Irritable Bowel Syndrome and Probiotics: Before, During, and After Pregnancy

Wait isn’t this a women’s health blog? Why are you talking about IBS? Well – IBS is more common in the female population than the male population. Some evidence suggests it may be related to the menstrual cycle and hormones in women. So – despite the fact that it doesn’t sound like a women’s health topic to some, it’s likely a very relevant and relatable topic for many women.

*Disclaimer: This blog is intended for informational purposes only. The information on this blog should not be used as a substitute to medical advice or medical treatment. As always, your Primary Care Provider, a doctor, or another health professional is your best resource for specific questions and medical advice. If you believe you or a loved one are experiencing a medical emergency, please contact 911.*

What is IBS?

IBS (or irritable bowel syndrome) is well, exactly what it sounds like. It is a disorder affecting the intestines – causing issues with intestinal motility and sensitivity (so, how food moves through the intestines & how the brain interprets messages from the intestinal nerves).

It won’t kill you, but it can be life changing in other ways, because the symptoms can be disruptive, embarrassing and uncomfortable. Abdominal pain, cramps, gas, diarrhea and/or constipation.. all possible symptoms of IBS, among others.

There are three “types” of IBS – IBS-C (mostly constipation), -D (mostly diarrhea), and -M (mixed). To see the specific diagnostic criteria for IBS, click here.

The cause of IBS is still up in the air – researchers aren’t really 100% sure yet but think that a wide variety of things may contribute to its development such as past food poisoning or infection of the GI tract; surgery; medication; diet; hormones; or a change in the natural flora of the gut (which can be frankly, caused by any of these things).

Stress may also be related (and has to do with that intestinal sensitivity I mentioned earlier). Notably, people who have IBS often also have anxiety or depression.

Why are women more affected?

Lower levels of hormones such as estrogen may contribute to IBS symptoms. So, if you have IBS you may notice an increase in symptoms just before you get your period.

However, higher levels of estrogen may also be related to IBS. For example, it appears that endometriosis and IBS often occur together. Additionally, pregnant women often report increased GI symptoms during pregnancy. More research is needed to better understand the relationship.

Personally – I suffer from IBS and found that my symptoms disappeared during pregnancy. I had no abdominal discomfort beyond first trimester, and barely any other symptoms. Maybe the relationship between hormones and IBS symptoms is different depending on the cause of the IBS and the body in which it exists? So many unanswered questions!

Ok, so why did you mention probiotics in the title…?

Probiotics are one of the only supplements I use or have used regularly as someone who lives with IBS.

First of all, let’s talk about what they are – a probiotic is a living microorganism which can, at a certain dose, have benefits for the human body. They have many different functions, one of which is helping to stop harmful invading organisms from penetrating the GI tract.

There are several studies that support of the use of probiotics with IBS to minimize symptoms. You may have to experiment a bit with the probiotic you use though. Each study, strain and type of bacteria seem to have slightly different results in regards to which symptoms are minimized. Another area where more research is needed.

The safety of probiotics has been pretty well studied and they are generally considered pretty safe for a healthy person (however keep in mind that there are so many different possible bacterial strains – not all of them have been studied and not all of them are alike, so results/effects of certain strains may vary). If you are planning to take a probiotic – it is a good idea to talk to your doctor especially if you are pregnant, nursing, or have any other health conditions.

Unlike many supplements, probiotics in capsule and tablet form are actually regulated to a certain degree in Canada. However, in food these same standards are not upheld. Previously there were the same issues with probiotics as there can be with other supplements – labels not truly telling us what is in the product since there was no strict regulation or review of the product by a health authority previously. Something to keep in mind – especially if you are outside of Canada in a country with little or no regulation.

I have IBS and I’m pregnant. Can I continue to take probiotics?

This is a question for your healthcare provider – as I mentioned, every probiotic is different and so is every person. Although they may be considered safe in pregnancy, some may not be (because there are so many, it’s hard to say for sure).

