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Inside Tract - Pregnancy and IBS with Constipation
Inside Tract Summer 2014
Pregnancy and IBS with Constipation
Date: June 2, 2014
Ellen Stein helps women manage pregnancy and irritable bowel syndrome.
Ellen Stein believes women often seek out other women when they need to discuss their bowel habits. That could be why so many women between 20 and 40 years old with irritable bowel syndrome with constipation as the primary symptom (IBS-C) come to see her. Likely because of the age group, the Johns Hopkins gastroenterologist says the topic of pregnancy just comes up. Here, Stein shares her experience in treating women with IBS-C who are interested in having a baby.
What first steps do you take for patients with IBS-C who are thinking about pregnancy?
Because pregnant women should be exposed to as few chemicals as possible, I try to wean my patients off of IBS-C medications such as Linzess, Amatiza or prucalopride. If they’ve had good results for at least 14 or 16 weeks on the drugs, they can often stop for a period of time, get pregnant and deliver, and then restart the medications if needed. If there is no bleeding, weight loss or celiac disease, then a typical workup is given.
What do you recommend once they are expecting?
Even before pregnancy, I start them on dietary and lifestyle changes to get them into a pattern of having regular bowel movements. Keeping their symptoms under control usually involves exercise, stress reduction, eating right and getting enough sleep. I work with the Johns Hopkins Integrative Medicine and Digestive Center to provide acupuncture and massage therapy to manage stress, which helps to control their symptoms. And the low FODMAP (fermentable oligo-di-monosaccharides and polyols) diet is also pretty popular for IBS. Before and during pregnancy, it’s safe as long as it is a broad diet, so I make sure they also see a nutritionist.
How do you treat constipation during pregnancy for these patients?
Natural remedies like fiber, fruits and vegetables are really helpful. We don’t like to use stimulant laxatives, because those can cause contractions in the uterus. If I have to use a nonstimulant laxative, I go to Miralax. But again, I start with the dietary and lifestyle changes to get them into a pattern of having regular bowel movements even before they get pregnant.
Any last words about IBS-C and pregnancy?
If the patient is really symptomatic and needs to stay on medication, then I get a maternal fetal medicine evaluation to see what the risks of the medications are, and if extra screening is needed to ensure there are no fetal anomalies that need to be managed.