Pregnancy can be a tough time for the digestive tract – the hormonal changes and increased pressure on the bowels from your growing baby puts you at higher risk of constipation, loose stool, abdominal pain and increased bloating. IBS may make this more pronounced. Mild symptoms will not put you or your growing baby at increased risk, but it may feel uncomfortable. As always, you should take care to avoid any food you know brings on IBS symptoms. Keeping well-hydrated is key, and gentle exercise can help regulate bowel movements and reduce stress. If you feel you need medication, there are options. One of our pharmacists will go through what’s safe. Pregnancy is a time of great change, and anxiety plays a part for most women. IBS sufferers will know that stress and anxiety can make IBS symptoms worse. So it’s important to keep yourself protected. Think of techniques that have helped in the past and start them before any flare-up. Or consider putting aside 20 minutes a day for something you find relaxing – reading, music, gentle yoga or putting a mindfulness podcast on.
Women may choose to take iron tablets to protect against any anaemia in pregnancy, but these can constipation. Iron supplements come in different forms – ferrous sulphate, ferrous gluconate, ferrous fumarate – and switching to another form may alleviate symptoms. Liquid versions can be more gentle on the gut, and more easily absorbed. Fersamal syrup is available from your pharmacy or on prescription, and Feroglobin or Spatone can be bought to maintain levels after an iron deficiency is addressed. It’s a good idea to take iron supplements with food to help reduce the risk of constipation, although avoid tea, coffee, dairy and so-called "phytic acid" foods, as these can make it harder to absorb iron. Laxatives may help move things along, especially in late pregnancy, as the pressure of the growing baby can slow down your bowels. Osmotic laxatives such as lactulose solution or macrogol sachets (Movicol) are a good option, as they cause less cramping or bloating than other laxatives. They work by drawing more water into the large bowel and thereby hydrate and soften stools, making them easier to pass. With these laxatives, and constipation in general, make sure you keep your fluids topped up, it can help. You’re likely to have even higher requirements in pregnancy.
If loose stool is problematic in your IBS, you may have got used to turning to loperamide (Imodium) to slow gut contractions down, but this is not recommended in pregnancy. The first stop is the make sure you’re keeping well-hydrated with plenty of water, and keeping your electrolytes (salts) in balance. An oral rehydration salt drink such as O.R.S. is safe to rehydrate and rebalance electrolytes and may be a consideration if you are opening your bowels frequently or diarrhoea is very watery. It’s safe to use in pregnancy, as it’s just replacing the electrolytes and fluids you’ve already lost. (Speak to your doctor first if you have kidney problems or have been put on a low sodium diet.) Enterosgel intestinal adsorbent is a mineral mixture that’s safe in pregnancy and aims to reduce stool frequency and duration of diarrhoea. It’s a gel foam that works physically to bind toxins and bile acids, expelling them in the poo and relieving many of the unpleasant symptoms they bring. It’s less likely to cause bloating than some other products. Adding soluble fibre such as Fybogel sachets can help alleviate loose stools, and it's safe in pregnancy. It’s also marketed as a laxative, which might sound counter-intuitive, but it adds air to the stools which makes them expand, bulking them up and improving symptoms. (It reduces the hard impacted stools in constipation.) Fybogel may cause temporary bloating, so take water with it and avoid lying down for 30 minutes afterwards, and bloating should ease.
As your growing baby takes up more room in your tummy, this can put pressure on the gut, causing trapped wind, bloating and crampy pains. You might have tried tablets to reduce gut spasms before, such as mebeverine, alverine or peppermint oil capsules. Unfortunately the manufacturers suggest to avoid these as they haven’t run clinical trials on pregnant women. Manufacturers do add that they are not known to be harmful in pregnancy, so if you are suffering a great deal, this may be a discussion to have with your doctor: whether theoretical risks outweigh the benefits of symptom relief. Some people stand by the benefits of a simple tea made with fresh peppermint leaves in warm water. This can ease bloating and cramping, and you’re safe to go ahead with this in pregnancy. Anti-flatulents such as Wind-eze contain an inert substance called simeticone. This relieves pain and discomfort due to trapped wind by reducing air bubbles, so they pass more easily through the gut, and this is a safe option in pregnancy.
If you’ve tried the above treatments and your symptoms persist, it’s worth booking an appointment with your doctor. While the process of IBS does not risk your pregnancy, you want to avoid any symptoms becoming severe, such as dehydration and salt imbalance. And you want to be able to enjoy your pregnancy, too. Your doctor will consider treatments you’ve tried and may suggest other medications. They may order investigations such as blood tests, and they can refer you to obstetric or gut specialists, depending on their concerns. With any pregnancy, if you experience vaginal bleeding or severe abdominal pain, or if you experience reduced foetal movements later in the pregnancy, you should speak to your doctor urgently, or refer yourself to the Early Pregnancy Unit (in your first trimester) or Maternity Ward (from 3 months onwards). They can advise over the phone whether you should attend for further investigations. * Written by Adil Naeem, Head of Caidr Platform and a practising pharmacist