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THE IBS DIETITIAN

Kirsten Jackson Consultant BSc Hons PG Cert RD

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IBS and Pregnancy – Dietitian Advice

by Kirsten Jackson Consultant Dietitian BSc Hons, RD, PG Cert Leave a Comment

Many women may feel a sense of concern when thinking about how they will manage their IBS and pregnancy. However, the advice for IBS and pregnancy does not differ hugely to the standard advice given for common symptoms during pregnancy.

This article will clarify the main questions about IBS and pregnancy through the management of various common pregnancy symptoms. These include constipation, morning sickness, haemorrhoids and iron deficiency anaemia.

pregnancy and IBS

Table of Contents

  • How does IBS change during pregnancy? 
  • How do pregnancy hormones impact IBS?
    • Oestrogen in pregnancy and IBS
    • Progesterone in pregnancy and IBS
  • How to manage constipation when pregnant
    • Causes of constipation during pregnancy; (5)
  • Management of constipation in pregnancy
    • Medications for constipation for IBS and pregnancy 
  • How to manage morning sickness
  • How to manage haemorrhoids when pregnant
    • Dietary and Lifestyle Management (9)
    • Pharmacological management (9)
  • How to manage iron deficiency when pregnant 
    • Prevention of iron deficiency in pregnancy (11, 12)
  • Can you do the low FODMAP diet whilst pregnant?
  • Summary

How does IBS change during pregnancy? 

You will be sad to know that we have no specific research looking at IBS and pregnancy.

What we do know is that in pregnancy, you may experience a range of common digestive issues including;(1)

  • Nausea
  • Vomiting
  • Heartburn
  • Constipation
  • Loose stools
  • Abdominal pain and discomfort.

All of these digestive symptoms are also often experienced in those with IBS. Theoretically, these symptoms may then get worse when you add pregnancy to the mix. But there is currently insufficient research to confirm this. 

Another element we see in practise is stress. For many women, pregnancy and childbirth can be quite daunting. We know that stress can impact IBS negatively via the gut-brain axis (1).

How do pregnancy hormones impact IBS?

As already mentioned, there is no direct research looking at IBS and pregnancy. But we do know that progesterone and oestrogen hormones impact IBS (2).  These hormones fluctuate during pregnancy.

Oestrogen in pregnancy and IBS

Oestrogen is produced early in pregnancy to help support the baby until the placenta takes over.

This hormone oestrogen has been shown to play a role in the gut-brain axis and increased levels have been associated with the worsening of  IBS symptoms. 

Symptoms include:  visceral hypersensitivity i.e. an increase in the sensation of pain resulting in abdominal pain and discomfort (3). 

High levels of oestrogen have also been shown to increase gut motility and intestinal permeability. This can result in diarrhoea or loose stools (3).

Progesterone in pregnancy and IBS

The production of the hormone progesterone is increased during pregnancy which is important for the healthy development of the baby. 

Progesterone along with oestrogen has been shown to produce a prolonged gut transit time resulting in constipation (4).

How to manage constipation when pregnant

Constipation is a very common symptom in both IBS and pregnancy. The good news is that managing constipation with IBS and pregnancy is not any different to managing constipation with pregnancy alone.

Causes of constipation during pregnancy; (5)

  • Increased progesterone
  • A reduction in movement and physical activity
  • Changes to your diet including a lack of fibre or fluid (this can often be due to nausea).
  • Taking iron and calcium supplements

Management of constipation in pregnancy

Taking the following steps can help manage your constipation when pregnant with IBS.

  1. Drinking adequate amounts of fluid
  2. Eating a high fibre diet
  3. Moving daily (please check what is appropriate with your doctor).
  4. fibre, fluid and daily movement can help to prevent or alleviate constipation with IBS and pregnancy. 

We have written this more comprehensive guide on constipation which you may wish to read.

TIP: Keeping a food log to see what foods trigger your IBS symptoms during pregnancy can also be helpful to know which ones to avoid!