Current existing research suggests that adverse effects from taking a probiotic in pregnancy are rare. Use of a probiotic during pregnancy is not associated with miscarriage, increased rate of C-section, or any harm to the fetus. So, they are generally considered safe but as always with any supplement, I advise to first have a chat with your most responsible care provider for your pregnancy.

What about if I’m breastfeeding?

Similarly to pregnancy, it is probable that probiotics are safe to use while nursing as it is expected that they would not transfer to baby via breast milk. There are not many studies studying this or any side effects in the infants of mothers who do take probiotics though, so once again – it’s hard to give a conclusive answer.

Kelly Bonyata, the IBCLC behind the website Kellymom, suggests taking it to prevent the development of thrush when mom is on antibiotics (since probiotics can help to decrease the overgrowth of the fungus related to thrush and antibiotics are known to increase the risk of thrush development). I’d advise talking to your doctor first in any case.

How will probiotics benefit me if I have IBS?

It’s another area that needs more research however there is currently a bit of evidence that some probiotics may help to ease the symptoms of IBS. Unfortunately a lot of the studies that currently exist are not representative (small sample population for the study – meaning they didn’t have a large number of participants/people to study) and generally considered ‘low quality’ studies (this can be as a result of the population size, the study methods

Bifidobacterium infantis has been most studied and appears to help reduce IBS symptoms (specifically bloating and gas). This strain may also help with diarrhea, as well as the more commonly known Lactobacillus plantarum. Name brands that you may have heard of that also appear to reduce IBS symptoms include Align and Culturelle. A recent study from 2019 showed that multi-strain products may be more effective in regards to symptom reduction.

Talk to your doctor, specialist or pharmacist about whether or not probiotics can benefit you. Usually they are included in IBS regimens, but there are other treatment options that may work better for your lifestyle, health goals, or with any conditions you may have (like Cognitive Behavioural Therapy which has been shown to be effective for IBS treatment and is generally a good option for those who cannot take medications).

Probiotics can be expensive and so can things like CBT if you don’t have health insurance coverage. That’s why it’s important to speak to your care provider to find something that can work for you!

Will my IBS get worse during or after pregnancy?

I had a hard time finding answers to this question while I was pregnant and now, researching the topic. It is likely understudied, or not studied at all (conclusions that might exist are likely the result of other studies that just happened to find out something about IBS as well).

What I can tell you is that pregnancy definitely changes your digestive system (among other things!!). Progesterone causes digestion to slow – so during pregnancy you may either have worsening IBS symptoms (if you have bad IBS-C for example), or a bit of relief (with IBS-M and IBS-D). It’s hard to say, and everyone will probably be affected differently.

Your growing uterus also displaces your organs, including the intestines. Have you ever seen this video or gif image? It’s one of my favourites to share – look where your intestines are near the end! Squished at the back. It’s not surprising that GI issues are a symptom of pregnancy, that there may be some changes in your IBS symptoms as a result, and that your IBS may either be worse or better (depending on the type) in the early postpartum period since everything has to return to normal.

So, will it get worse? As usual, the answer to that question depends on the person and is likely multifactorial. *Personally*, mine was essentially dormant after first trimester until about 6-8 weeks postpartum. It came back with a bit of a vengeance, but as long as I am mindful of what I’m eating (I don’t follow low FODMAP exactly, which I’ll cover in another post, but follow some of its guidance + avoid my personal triggers), it has gone back to pretty much ‘baseline’ or ‘manageable’ now.

IBS is a complex thing to live with – it’s often overlooked (even by professionals at times) because it’s ‘manageable’ and not life threatening. However, it is a burden to bear daily in its own way and I find that only people with it truly understand the struggle. As a pregnant woman I was really worried that it would make my pregnancy miserable, but for me it was actually a breeze. Every case is different though – speak to your doctor for the best way to manage IBS symptoms during/after pregnancy, or just on a day-to-day basis. There are different options available, and if you find that you’re only getting one solution from your provider (and it’s not working), don’t be afraid to seek a second opinion.

Additionally, probiotics may be helpful for you – but as always, discuss any supplements with your provider before taking them.

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