IBS In Pregnancy: Causes, Symptoms, Diagnosis & Treatment

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Irritable bowel syndrome or IBS is a disorder of the intestines that leads to frequent abdominal pain and discomfort (1). IBS is different from inflammatory bowel disease (IBD). IBS and pregnancy may co-exist, especially in women who already had the disorder. The pregnancy condition causes changes in bowel movement and gastrointestinal (GI) discomfort, usually with no underlying pathological causes.

Read on to know about IBS during pregnancy, its causes, symptoms, treatment, risk factors, and possible treatments.

Causes Of IBS During Pregnancy

The connection between IBS and pregnancy is not fully known, and there is insufficient conclusive research on the matter (2). The following pregnancy-related factors may increase the chances of developing IBS during pregnancy (1) (3).

  • Hormonal changes: The intestines are directly affected by hormones and the brain’s nerve signals (gut-brain axis).
    • Elevated ovarian hormones, such as estrogen, affect the intestines and may also change nerve signals. This may cause the intestines to become hypersensitive and more motile.
    • High levels of progesterone may lead to a release of smooth muscle fibers mainly to decrease uterine contractions and avoid premature delivery. But this has the side effect of slowing the motility of the large intestine leading to constipation
    • It is common to observe pyrosis and eructations, probably explained by delayed gastric emptying and gastroesophageal reflux by the release of the lower esophageal sphincter and diaphragm orifice. This can also cause gastrointestinal effects such as nausea, vomiting, and heartburn.
    • There may also be an increase in the immune response of the intestinal mucosa. These events may eventually lead to IBS.
  • Psychological reasons: Pregnant women may often encounter mental stress for various reasons. Stress may affect the nerve signals sent by the brain to the intestines, making them more sensitive and causing them to contract more. Women with anxiety or depression may be prone to IBS due to psychological factors.
  • Pressure from the uterus: The growing fetus causes the uterus to enlarge, causing pressure on the gastrointestinal system. It may cause frequent abdominal cramps and changes in bowel habits.

Some non-pregnancy-specific reasons include gastrointestinal infections, such as parasitic and bacterial infections, which may spread through the consumption of contaminated food and water. This type of IBS is called post-infectious IBS.

Common Symptoms Of IBS

The condition is divided into three types, IBS-C (IBS with constipation), IBS-D (IBS with diarrhea), and IBS-M (IBS with mixed bowel habits) (4). Some pregnant women may notice improvement of symptoms, while for some, it may worsen (5). The symptoms may emerge during any stage of pregnancy.

The signs and symptoms that are commonly seen are as follows (1).

  • Diarrhea in IBS-D
  • Constipation in IBS-C
  • Cramps and pain in the abdomen
  • Bloating and gassiness
  • Change in bowel habits
  • Loss of appetite may occur in some cases

Diagnosis And Treatment For IBS During Pregnancy

There is no specific diagnosis and treatment for IBS (1) (4). The doctor may check symptoms and order different tests, such as stool test, to rule out other problems, such as infections, lactose intolerance, gluten intolerance, and ulcerative colitis. The more important is to be sure there is nor organic lesion or tumor to explain these gastrointestinal symptoms.

The treatment focuses on identifying the triggers for abdominal discomfort and managing the symptoms to prevent discomfort. The following treatments could be considered if you are diagnosed with IBS during pregnancy.

  • Hypnosis: The treatment of IBS with the help of hypnosis has been proven effective in several clinical studies. The process of hypnotherapy for treating IBS entails progressive relaxation with the help of sensations distinctly based on the individual’s symptoms (6). Hypnosis may be conducted with other therapies, such as cognitive therapy, depending on the patient’s response.
  • Medications: The use of over-the-counter (OTC) medications to treat IBS during pregnancy is usually not recommended due to the potential harmful effects. Medicines may usually be prescribed to reduce diarrhea in case of IBS-D or improve bowel movement in case of IBS-C. The prescribed medication may vary based on various factors, including the severity of IBS and the pregnancy trimester. It can include laxatives, antispasmodics, and gas absorbent carbon. Speak to your doctor to know medicines to treat your specific condition.

