IBS products in pregnancy

Women may choose to take iron tablets to protect against any anemia in pregnancy, but these can cause constipation. Iron supplements come in different forms – ferrous sulfate, ferrous gluconate, ferrous fumarate – and switching to another form may alleviate symptoms.

Liquid versions can be more gentle on the gut, and more easily absorbed. Your doctor may start with a prescription formulation, then over-the-counter versions can be bought to maintain levels after an iron deficiency is addressed.

It’s a good idea to take iron supplements with food to help reduce the risk of constipation, although avoid tea, coffee, dairy and so-called "phytic acid" foods (grains, beans, nuts, tubers), as these can make it harder to absorb iron.

Laxatives may help move things along, especially in late pregnancy, as the pressure of the growing baby can slow down your bowels. Osmotic laxatives such as lactulose solution or macrogol sachets (Movicol) are a good option, as they cause less cramping or bloating than other laxatives. They work by drawing more water into the large bowel and thereby hydrate and soften stools, making them easier to pass.

With these laxatives, and constipation in general, make sure you keep your fluids topped up. You’re likely to have even higher fluid requirements in pregnancy.

If loose stool is problematic in your IBS, you may have been used to turning to loperamide (Imodium) to slow gut contractions down, but this is not recommended in pregnancy. The first step is to make sure you’re keeping well-hydrated with plenty of water, and keeping your electrolytes (salts) in balance.

An oral rehydration salt drink such as O.R.S is safe to rehydrate and rebalance electrolytes and may be a consideration if you are emptying your bowels frequently or diarrhea is very watery. It’s safe to use in pregnancy, as it’s just replacing the electrolytes and fluids you’ve already lost (speak to your doctor first if you have kidney problems or have been put on a low-sodium diet).

Enterosgel intestinal adsorbent is a mineral mixture that’s safe in pregnancy and aims to reduce stool frequency and duration of diarrhea. It’s a gel foam that works physically to bind toxins and bile acids, expelling them in the stool and relieving many of the unpleasant symptoms they bring. It’s less likely to cause bloating than some other products.

Adding soluble fiber such as Fybogel sachets can help alleviate loose stools, and it's safe in pregnancy. It’s also marketed as a laxative, which might sound counter-intuitive, but it adds air to the stools which makes them expand, bulking them up and improving symptoms (it reduces the hard impacted stools in constipation). Fybogel may cause temporary bloating, so take it with water and avoid lying down for 30 minutes afterward, and bloating should ease.

As your growing baby takes up more room in your tummy, this can put pressure on the gut, causing trapped gas, bloating, and crampy pains. You might have tried oral medications to reduce gut spasms before, such as peppermint oil capsules. Unfortunately, the manufacturers suggest avoiding these as they haven’t run clinical trials on pregnant women.

Manufacturers do add that they are not known to be harmful in pregnancy, so if you are suffering a great deal, this may be a discussion to have with your doctor: whether theoretical risks outweigh the benefits of symptom relief.

Some people stand by the benefits of a simple tea made with fresh peppermint leaves in warm water. This can ease bloating and cramping, and you’re safe to go ahead with this in pregnancy.

Antiflatulents such as Gas-X contain an inert substance called simethicone. This relieves pain and discomfort due to trapped gas by reducing air bubbles, so they pass more easily through the gut, and this is a safe option in pregnancy.

If you’ve tried the above treatments and your symptoms persist, it’s worth booking an appointment with your doctor. While the symptoms of IBS do not present a risk to your pregnancy, you want to avoid any of them becoming severe, such as dehydration and salt imbalance. And you want to be able to enjoy your pregnancy, too.

Your doctor will consider treatments you’ve tried and may suggest other medications. They may order investigations such as blood tests, and they can refer you to obstetric or gut specialists, depending on their concerns.

With any pregnancy, if you experience vaginal bleeding or severe abdominal pain, or if you experience reduced fetal movements later in the pregnancy, you should speak to your doctor urgently or call the nearest emergency room. They can advise over the phone whether you should come in for evaluation.