What is Irritable Bowel Syndrome?

Irritable bowel syndrome (IBS) is a common illness that affects the stomach and intestines, generally known as the digestive tract. Symptoms include cramping, abdominal pain, bloating, gas, and either diarrhoea or constipation. IBS is a chronic ailment that requires long-term management. Only a few people with IBS experience severe symptoms, with some being able to manage their symptoms by adjusting their diet, lifestyle, and stress. More severe symptoms can be managed with medication and counselling.¹

A chronic condition that primarily affects young individuals in their reproductive years, IBS has a significant impact on people’s family planning decisions. Those who wish to conceive should be informed about pregnancy outcomes and therapy choices both before and during pregnancy. The majority of medications used to treat IBS are associated with no increased risk of congenital malformations or bad effects on the foetus, making them safe to use during pregnancy.²

Understanding Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a collection of symptoms that occur simultaneously, including abdominal pain and changes in bowel motions, which might be diarrhoea, constipation, or both. IBS causes these symptoms without any apparent indicators of injury or disease in the digestive tract. IBS is classified into three kinds based on various patterns of changes or irregular bowel movements. Sometimes your doctor needs to know the kind of IBS you have. Some medications are only effective for certain types of IBS and may worsen others. Your doctor may diagnose IBS even if your bowel movement pattern does not fit into a certain kind. Many patients with IBS experience normal bowel movements on some days but abnormal bowel movements on others.³

Types include:

• Crohn's disease: Causes pain and swelling in the digestive system and can affect any region of the body, including the mouth and anus. It primarily affects the small intestine and the upper portion of the large intestine
• Ulcerative colitis: Causes swelling and ulceration in the large intestine, both colon and rectal regions
• Microscopic colitis: Produces intestinal inflammation that can only be seen using a microscope⁴

What causes IBS?

Researchers are still investigating why some people get IBS. Three factors seem to play a role:

• Genetics: Approximately one in every four people with IBS have a family history of the disease
• Immune system response: The immune system normally fights infections. In persons with IBS, the immune system confuses foods as foreign substances. It produces antibodies (proteins) to combat this threat, resulting in IBS symptoms
• Environmental triggers: Individuals with a family history of IBS may develop the disease following exposure to an environmental trigger. These triggers include smoking, stress, pharmaceutical use, and depression⁴

Diagnosis of IBS

Crohn's disease and ulcerative colitis have similar symptoms. There is no single test that can detect either disease. Your examination may begin with a complete blood count (CBC) and a stool test to look for symptoms of intestinal inflammation.

You may also receive one or more of the following diagnostic tests:

• Colonoscopy: Used to inspect both the big and small intestine
• EUS (endoscopic ultrasound): Scans the digestive tract for swelling and ulcers
• Flexible sigmoidoscopy: Used to inspect the interior of the rectum and anus.
• An imaging scan: Such as a CT scan or an MRI, is used to look for symptoms of inflammation or an abscess
• Upper endoscopy: Involves examining the digestive tract from the mouth to the beginning of the small intestine
• Capsule endoscopy: Performed by utilising small camera equipment that you swallow. The camera records photographs as it passes through the digestive tract⁴

Management and treatment

Crohn's disease treatment options differ according to the symptoms and severity. Aminosalicylates, antibiotics, biologics, corticosteroids, and immunomodulators are among the medications that can help regulate inflammation and alleviate symptoms. Over-the-counter treatments include antidiarrheal medications, NSAIDs, and vitamins/supplements such as probiotics. However, if drugs fail, surgical intervention may be required. Bowel resection, a common surgical procedure for Crohn's disease, consists of removing the diseased intestinal segment and reconnecting healthy portions. Despite surgery, recurrence is common, with almost six out of ten individuals suffering it within ten years, which may result in them needing another surgery.⁴

Pregnancy and its impact on the digestive system

Pregnancy causes physiological changes that might lead to various symptoms. Pregnancy can cause gastrointestinal issues such as nausea, vomiting, acid reflux, heartburn, and constipation. Nausea and vomiting are common, with rates ranging from 50 to 80%. Hyperemesis gravidarum is a severe nausea and vomiting condition that affects approximately 1.2% of pregnant women.⁵