Medications for constipation for IBS and pregnancy 

There are many over the counter constipation medications available. BUT rarely have they been researched for safety in pregnancy. So, be safe and consult with your doctor first.

How to manage morning sickness

Nausea and vomiting are not symptoms of IBS but commonly occur in the first trimester of pregnancy (6).

As with anyone who is pregnant and experiencing morning sickness, the symptoms should ease throughout your pregnancy. If you are really struggling, there are some dietary and lifestyle changes that could help to ease your symptoms. 

Dietary and Lifestyle changes for morning sickness (7)

  • Get plenty of rest as tiredness can make nausea worse
  • Avoid the foods or smells that make you feel sick
  • Eat dry toast or a plain biscuit before getting out of bed
  • Eat small, frequent meals of plain foods that are high in carbohydrate and low in fat and IBS appropriate for example, wheat free bread, crackers etc.
  • Eating cold foods instead of hot ones if the smell of hot meals makes you feel sick.
  • Stay hydrated – sipping little and often to help prevent vomiting
  • Eating and drinking little and often which can also help to prevent dehydration

If you are suffering from severe and frequent vomiting and feeling dehydrated, please seek prompt medical advice. 

How to manage haemorrhoids when pregnant

Haemorrhoids, also known as ‘piles’ can occur in pregnancy due to hormones making your veins relax. Typical symptoms include itching, aching, soreness or swelling around the anus (8).

Below are the various ways of dietary, lifestyle and pharmacological management tools for haemorrhoids when pregnant. 

Dietary and Lifestyle Management (9)

  • Avoid constipation (see section above)
  • Avoid standing for long periods
  • Engage in regular movement and exercise (based on what your doctor has advised is safe).

Pharmacological management (9)

Certain medications can help to soothe and alleviate the inflammation caused by haemorrhoids but they do not treat the cause of haemorrhoids. 

Ask your GP or pharmacist for advice on suitable medications for haemorrhoids with pregnancy and IBS.

How to manage iron deficiency when pregnant 

Iron deficiency can occur in pregnancy due to poor dietary intake and increased requirements.

If you become deficient in iron then your doctor will prescribe a supplement. Sadly, these usually cause digestive problems such as nausea, flatulence, abdominal pain, diarrhoea black/tar-like stools and in particular constipation! (9)(10).

To alleviate the symptoms related to iron supplements, try to follow our advice on constipation above.

Prevention of iron deficiency in pregnancy (11, 12)

High dose iron supplements required to treat anaemia can cause constipation. So, it is important to avoid anaemia by including iron sources in your diet.

Below are some haem and non-haem iron rich foods that you incorporate into your  diet;

  • Haem iron include red meat, pulses, dried fruits and fortified foods such as breakfast cereals. Animal sources of iron including red meat tend to be a more highly absorbable form of iron known as haem iron. 
  • Non-haem iron – Plant foods including green leafy vegetables, legumes and beans tend to be a less absorbable form of iron known as non-haem iron. This is why combining vitamin C with non-haem sources of iron from plants can help boost its absorption. For example, a glass of fruit juice with a meal. Also, consuming higher quantities of plant sources of non-haem iron can also help to boost its absorption. 
  • Phytates and oxalates are compounds found in tea and calcium rich foods including dairy which can impact the absorption of iron. This is why it is best to avoid these foods and drinks with iron-rich meals. For example, drinking milk with meals.

Can you do the low FODMAP diet whilst pregnant?

The simple answer is no. This is due to the restrictive nature of the diet, meaning that you may restrict nutritional deficiencies. This could potentially impact your baby.

Summary

Overall, many of the common digestive symptoms experienced throughout your pregnancy are also experienced with IBS. This could explain why symptoms of IBS in pregnancy can appear worse. 

