short-chain molecules. Your intestine cannot digest and absorb them completely. 

• • Fermentable: means that gut bacteria break them down producing lots of gas.
  • Oligosaccharides: Refers to compounds called fructans and galacto-saccharides present in wheat, barley,  rye, onion, garlic, and legumes.
  • Disaccharides: Refuse to fructose sugar present in milk ice cream custard and yogurt.
  • Monosaccharides: Refers to free fructose present in Apples, pears, mangoes, cherries, watermelon, asparagus, sugar snap peas, honey, high-fructose corn syrup.
  • And
  • Polyols: They are substances called sorbitol mannitol xylitol and maltitol present in certain types of fruits like apples and watermelon and artificial sweeteners like artificially sweetened gum and alcohols.

(3) Gradually increase your fiber intake:

Fiber is a double-edged sword for IBS. Deficient fiber intake is thought to be a cause of IBS. on the other hading eating too much fiber or increasing its amount too fast can hurt your IBS. 

You should gradually increase the amount of fiber intake whether soluble (better for IBS) or insoluble. 

Choosing the right type of fiber and its food source can be challenging. You can learn how to exactly eat fiber for IBS in our in-depth article: “Fiber and IBS”.

Also, if you have IBS-constipation, you can consult your doctor about taking a safe fiber supplement like Psyllium.

(4) Manage your stress:

Physical and mental stress not only increase your IBS flare-ups but also may affect your pregnancy. 

Simply, Understanding and accepting your IBS can help to relieve your pain. Try to:

• Talk about your conditions with your partner or close family members or friends. Just talking can relieve your stress and IBS.
• Do Yoga for IBS.
• Consult your doctor about CBT (Cognitive Behavioural Therapy) for IBS.

(5) probiotics are safe during pregnancy. [6]

In this Review article about probiotics and pregnancy, the authors concluded that probiotics are safe during pregnancy.

Although the scientific evidence for the use of probiotics is still not strong enough. We usually recommend a trial of a probiotic for IBS sufferers.

Probiotics (in some patients) can decrease IBS symptoms like gas, bloating, cramps, and diarrhea. 

We suggest you try it for one month as it may be effective for you. For the best probiotics for IBS and how to take it, refer to this article.

7- Pregnancy and IBS-C management

The most effective and most safe strategies for managing your IBS-C are: [7]

• Gradually increasing your dietary fibers (very effective). See how to eat fiber for IBS here.
• Drink plenty of water.
• Increase your daily exercise: for example, you can walk for 20 minutes twice a day after meals.
• Use safe laxative: A bulk-forming laxative like psyllium (Metamucil) may help you with constipation but consider using it for short term periods.

Management of IBS-constipation during pregnancy can be difficult. If the above tips didn’t help please consult your doctor.

8- Pregnancy and IBS-D management

Diarrhea can be due to IBS or due to infections. If you are not sure about the cause of your IBS diarrhea you can contact your doctor.

If you have IBS diarrhea It is vital to drink lots of water. Water helps you to avoid becoming dehydrated.

The famous over the counter drug for IBS diarrhea “Immodium” is a category “C” during pregnancy. A category C drug means that the studies on humans are inadequate. 

So, the drug may be potentially harmful. Never take Immodium without the consultation of your obstetrician or Gastroenterologist.

Try to avoid trigger foods like FODMAPs and take probiotics. This can help IBS-Diarrhea. 

And If the attack of diarrhea is mild, you can just wait for a few days. In most cases, it is self-limiting.

C- IBS medications during pregnancy.

Many drugs are used for IBS. whether you use a prescription drug or over the counter supplement you have to discuss it with your doctor.

Some of the over the counter drugs and supplements are not considered safe during pregnancy. The below table summarizes the pregnancy category of each IBS medications and its safety with pregnancy: [8]

• Category A drugs: studies showed that the drug is safe for the fetus.
• Category B drugs: studies on animals showed that the drug is safe, but no controlled human studies.
• Category C drugs: No controlled studies done on animals nor humans. Potentially unsafe. 
• Category D drugs: evidence of risk to fetus presents. But can be taken in dangerous or life-threatening conditions.
• Category X drugs: strong evidence of risk in both animal and human studies. Its risks overweigh any benefits.
• N: Not classified by FDA

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You can find the full list of IBS drugs and their pregnancy category at Drugs.com

ALWAYS WORK WITH YOUR DOCTOR TO SELECT THE BEST TREATMENT OPTIONS WITH YOUR PREGNANCY.

ALSO, ALWAYS CHECK FOR PREGNANCY CATEGORY FOR ANY DRUG OR SUPPLEMENT YOU USE!