Is it a baby, or is it a bowl of pasta?
A comment never more relevant than in the case of IBS in pregnancy.
Irritable Bowel Syndrome (IBS) is a functional gut disorder which affects about 30% of Australians. IBS is more common in women, which increases the risk of juggling IBS in pregnancy.
Pregnancy is functional uterine condition where a tiny human (or humans) take up rent-free residence in the uterus for 9-10 months with zero abandon for other organs 😉
IBS is a diagnosis of exclusion. At time of writing, it has no known cause, but similar symptoms -which are varied between individuals, such as:
- altered GI motility (movement of food through the GI tract)
- altered gut-brain-axis communication (the brain talking to the gut and the gut talking the brain)
- visceral hypersensitivity (highly sensitive nerves around the GI tract)
- low grade inflammation
- intestinal permeability
- altered microbial diversity
- altered bowel habits and urgency (constipation and diarrhoea)
- pain, bloating, excessive gas and appetite changes
What does IBS treatment look like?
Numerous treatment options are available to manage IBS preconception (before pregnancy occurs).
You can work with a qualified dietitian to undertake an elimination protocol (ie: FODMAP) if appropriate. Gut directed hypnotherapy and meditation can be wildly effective in reducing symptoms. Making lifestyle changes like increasing sleep and reducing stress (easier said than done sometimes). Improving and regulating your diet pattern and quality. And if appropriate specific supplements and nutrient composition to improve gut health/microbial diversity. This list is not exclusive, just an idea of strategies I look at in clinic.
But for today, I want to talk about IBS in pregnancy. Because many IBS symptoms overlap with symptoms of pregnancy, like:
- pain, bloating, excessive gas and appetite changes
- altered bowl habits (constipation and diarrhoea)
- increased GI sensitivity
- nausea
- reflux
- altered gut transit time
- increased stressed
If you you have unmanaged IBS in pregnancy, there is a risk of micronutrient deficiency. Particularly if specific foods or whole food groups are avoided as symptom control. Some at-risk nutrients I tend to look for in clinic include b-vitamins, calcium, fibre and iron + protein & zinc if following a vegetarian or vegan diet.
Dehydration and nutrient deficiency risk is increased if you suffer from IBS-D (diarrhoea), while pelvic floor complication and haemorrhoids may arise if you suffer from IBS-C (constipation).
There is unfortunately not much available evidence for treatment of IBS in pregnancy. And as symptoms are known to change in pregnancy ie: bowel habit changes are not uncommon like alternating IBS-D to IBS-C or vice versa, it always a good idea to check in with your treating team if changes occur.
Pregnancy is not a time to diagnose IBS as the symptoms are too similar to know specifically what the cause is.
But if you do experience symptoms, here are some hacks to get you started with relief.
No. 1 See your GP & dietitian to manage IBS in pregnancy
Don’t pass go. Do not Google the FODMAP diet and do it on your own. Don’t cut out food groups or start supplements without first speaking to your GP and dietitian, particularly in pregnancy.
A prenatal dietitian will ensure you are still obtaining optimised nutrition through food swaps and supplements if you omit foods and food groups to manage your IBS.
Focus on improving sleep
Go to bed early, stop scrolling, put away screens, do whatever you need to do to boost your sleep hygiene. I wrote an article on food for sleep, read it here
Eat slowly and chew mindfully
Eating and chewing too quickly (like between meetings or on the run) will suck up more gas into your GI tract -leading to gas buildup. It also increases the volume of inefficiently chewed food particles in your GI tract. This further increases the risk of bloating and other gut symptoms related to unprocessed foods in the small and large intestines.
Reduce caffeine, spicy foods & fried foods
These foods are the top contributors to symptoms. If you investigated IBS symptoms before pregnancy and know your tolerable threshold for these foods – and they change in pregnancy, it may be worth reducing intake a little more.
Keep a food and symptom diary
Become a food detective and investigate your symptoms related to meals. If you can’t find a diet link to symptoms, work with a dietitian to help you (we’re really good at being food detectives ;)).
Should you find specific trigger food on your own, do not just cut out the food (or food group) out. Instead, find your tolerance threshold. If you do cut down on specific foods, be sure to replace them equally nutrient rich foods. For example, if you discover lactose causes you GI discomfort, look for calcium fortified and protein rich alternatives to replenished the right micronutrients for you and baby.
Hydrate
This one can be very tricky in trimester 1 in beyond in cases hyperemesis gravidarum.
Use fluid flavourings like natural fruit to make water more appealing if nausea if strong. Drink lightly sparkling water. And chat to your midwife/OB/GP/dietitian if you just cannot drink enough water.
Gut directed hypnotherapy & stress management
I prescribe stress reducing strategies with my clients regularly in clinic because they can be so wildly effective. These are all safe alternatives to try in pregnancy which won’t risk nutrient deficiency because they do not cut out food groups.
- Add prenatal yoga into your routine
- Make daily body movement non-negotiable
- Utilise box breathing as a technique to reduce pain
- trial gut directed hypnotherapy
Managing any health and gut condition on top of pregnancy is tricky. You are juggling multiple healthcare appointments, preparing for a new human to enter your life and then managing painful bloating, gas, bowels and potentially a fear of high nourishing foods.