Although there is a limited amount of evidence around the management of IBS and pregnancy, with support from a registered dietitian and your doctor, there are a range of dietary, lifestyle and in some cases pharmacological approaches to help alleviate these digestive symptoms.

Emily Stynes BSc. in Human Nutrition and reviewed by Kirsten Jackson

Kirsten Jackson Consultant Dietitian BSc Hons, RD, PG Cert

Kirsten Jackson is a UK registered Consultant Gastroenterology Dietitian and founder of The Food Treatment Clinic. She has undergone many qualifications to get where she is today, including a UK BSc Honours Degree in Dietetics and Post-Graduate Certificate in Advanced Dietetics. In addition to this, she has FODMAP Training from Kings College London University. Kirsten set up The Food Treatment Clinic in 2015 after first experiencing digestive problems herself. She felt that the NHS was unable to provide the support individuals needed and went on to specialise in this area before opening a bespoke IBS service. Kirsten also participates in charity work as an Expert Advisor for the IBS Network. In addition, she can be seen in publications such as Cosmopolitan and The Telegraph discussing IBS as an Official Media Spokesperson to the IBS Network.

Filed Under: Treatments, Testing and Diagnosis Tagged With: pregnancy and IBS

About Kirsten Jackson Consultant Dietitian BSc Hons, RD, PG Cert

Kirsten Jackson is a UK registered Consultant Gastroenterology Dietitian and founder of The Food Treatment Clinic. She has undergone many qualifications to get where she is today, including a UK BSc Honours Degree in Dietetics and Post-Graduate Certificate in Advanced Dietetics. In addition to this, she has FODMAP Training from Kings College London University. Kirsten set up The Food Treatment Clinic in 2015 after first experiencing digestive problems herself. She felt that the NHS was unable to provide the support individuals needed and went on to specialise in this area before opening a bespoke IBS service. Kirsten also participates in charity work as an Expert Advisor for the IBS Network. In addition, she can be seen in publications such as Cosmopolitan and The Telegraph discussing IBS as an Official Media Spokesperson to the IBS Network.

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the.ibsdietitian

the.ibsdietitian
😩What other methods have you tried? SAVE THIS P 😩What other methods have you tried? SAVE THIS POST!​​​​​​​​​

😭Diarrhoea can be distressing and often embarrassing, especially when you don't know when it will strike! The thought of leaving the house might terrify you, but you want to get on with your day-to-day life... does this sound like you?

😤Tired of feeling this way? I recommend some of the tips provided in this post that we use in the Take Control Programme. For example, try to fit some gentle movement into your routine, such as walking, yoga, jogging, or anything you enjoy! By making these small changes, you'll be able to tackle your day without the fear of your IBS-D ruining your plans!

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HOW DOES BLOATING MAKE YOU FEEL? COMMENT BELOW ⬇ HOW DOES BLOATING MAKE YOU FEEL? COMMENT BELOW ⬇️​​​​​​​​​
😔Bloating is a common symptom of IBS that can really affect an individual's self-esteem. I have seen it time and time again in clinics where my clients don't want to leave the house for fear of bloating. It can ruin your whole day and make you feel downright rubbish!

❤️Life should not and does not have to be like this! Invest in yourself by investing in a qualified professional, such as an IBS dietitian, so that you can take control of your life and live bloat free!

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CAN YOU ADD ANYTHING ELSE? Comment below 👇

🤷‍♀️IBS is such a frustrating condition it can take a lot to mentally process. Why you? What did you do to deserve to get a condition that no one understands, that impacts your whole life and for which there is no cure?

🙋‍♀️I often hear awful client stories about how when they finally pluck up the courage to reach out for help, they are dismissed. This could be opening up to a friend about trialling the low FODMAP diet or perhaps seeking medical help from a doctor. Again frustration, anger and hurt can build.

🤓Whilst you have SO much to be angry about (yes, even in a world where others have it worse, it is ok to be angry about your own situation), you need a support network. 1 in 5 people have IBS, so my suggestion is this (if you can build that courage back up) try to be open about having IBS because you will be surprised about how many other people around you also have the condition! Talking to other people who have it = immediate understanding.