The impacts on the gastrointestinal tract during pregnancy are mostly induced by hormonal changes rather than physical effects of the gravid uterus. Motility changes occur throughout the gastrointestinal tract, including a decrease in lower esophageal sphincter pressure and physiologic function, which results in gastroesophageal reflux and an increased risk of aspiration; changes in gastric motor function associated with nausea and vomiting; and a decrease in the rate of small-bowel and colonic transit, which manifests primarily as abdominal bloating and constipation. These effects are mediated by the hormone progesterone, with oestrogen likely serving as a primer.⁶

Managing Irritable Bowel Syndrome during pregnancy

Irritable bowel syndrome, constipation, and diarrhoea can all complicate a pregnancy. Non-pharmaceutical treatments can be used to treat IBS and constipation symptoms. A thorough history should be taken to ascertain whether these issues are acute or chronic in character. Conservative treatment for IBS is indicated, which may include stool-bulking medications, a high-fiber diet, the avoidance of unpleasant foods, and behavioural treatments such as passive muscle relaxation, biofeedback, or supportive psychotherapy. Constipation is usually self-limiting. It can also be treated conservatively with stool-bulking medicines, dietary fibre supplements, and pelvic muscle exercises, preferably with electromyographic biofeedback. 

Diarrhoea is most commonly caused by infectious agents during pregnancy, but it can also be caused by food poisoning or a viral illness. Infectious diarrhoea can be treated with mild antidiarrheal medications and safe antibiotics. Fluid replacement is the mainstay of treatment, and caution should be exercised given that the treatment involves two patients. These problems can normally be treated relatively quickly and safely, but persistent cases should be evaluated in the same way as nonpregnant people are.⁷

There is no indication that ulcerative colitis or inactive Crohn's disease (CD) impair fertility. If you have inactive IBS, you are likely as fertile as someone who does not. However, active CD, previous pelvic surgery (for example, pouch surgery), or a previous complication such as a pelvic abscess may limit your fertility. Any biological woman considering a pregnancy should aim to eat as healthily as possible, maintaining a consistent diet that reduces risk of digestive complications. This is also true if you have IBS. You may also need blood tests to ensure that your vitamin B12, vitamin D, folate, and iron levels are normal. These nutrients should then be supplemented as needed. Your doctor should be able to prescribe you vitamins if necessary.⁸

Seeking help

IBS symptoms, such as stomach discomfort, diarrhoea, constipation, and gas, are unpleasant and can disrupt your life. But IBS is manageable. Changing your diet and everyday behaviours can help you manage triggers and improve your symptoms. If you are experiencing persistent stomach issues, consult your doctor. Together, you may develop an IBS treatment strategy that is effective for you.⁴

Summary

Irritable Bowel Syndrome (IBS) causes a wide range of digestive symptoms, including cramping, stomach pain, and changes in bowel habits. While IBS does not directly threaten pregnancy, controlling its symptoms becomes critical during gestation due to the physiological changes that occur. Pregnancy presents its own set of gastrointestinal problems, including nausea, vomiting, and constipation, which can aggravate IBS symptoms. As a result, pregnant women with IBS must prioritise symptom treatment in order to guarantee their own and their baby's health.

Seeking expert advice and assistance is essential during this process. From comprehending the complexities of IBS and its management approaches to navigating the effects of pregnancy on gastrointestinal health, healthcare experts play an important role in providing individualised advise and treatment options. Whether it's changing their food, making lifestyle changes, or taking medication under medical supervision, pregnant people with IBS should feel empowered to seek the help they require.

It is essential to understand that each pregnancy is unique, and what works for one person may not work for another. As a result, maintaining open contact with healthcare practitioners and actively participating in the management of IBS symptoms can help you have a more comfortable and enjoyable pregnancy. Pregnant individuals with IBS can traverse this path with confidence and peace of mind by prioritising self-care, obtaining professional advice, and remaining attentive about symptom management.