Home Remedies For IBS

Key Pointers

  • Hormonal, psychological, and physical changes during pregnancy may lead to irritable bowel syndrome or IBS.
  • Notable symptoms of IBS include abdominal pain, cramps, and changes in bowel movements.
  • Lifestyle and dietary changes usually provide relief. Medications may be considered if prescribed by the doctor.
  • IBS is not noted to cause any fetal complications. The condition may persist for a long time but does not permanently damage the intestines.

IBS symptoms may be manageable with some interventions at home. You may consider the following practices to reduce abdominal discomfort.

1. Dietary changes

Dietary modifications include staying hydrated and avoiding gas-producing foods, such as broccoli, cabbage, sprouts, foods containing excess spices and certain foods that may lead to increased gas. Of course rapid sugar and carbonated and alcoholic beverages should be avoided during pregnancy.

Studies show that some people with IBS report improvement in diarrhea symptoms if they stop eating gluten (wheat, barley and rye) even if they don’t have celiac disease.

Recent study results have shown that the reduction in consumption of fermentable oli-, di-, and monosaccharides and polyols (FODMAPs) has helped reduce IBS symptoms (7).

FODMAP is a type of carbohydrate that is poorly absorbed by the intestines, causing abdominal discomfort and cramping. A few foods rich in FODMAPS include the following (8).

  • Beans and lentils
  • Certain fruits, such as peaches, pears, apples, and cherries
  • Certain vegetables, such as onion, garlic, asparagus, and artichokes
  • Wheat products
  • Dairy products

You may not show the same sensitivity to all high FODMAP foods. Therefore, maintain a food diary to note the food you eat and the quantity eaten. You can use the diary to check your last meal when you develop symptoms and also share it with your doctor.

Those who have IBS with constipation can alleviate it with the following methods.

  • Drink more water
  • Include high-fiber food items, such as fruits and vegetables
  • Include natural sources of fiber in the diet, such as ispaghula and psyllium husk

You may also try the following general dietary changes to minimize the chances of gastrointestinal discomfort.

  • Minimize intake of fatty or deep-fried foods
  • Avoid soda or cola and beverages with caffeine such as tea and coffee
  • Eat multiple smaller meals
  • Eat slowly with small bites

2. Lifestyle changes

These include managing any triggers that lead to IBS symptoms. You may consider the following measures.

  • Try relaxation techniques, such as gentle breathing exercises, walking, and other activities, such as listening to music, which may relax you.
  • Quit smoking or alcohol.
  • Reach out to support groups or have a social circle to speak about your challenges through pregnancy. It may help you vent out your feelings and feel less stressed.
  • Consult a counselor or psychologist to learn ways to manage depression or anxiety.

IBS Complications In Pregnancy

There are no widespread pregnancy-specific complications of IBS. A study noted spontaneous miscarriage, ectopic pregnancy, preeclampsia, and stillbirth to be complications of having IBS before pregnancy (2). However, there are no additional studies or conclusive research data to prove that IBS can consistently increase the risk of these conditions in most women. The syndrome may last for a long time or a lifetime, but it does not cause permanent damage to the intestines (1). IBS is not life-threatening and does not increase the risk of other gastrointestinal problems (4).

IBS and other gastrointestinal issues often arise during pregnancy due to hormonal changes, stress, and lifestyle changes. IBS can often be managed at home with remedies that can provide long-term benefits and improve quality of life. Although there are known preventive measures for IBS, identifying the triggers and avoiding them can usually prevent the onset of symptoms again.

References:

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Dr. Ben Abbes Taarji Hicham

Dr. Ben Abbes Taarji Hicham is a practicing obstetrician and gynecologist with over 20 years of experience. Having worked in various Moroccan hospitals, he currently runs a private practice. Dr. Hicham specializes in rejuvenation and cosmetic gynecology, medically assisted reproduction, breast and gynecological cancers, HPV diseases, hysteroscopy and laparoscopy, and hormonal disorders.

Sanjana Bhattacharjee

Sanjana did her post graduation in Applied Microbiology from Vellore Institute of Technology, India. Her interest in science and health, combined with her passion to write made her convert from a scientist to a writer. She believes her role at MomJunction combines the best of both worlds as she writes health-based content based on scientific evidence. Sanjana is trained in classical... more

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