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🙏 Are your symptoms worse during your period? S 🙏 Are your symptoms worse during your period? SHARE THIS POST.

🤷‍♀️Do you know that more women are diagnosed with IBS than men? We don't know 100% why, but my guessing is this cycle has something to do with it!

🙋‍♀️In the week before your period, your progesterone and testosterone levels drop, causing your gut to become more sensitive. Your behaviour also changes. Research has shown that our portion sizes tend to be larger at this time, AND to top it off, your mood will be lower. All these things will impact your IBS.

😅 You may wish to curl into a ball, but this will only worsen the situation. So here are some easy-to-implement tips;
1. Balance your portions of food.
2. Move daily (even a gentle walk or stretching for 30 mins).
3. Prioritise sleep.
4. Try meditation.

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💩 Do you suffer with gut problems during Ramada 💩 Do you suffer with gut problems during Ramadan?

😭 Many of my clients find that Ramadan worsens their constipation which means they feel uncomfortable instead of feeling like they can embrace the holy month.

➡️ The truth is that constipation during this time can easily be avoided by making small changes to your diet and lifestyle. One example of this is to add psyllium husk to your diet which will boost your fibre intake without causing more gas or bloating.

🙏 If you would like further support check out my FREE morning guide (link in bio) which can be implemented at Suhoor.

#uaeramadan #ramadankareem #theibsdietitian #fasting
🤷‍♀️Which tests have you had done? Commen 🤷‍♀️Which tests have you had done? Comment below ⬇️​​​​​​​​
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🙋‍♀️At the start of the Take Control Programme, I talk through the importance of testing. The reason is that IBS symptoms could also be symptoms of numerous other conditions such as IBD, coeliac disease and even cancer. So best to get tested!​​​​​​​​
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🤓The tests above are recommended tests from NICE guidelines (the gold standard in the UK). You will also need testing for an inflammatory marker known as CRP. Your doctor may wish to do additional testing if you are showing symptoms or potential increased risk of other conditions, but these are not standard and not always required.​​​​​​​​
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🤓On the right-hand side, you have tests which are NOT required. The first one is mapping or testing your gut microbiome. Regardless of how accurate this is, it is pointless. This is because we don't yet know what a normal gut microbiome looks like, so what are you going to do with those results? It is a waste of $.​​​​​​​​
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🤓The next test is for food intolerances - VERY inaccurate! The only way to accurately diagnose a food intolerance is through elimination and reintroduction.​​​​​​​​
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⏩⏩ fed up with trying everything? I have a FREE ‘morning routine’ guide for you in my bio!​​​​​​​​
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🌙 Ramadan Kareem to all my Muslim followers, fr 🌙 Ramadan Kareem to all my Muslim followers, friends and colleagues.

May you all have a blessed Ramadan.

