Pregnancy With IBS Can Feel Like a Roller Coaster Ride, but There Are Safe Ways To Manage Your Symptoms

But what happens if you're already dealing with a pre-existing GI issue, like irritable bowel syndrome (IBS), and get pregnant? Does your condition worsen, or maybe even improve, while you're expecting? And if it does worsen, can you still take the same medications (or eat the same foods, exercise the same way, etc.) that once helped alleviate your flares?

To learn more about the connection between IBS and pregnancy, we spoke with Karina—a mother of two with IBS—about her experience managing her condition while expecting. We also tapped two experts for tips on managing IBS flares while also keeping you and your baby healthy and safe.

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What's it like to have IBS while pregnant?

Navigating IBS during pregnancy can be a different experience for each person, but for Karina, it was a bit of a roller coaster ride. The beginning of Karina's first pregnancy made her feel like she was in a constant IBS flare, with her diarrhea getting worse by the day.

"After the first few weeks, I started dealing with morning sickness, too, which made it very hard to eat safely," she says. She could only stomach foods that happened to be IBS triggers, while foods historically "safe" for her IBS were impossible to even look at. (Pregnancy food aversion is real, folks).

But there came a light at the end of the tunnel: At the end of her first trimester, Karina's IBS actually improved, and even felt nonexistent at times. By her second and third trimesters, she hardly dealt with diarrhea. She had occasional bloating, heartburn, and even bad gas pains (that sent her to the hospital to make sure everything was okay), but overall, she was in the clear.

Getting to that point involved a lot of changes to her typical IBS treatment. Many coping skills she'd acquired were now considered "no-nos" in pregnancy. She couldn't use a heating pad on her belly to alleviate IBS cramps, and she couldn't take certain medications to stop diarrhea. She also had to re-learn which foods caused (or didn't cause) IBS flares—both during and post-pregnancy.

Thankfully, certain habits she had already implemented for a healthy pregnancy helped her IBS. She began taking iron supplements for her iron-deficiency anemia, which causes constipation in some people, but actually helped her stop taking so many trips to the bathroom. She also started prenatal yoga, which helped alleviate some GI discomfort like cramping and gas.

Managing IBS while pregnant helped Karina mitigate some potential risks to her and her baby's health. (More on this below.)

Is there any risk of pregnancy complications from IBS?

"IBS can increase a person's risk of dehydration and nutritional deficiency during pregnancy," says Keren Kohath, DO, OB/GYN at Pediatrix Medical Group in San Jose, California. This may be the case if a person has frequent diarrhea or if they are avoiding many foods that trigger their IBS symptoms. For this reason, it's important to work with your doctor and/or a registered dietitian well-versed in IBS to help manage your symptoms during pregnancy.

It's possible there may also be an increased risk of certain pregnancy complications with IBS, though the research is limited. There is one small May 2021 review in The Journal of Obstetrics and Gynaecology Research² that found a slight increased risk of ectopic pregnancy in people with IBS compared to those without. Another December 2022 study in the Journal of Maternal-Fetal & Neonatal Medicine, which looked at over 9 million deliveries, concluded IBS was associated with increased risk of preeclampsia, deep venous thrombosis (DVT), and birth defects.

Keep in mind: This information isn't meant to scare you, and more research is needed to completely support these findings. Most people with IBS go on to have perfectly normal pregnancies, and just because IBS is associated with these outcomes does not mean IBS caused them.

Either way, it's important to bring up to your OB/GYN whether you have IBS or start to develop symptoms. That way, they can monitor you closely and help prevent any complications.

Can pregnancy cause new-onset IBS?

Pregnancy can cause new-onset IBS for several reasons. “Pregnancy causes significant hormonal changes, including an increase in progesterone—which can lead to constipation,” says Dr. Kohath. She adds that significant structural changes during pregnancy, like increased pressure on your gastrointestinal organs, can also contribute to the development of IBS symptoms.

And it’s not just the physical changes that can cause IBS-like symptoms. “Pregnancy and the postpartum period can be times of heightened emotional stress and anxiety, which are known to exacerbate GI symptoms,” says Sarah Robbins, MD, MSc, gastroenterologist and founder of Well Sunday. “Stress can influence the severity and perception of IBS symptoms due to its effect on the gut-brain axis,” she adds.

Some symptoms to watch out for include constipation, diarrhea, or a combination of both, says Dr. Kohath. Other symptoms of IBS include abdominal pain and bloating. If you’re having these symptoms, Dr. Kohath recommends seeking personalized care from your physician, as these symptoms could be related to several causes. Dr. Robbins also notes in the context of pregnancy, distinguishing new-onset IBS from typical pregnancy-related GI issues can be challenging, due to the overlap in symptoms. Your doctor can help you figure out the difference.

