Irritable bowel syndrome, also known as IBS, is a syndrome or cluster of symptoms that includes abdominal pain, diarrhea, constipation, gas, passing mucous and other irregularities. Although pregnancy does not increase the risk of developing IBS, according to Dr. Chung Owyang, chief of gastroenterology for the University of Michigan Health System, most cases develop in women of child-bearing age.
IBS is thought to be the product of overactive nerves in the colon. Stress and female sex hormones don't cause IBS, but they do number among the recognized triggers that seem to set off overactive nerves. Systemic antibiotics used to combat group B Streptococcus and other bacteria in pregnant women can disrupt the balance of bacteria that normally reside in the intestine, providing another possible trigger for IBS.
Doctors diagnose IBS on the basis of history, physical examination and, sometimes, blood tests. Although pregnancy does not factor into the 2006 Rome Criteria used to diagnose IBS, doctors are often reluctant to make the diagnosis until at least six months after a pregnancy, because normal physiologic, metabolic and anatomic changes associated with pregnancy may confound the diagnosis.
Most patients with IBS report a waxing and waning course. Symptoms may disappear for a while or they may change their pattern. A 2008 study in the "World Journal of Gastroenterology" found higher levels of prolactin, a hormone associated with breastmilk production, in women with constipation-predominant IBS. So, nursing women who previously suffered from diarrhea-predominant IBS may find that their symptoms shift to a constipation-predominant or mixed pattern.
Diet therapy for IBS consists of gradually increasing dietary fiber either through fiber supplements, increasing consumption of whole grains, legumes, fruits and vegetables or a combination of the two. In addition, patients should avoid triggers such as fatty foods, large meals, dairy products, chocolate, caffeine, alcohol, artificial sweeteners called sugar alcohols and carbonated beverages. Although most of the foods emphasized in the IBS diet are already low in calories, a registered dietitian can help identify additional calorie-cutting strategies for women who experience difficulty returning to their pre-pregnancy weight.
Stress often triggers IBS symptoms, so stress management figures prominently into first line treatments for the disorder. In addition to normal stressors, new mothers face the sometimes overwhelming burden of physically, emotionally and financially caring for an infant. Managing stress through outlets such as exercise, counseling, hobbies and even alternative remedies such as hypnosis or meditation reduces IBS symptoms and improves overall well-being.
Medications often figure prominently in the management of constipation-predominant IBS among women who have recently delivered a baby. Women who have undergone Cesarean section are commonly advised to avoid straining with bowel movements, and relaxation of the muscles in the pelvic floor is a common complaint among all women who have been pregnant, regardless of delivery method. Over-the-counter laxatives and antidiarrheals are generally safe for post-partum women, although nursing women should contact their doctors for advice.
IBS exerts a toll on patients' quality of life that far exceeds its impact on actual health. According to the American College of Gastroenterology, IBS decreases work productivity, interferes with social relationships and even increases risk of suicide. Women who have recently delivered a baby are already at increased risk for post-partum depression. IBS can make the problem worse.
- "Harrison's Principles of Internal Medicine;" A.S. Fauci et al. (eds.); 2008
- "World Journal of Gastroenterology"; Irritable Bowel Syndrome Subtypes: E.M. Eriksson, et al.; 2008
- National Institutes of Health: What I Need to Know About Irritable Bowel Syndrome