#uaeramadan #ramadan2023 #ramadankareem
CAN YOU RELATE?.​​​​​​​​ ​​​ CAN YOU RELATE?.​​​​​​​​
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🤷‍♀️Anyone else feels like IBS zaps their energy?​​​​​​​​
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🙋‍♀️When I ask people what their main IBS symptoms are, yes they say diarrhoea/constipation, bloating BUT also fatigue. It is crazy how your digestion can make you feel like you are in this big cloud and only have enough energy to do the minimum each day. The problem is that you were not put on this planet to just do the minimum in life, and knowing this will make you feel sad and helpless. The good news is that when your digestion is actually functioning well, you will feel like the light has been turned on inside your brain.​​​​​​​​
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🎉Do you want the light to be turned on again? Download my FREE morning routine guide (link in bio).​​​​​​​​
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What are you incorporating into your routine? SAVE What are you incorporating into your routine? SAVE THIS POST! ❤️​​​​​​​​
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😫 It can be so stressful when IBS strikes at work! The fear of a flare-up, the embarrassment of sharing a toilet, and fatigue can all can stop you from feeling comfortable and confident at work.​​​​​​​​
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🙋‍♀️ It doesn't have to be like this! Why don’t you try adopting some of the examples above which can help alleviate some of your symptoms! 🙌​​​​​​​​
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🎉 🎉 Fed up of trying everything you can, but nothing seems to be working? Download my FREE IBS morning routine guide! Link in bio.⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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Is IBS dictating your schedule? Comment below! 👇 ​​​​​​​​
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😫 Your day may not go to plan when you have IBS - you could spend ages on the toilet, unsure what clothes to wear due to the bloat, and be in so much pain that you have to cancel your plans with your friends and family!​​​​​​​​
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🙇‍♀️ Tired of constantly cancelling your plans? Why not use the low FODMAP diet to identify your triggers so you can predict your symptoms? Therefore, your life will not revolve around cancelling plans at the last minute!​​​​​​​​
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🎉 🎉 Fed up of trying everything you can, but nothing seems to be working? Download my FREE IBS morning routine guide! Link in bio.⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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CAN YOU RELATE? ​​​​​​​​​​​​​​​​​​​​​​​​
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😭 I think this post emphasises the point that NOT EVERY DISABILITY IS VISIBLE. As IBS sufferers we often hide our pain in silence day in day out, hoping nobody notices or asks questions. When people ask how we’re doing, we do the polite thing and reply with “I’m fine”. Leaving the burden of IBS to be dealt with alone…​​​​​​​​​​​​​​​​​​​​​​​​
​​​​​​​​​​​​​​​​​​​​​​​​
🤔 But what about instead of struggling alone in silence, you embody the Take Control Method whereby you prioritise emotional support. Open up to a friend, a colleague or a loved one - problem shared is a problem halved. ❤️​​​​​​​​​​​​​​​​​​​​​​​​
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🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE IBS morning routine guide! Link in bio.⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree  #gutinstinct #healthygut #ibsd #ibd #tea #5steps #chronichealth #multifactorial. #chronicallyunwell #endo #ibstype #ibstyping #ibsc
💩💩 Check out my new gut health advice in the 💩💩 Check out my new gut health advice in the @guardian

Link in stories 😊
CAN YOU RELATE? Comment below👇 ​​​​​​​​
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😭 Do you feel like you've lost the previous you? You're trying to shove your symptoms & feelings under the rug. This takes a toll on not only your physical but also your mental health.​​​​​​​​
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Your feelings ARE validated. Being open about your feelings instead of hiding them can allow you to receive the support you need. By taking this approach, you won't have to fight this battle alone ❤️​​​​​​​​
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🎉 Fed up trying everything you can, but nothing seems to be working? Download my FREE morning routine guide! Link in bio. ​​​​​​​​​​​​​​​​
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Post credits to @the_migraine_life​​​​​​​​
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#ibs #irritablebowelsyndrome #fodmap #lowfodmapdiet #lowfodmaprecipes #guthealth #guthealthy #gut #ibsdietitian #ibsdietician #ibsdiet #ibsfood #guthealthy #guthealthdiet #guthealthiskey #fodmapfree #chronicillness
💩💩 30% of people in this study who were diag 💩💩 30% of people in this study who were diagnosed with IBS-D were found to have bile salt malabsorption.

🤓 Bile salts are needed in digestion to break down fats. After the salts have been used they are recycled and when this process is broken you can end up with inadequate amounts of bile acid available. This means that your dietary fat is unable to be broken down and you can end up with loose stools.

➡️ If you have watery stools 3 or more times a day and have IBS please mention this to your doctor 🙏.