"Managing IBS during pregnancy involves balancing the need to alleviate IBS with diet changes and ensuring you get enough nutrients for you and your baby." —Sarah Robbins, MD, gastroenterologist

How to safely manage IBS while pregnant

If you have IBS and are planning to get pregnant, you may have a lot of questions about how to safely manage your condition while carrying your child. Fortunately, there are many effective management strategies you can use.

Make slight dietary modifications

"Managing IBS during pregnancy with diet changes is a nuanced topic, because it involves balancing the need to alleviate IBS with ensuring you get enough nutrients for you and your baby," says Dr. Robbins. While avoiding trigger foods—like those high in certain carbohydrates, called FODMAPs—may help relieve IBS symptoms, avoiding these foods for too long can lead to nutrient deficiencies if not managed carefully, she adds.

Rather than broad dietary restrictions, Dr. Robbins recommends selectively eliminating the most symptom-provoking foods. You can figure out which ones those are by keeping a food diary or following a brief elimination diet. If you can't figure out which foods are triggering, stop your elimination diet and let your doctor know.

With that in mind, it's also important to work with your doctor or a registered dietitian on slowly eliminating certain foods from your diet, while still meeting your nutrient requirements. For example, if you're cutting back on dairy, you may need to take a supplement to fill nutrient gaps—like calcium or vitamin D.

Get more fiber

Adding more fiber to your diet is a general recommendation for people with IBS (whether they're pregnant or not), but different types have different benefits, according to a March 2021 review in the American Journal of Gastroenterology.

Insoluble fiber, which can be found in things like wheat bran, fruit, and vegetable skins, helps bulk up and move stool through your intestines. Soluble fiber, on the other hand, bulks up stool by pulling water into your GI tract. It can be found in things like psyllium husk, oats, bananas, and apples without the skin, per Dr. Robbins.

“Soluble fiber is generally recommended, especially during the third trimester when constipation can become more pronounced,” she says. "If you’re increasing your fiber intake, do it slowly to reduce the risk of gas and bloating."

Hydrate, hydrate, hydrate

Because constipation is already a common pregnancy symptom, Dr. Kohath advises all pregnant people to stay properly hydrated to get things moving. If you have a hard time getting enough H2O throughout the day, try keeping a fun water bottle nearby and taking sips at regular intervals. You can even download an app that will ping you when it's time to drink more water.

And if you simply don't like the taste of plain ol' water? Try adding pieces of fresh mint, slices of cucumber, or a few berries to your glass.

Eat small, frequent meals

If you feel IBS symptoms coming on right after you eat, you may want to adjust the frequency of your meals. Dr. Kohath recommends eating small, frequent meals throughout the day to avoid overloading your digestive system. You may find this also keeps blood sugar crashes and hunger pangs at bay when you're pregnant.

Small, frequent meals and snacks may also help stave off nausea, which is common in the first trimester, she adds.

Incorporate stress-management techniques

“Pregnancy can be a stressful time, and stress can exacerbate IBS symptoms,” says Dr. Robbins. Not only are you dealing with the stressors of everyday life, but you're also busy prepping for your baby's arrival, and keeping you and your baby as healthy as possible.

To ease some of that stress away, you can try things like prenatal yoga, meditation, deep-breathing exercises, and mindfulness. All can help lower your stress levels, and possibly improve your IBS symptoms, she adds.

Try gentle exercise and stretches

There are still plenty of exercises you can do while pregnant. In fact, they're encouraged for a smoother pregnancy and birth. Dr. Robbins recommends gentle exercise like walking, prenatal yoga, or swimming to help reduce stress, strengthen your muscles, and regulate bowel movements.

But of course, talk with your OB/GYN before starting any new exercise regimen during pregnancy. You want to make sure it's a safe and healthy fit.

Ask your doctor about pregnancy-safe medications

Unfortunately, the safety¹ of most medications used to treat IBS with constipation (IBS-C) during pregnancy and breastfeeding, in particular, is not well established, says Dr. Robbins. This means, it's important to ask your OB/GYN for the final say on what medication is safe to take or not. While your primary-care doctor may have suggestions (or even give you hard "nos" about certain meds), they may not be as accustomed to treating common symptoms during pregnancy/postpartum.

