How to Manage IBS-D When You Are Pregnant

The management of diarrhea-predominant irritable bowel syndrome (IBS-D) is not easy under most circumstances, and is certainly complicated by pregnancy. You will need to find strategies that help to manage your symptoms without putting your baby at risk.

IBS and Pregnancy

In general, women who are pregnant tend to experience more IBS symptoms than women who are not pregnant. This is most likely because the hormones of pregnancy have an effect on the function of your digestive system. This affects how quickly stool moves through your large intestine and how much water is absorbed from the stool as it makes its way through.

One chart review of over 100,000 women in the United Kingdom found an increase in the risk of miscarriage and ectopic pregnancy in women who have IBS. No increased risk was found for preeclampsia or stillbirth. This study did not provide any information as to how this risk relates to IBS subtype.

Keep in mind that such studies point to a correlation and not causation. It may not be your IBS-D that raises your personal risk, but it is important to obtain quality prenatal care, especially with a preexisting condition like IBS.

Work Closely With Your Healthcare Provider

It is essential to speak with your obstetrician before taking any medication to treat your IBS-D symptoms, including over-the-counter products. When it comes to the safety of prescription medications for diarrhea, your healthcare provider is in the best position to advise you about the safety record of the various options. Some medications may be okay if used infrequently; others are best avoided.

Although you may have reached for the Imodium regularly before you got pregnant, it may not be a good option for you now. There are mixed research results as to whether or not Imodium can cause problems for a developing fetus. It is always essential to work with your healthcare provider or pharmacist to figure out which medications can be used safely while you are pregnant or breastfeeding.

Eat Wisely

The safest way to try to manage your IBS-D symptoms while pregnant is through dietary modification. You will want to make sure to follow a well-rounded diet to ensure optimal nutrition for your developing baby. While doing so, keep these basic guidelines in mind:

• Avoid eating a diet filled with unhealthy fats. This includes fried foods, greasy foods, and fast foods, as these foods can strengthen intestinal contractions contributing to abdominal pain and diarrhea episodes. Don't neglect to take in healthy fats, as these fats are important for your health and that of your growing baby. Examples of healthy fats include avocados, coconut oil, nuts, and nut butters.
• Avoid poorly digested sugars, such as lactose, fructose, and sorbitol, if you tend to experience bloating along with diarrhea. Some people with IBS find a low-FODMAPs diet to be helpful in managing their symptoms.
• Minimize your intake of gassy foods if you are experiencing excessive flatulence,

Try Some Soluble Fiber

Psyllium fiber (like is found in Metamucil) is a soluble fiber that may help with IBS symptoms.

In their 2021 clinical guidelines for IBS, the American College of Gastroenterology recommends soluble fiber for IBS, but not insoluble fiber. Soluble fiber is found in psyllium, oat bran, barley, and beans. Insoluble fiber is found in wheat bran, whole grains, and some vegetables. Psyllium has the added advantage of not fermenting in the gut well, because foods that ferment in the colon can lead to extra gas and liquid, potentially making symptoms worse.

Psyllium works by absorbing water and becoming viscous. That is why is helps to lubricate and soften stools in people with constipation, but it also help stools to be bulkier and more formed in people with diarrhea.

Psyllium is generally regarded as safe during pregnancy, but it may interfere with iron absorption or the absorption of other medications. If you are taking iron supplements, it is recommended that you take iron one hour before or four hours after taking psyllium. If you are taking other medications, talk with your healthcare provider before using psyllium. It is important to drink plenty of water with psyllium in order for it to work properly.

Drink Plenty of Fluids

Remember that you are drinking for two. Maintaining adequate hydration is essential for your health and that of your baby. If you are experiencing chronic episodes of diarrhea, you are at risk for excess fluid loss and therefore a state of dehydration. You will know that you are taking in enough water if your urine is clear or a light "straw" color.

Use Stress Management Options

If you haven't already tried psychotherapy as a treatment for your IBS-D, your pregnancy may be just the thing to get you motivated. This may be particularly essential if you experience anxiety or depression alongside your IBS, as research has shown that these combos increase the risk of miscarriage and ectopic pregnancy.

Two types of therapy—cognitive behavioral therapy (CBT) and hypnotherapy—have been shown to be effective in reducing IBS symptoms. The major advantage of these treatments is that you do not have to worry about any negative effects on your baby.

Other mind/body approaches offer additional options. Yoga may not only be of benefit for your IBS symptoms, but it may also help to ease discomfort during labor and delivery. Meditation is also a wonderful option for offsetting the effects of external stress on your body.