📚 DOI: 10.1111/apt.13227

#theibsdietitian #irritablebowelsyndrome
Do you have these symptoms? Comment below ⬇️ ​​​​​​​​​
🤔 Endometriosis is when the lining of the uterus is found in other areas of the body. Many IBS symptoms are also symptoms of endometriosis, so it often is misdiagnosed as IBS. Unfortunately, many women wait 7-10 years before a diagnosis.

🙋‍♀️ Interestingly, following the low FODMAP diet for 4 weeks showed a 50% improvement of symptoms in 72% of women who suffer from endometriosis. However, please consult a doctor for a proper diagnosis and a dietitian before following a restrictive diet!

🩸ALWAYS mention any unusual period-related symptoms to your doctor!

#endometriosis #endometriosisawareness #endometriosisawarenessmonth #ibsawareness #pain #menstrual #menstrualcycle #periods #ibs #bodypositivity #ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #gutmicrobes #gutscience #dietitian
😭 Can you relate? Comment below 👇 ​​​​​​​​​​​​​​​​​​​​​​​​
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😢 Having IBS can really take a toll on your mental health. In turn your IBS can cause anxiety and your anxiety can then cause IBS symptoms leading to a viscous cycle. Your fears are REAL and they are VALID and they can be really debilitating! IBS can impact so many aspects of your life big and small! ⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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🤔 But what if you no longer had to deal with any of these fears and could get your symptoms under control! Instead of continuing with these behaviours adopt the take control method of social support and open up about your IBS to someone!⠀⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE morning routine guide! Link in bio. ​​​​​​​​​​​​​​​​
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#ibs #ibsdietitian #guthealth #irrtablebowelsyndorme #guthealth #lowfodmapdiet #guthealth #healthygut
Do you suffer from bloating? ❤️ SAVE THIS CHEC Do you suffer from bloating? ❤️ SAVE THIS CHECKLIST ​​​​​​​​​
Bloating can impact our daily lives - lower our self-esteem as we look like 9 months pregnant and trying to find loose clothing to wear 😫

💨 Wouldn’t it be amazing if we could beat the bloat? These 8 tips are based on the Take Control approach, which can help you to lessen the bloat and ultimately let you achieve symptom relief 😮‍💨

🎉 Tired of advice that just doesn't work? Download my FREE IBS morning routine! Link in bio.​​​​​​​​

#ibsawareness #ibsbloating #bloatingtips #ibs #bodypositivity #ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #dietitian
Can you add any more? Comment below!👇👇​​ Can you add any more? Comment below!👇👇​​​​​​​​​​​​​​​​​​​​​​​​
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😥 IBS has widespread implications on our overall health and well-being and it can feel like a never ending battle.​​​​​​​​​​​​​​​​​​​​​​​​
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😊 Our gut health plays a big role in our overall health and well! The Take Control Method focuses on all aspects of well-being not just nutrition! ​​​​​​​​Sleep, movement and mental health optimisation are just as important!​​​​​​​​ This this can help you achieve that ultimate symptom relieve! ​​​​​​​​​​​​​​​​
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👏👏Fed up of trying everything you can but nothing seems to be working? Download my FREE IBS morning guide! Link in bio.​​​​​​​​​​​​​​​​​​​​​​​​
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#loveyourgut #loveyourgutweek2022 ibsdiet diet #ibs #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #bloating #irritablebowelsyndrome #fodmapfree  #healthygut #goodguthealth #gutfood #fermentedfoods #trustyourgut #chronichealth #microbiome #tipsforgoodguthealth #guthealth #guthealthtips
💩 What movement are you planning today? Comment 💩 What movement are you planning today? Comment below👇

➡️ Did you know that regular movement has been proven by research to improve IBS symptoms?

➡️ I use the term 'movement' in my Take Control method because we have already built up so many negative emotions and ideas around 'exercise.'

💩 Movement should be daily and can be anything from an HIIT class to simple stretches.

➡️➡️➡️ For more tips like this one, check out my FREE IBS morning routine guide (link in the bio) 

#theibsdietitian #lowfodmapdiet #irritablebowelsyndrome
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