A low-risk option is an osmotic laxative, which pulls water into your bowels, and includes some of the following, per Dr. Robbins:

• Polyethylene glycol (PEG) 3350
• Magnesium
• Lactulose

Options that should be avoided (and come with increased risk) include the following, per Dr. Robbins:

• Lubricants like castor oil
• Secretagogues (i.e., insulin-releasing pills) like linaclotide
• Prokinetic agents (which help stimulate your GI tract) like prucalopride

With IBS-D, things become a little trickier. “Choosing the right therapy for IBS-D during pregnancy and breastfeeding also requires a balanced approach to potential risks and benefits associated with each option,” says Dr. Robbins. Ask your doctor before taking the following medications to ease IBS-D while pregnant:

• Loperamide (Imodium)
• Bismuth subsalicylate (Pepto Bismol)
• Certain SSRIs
• Bile acid sequestrants

Ultimately, before trying any over-the-counter remedy (or prescription you once used), it's important to talk to your doctor. "They can prescribe or recommend pregnancy-safe medications for managing symptoms, like antispasmodics for pain or bulk-forming laxatives for constipation,” says Dr. Robbins.

Get your partner involved

Another way to manage IBS symptoms while pregnant is by getting your partner (or a trusted loved one) involved, says Karina. Let them know when you are feeling GI issues like morning sickness, diarrhea, constipation, etc. Make a list of triggering and safe foods so they are aware, and ask for help shopping and prepping meals for the week.

This type of support can be especially important when your symptoms are too intense to cook or care for yourself properly (which happened for Karina in those early weeks of pregnancy).

Ask about getting an IBS-friendly meal post-birth

This may not be top-of-mind right now, but making sure you have a meal that's not going to bother your stomach after you've given birth at the hospital (or birthing center) is important. Karina didn't let doctors and midwives know about her requirements at her first birth, and she ended up not being able to eat anything the hospital provided for her.

With her second pregnancy, she was clear about her dietary needs from the beginning and was even able to talk with the hospital's dietitian well before birth. They were able to get her a meal that was nutritious and IBS-friendly.

Ask about medications after birth

"For my entire first pregnancy, I solely focused on the pregnancy and giving birth part," says Karina. Once she had her baby, she didn't pay much attention to what was happening at the hospital, and didn't notice that staff were giving her laxatives. (FYI, laxatives are very commonly given after birth as a standard of care, to avoid straining and reopening vaginal tears with that first BM, or to relieve constipation from meds given during labor.)

As someone with IBS-D, this was a huge "no-no," and it sent her into a horrible flare that lasted for weeks. The second time around, she was careful to inquire about everything she was being given and did not get a flare after her second delivery.

Bottom line: Ask about the medications being given to you after birth, and whether or not they'll interfere with your IBS symptoms.

Consider pelvic floor therapy

Pelvic floor therapy is not just a great option for strengthening a weak pelvic floor post-birth. It's also a great way to help regulate bowel incontinence—a common issue for people with IBS-D. Karina found pelvic floor therapy during and after birth to be helpful in reducing her bowel incontinence issues, and she recommends it to anyone dealing with IBS flares while pregnant.

Of course, ask your OB/GYN first about whether pelvic floor therapy is right for you.

When to see a doctor

According to Dr. Robbins, it's pretty common to have GI symptoms during pregnancy, especially due to all the physiological and hormonal changes happening in your body. That said, distinguishing between normal pregnancy issues and IBS requires the expertise of a doctor. Getting properly checked out "can be crucial to the health and well-being of both mother and fetus," she adds.

Talk to your doctor about any changes in bowel habits you've noticed, and seek immediate medical attention if you have any of the following, per Dr. Robbins:

• Persistent vomiting, which can lead to dehydration and malnutrition if not treated
• Severe abdominal pain
• Changes in bowel movements, like severe or prolonged constipation or severe diarrhea lasting more than 48 hours
• Blood in stool or vomit
• Signs of dehydration, such as dizziness, excessive thirst, dry mouth, and decreased urine output
• Unexplained weight loss
• Persistent heartburn or indigestion
• Jaundice (yellowing of the skin or eyes), which can indicate liver problems

“It’s always best to err on the side of caution and bring up concerns or unusual symptoms with your doctor during pregnancy," says Dr. Robbins. “Early intervention can prevent complications and ensure both maternal and fetal health throughout the pregnancy,” she adds.

If you have IBS, it's understandable you might be worried about it getting worse during pregnancy. Fortunately, there are many things you can do to alleviate flares while in this precious stage of life. By slightly changing up your routine, working closely with your doctor, and advocating for your care post-birth, you can decrease your chances of IBS flares before and after birth.

—medically reviewed by Andrea Braden, MD, OB/GYN