Irritable Bowel Syndrome

INFORMATION FOR WOMEN WHO HAVE IRRITABLE BOWEL SYNDROME DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a common disorder of gastrointestinal function. It can result from a variety of abnormalities that are generally minor, as they are not connected with any anatomic problems, inflammation, or other disease processes, such as infection or cancer. Such abnormalities include intolerance to certain types of carbohydrates, often due to a deficiency of the enzymes needed to break down the particular substance. The abnormalities also include anxiety and similar behavioral disorders that make nervousness a trigger for an IBS attack. In all cases, IBS is characterized by abdominal pain and altered, or unpredictable bowel habits, including diarrhea and constipation. In the past, the condition often was called a spastic colon, but this term has mostly been replaced by IBS. It is important not to confuse IBS with IBD, which stands for inflammatory bowel disease.

How common is irritable bowel syndrome during pregnancy?

About 10 15 percent of adults in the US suffer from IBS. The condition is diagnosed most often during the 20s and 30s, so it overlaps with the reproductive years. On top of this, females are affected twice as often as males, so IBS quite often co-exists with pregnancy.

How is IBS diagnosed?

IBS is typically a diagnosis of exclusion. This means that you are sent to a specialist in this case, a gastroenterologist to evaluate you for several different diseases, such as IBD, serious gastrointestinal infections, genetic disorders affecting the digestive tract, and cancers, and if all tests turn out negative IBS is diagnosed. The various workups generally include blood tests and several types of imaging. In some cases IBS may be found to result from minor enzyme deficiencies, such as a lactose deficiency (inability to digest milk sugar) or the person is found to have what is called a fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) intolerance. This means that they have trouble digesting any of a range of carbohydrates. In either case, the condition may be controlled at least partly through control of the diet.

Does IBS cause problems during pregnancy?

IBS generally does not produce any severe complications, but the symptoms, which are already very uncomfortable, can be exacerbated as pregnancy progresses, due to the increasing growth of the womb and the resulting pressure increase on the intestines. Diarrhea caused by IBS also can aggravate hemorrhoids, which themselves are provoked by pregnancy. Also, if your digestive disturbance comes at night, which it often does with IBS, this could lead a pregnant woman to go to sleep later than planned. Combined with a schedule that requires you to wake early in the morning, this can lead to inadequate sleep.

Does IBS during pregnancy cause problems for the baby?

IBS does not cause any particular problems for the developing baby.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the IBS
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat IBS during pregnancy?

IBS is treated symptom by symptom, which can involve some medications. Cramping in the digestive tract is treated with medications called antispasmodics. Certain antidepressant drugs, such as amitriptyline and fluoxetine may be used. The way that these drugs fit in with pregnancy is that their safety for the developing baby has not been proven, but theres no clear indication that theyre harmful either, so they can be used in certain cases, namely when the patient shows that her symptoms improve dramatically with them.

In contrast, the drug loperamide, given for diarrhea is very safe for the developing baby, because it is not absorbed from the intestines into the bloodstream, so there is no way that it can reach the baby in the first place. Some concern, however, surrounds an anti-diarrheal drug called alosetron, so if loperamide works for you this is the drug of choice against diarrhea. Theres another anti-diarrheal drug called eluxadoline, which works similarly to loperamide, but its safety issues in pregnancy have not been studied widely.

Finally, laxatives also are used for IBS, particularly a type of laxative called an osmotic laxative. These work by drawing water into fiber to add bulk to stool, which helps both against diarrhea and constipation.

Who should NOT stop taking medication for irritable bowel syndrome during pregnancy?

Medications are often not necessary for IBS, but they can make you more comfortable.

What should I know about choosing a medication for my irritable bowel syndrome during pregnancy?

You may find Pregistrys expert reports about the individual medications used to treat IBS here. Additional information can also be found in the sources listed at the bottom of this report.

What should I know about taking a medication for my irritable bowel syndrome when I am breastfeeding?

Some of the agents used in IBS, particularly loperamide and osmotic laxatives, are thought to be very safe as they are not absorbed from the mothers digestive tract into her bloodstream.

What alternative therapies besides medications can I use to treat IBS during pregnancy?

Dietary approaches to IBS are very important and include adequate intake of fiber and fluids, assessment of the effects of spicy or fatty food and reduction of these foods if helpful, and reductions of caffeine and alcohol. A diet low in FODMAPs also should be attempted for a minimum of 3–4 weeks under dietitian guidance. A low, or no, lactose diet also should be attempted. With the dietary approaches, its basically trial and error. Certain approaches work for some people and not for others.

Symptoms also tend to improve with regular aerobic exercise, plus there are psychological therapies that can be helpful.

What can I do for myself and my baby when I have IBS during pregnancy?

Cooperate with your physicians, engage in a regular exercise program thats appropriate for pregnancy, and visit a dietitian to discuss possible dietary changes.

Resources for IBS in pregnancy:

For more information about IBS during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or check the following links:

 

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General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


Medications for Irritable Bowel Syndrome


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