How to treat IBS if pregnant or breastfeeding

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IBS and pregnancy are independent; there is no evidence that one affects the other. A prominent feature of IBS is its unpredictable, chronic and relapsing nature. Therefore, in a patient with IBS, pregnancy may be accompanied with worsened, improved or unchanged IBS symptoms. IBS does not contraindicate pregnancy, nor are there any precautions beyond those recommended above prior to pregnancy. Management of IBS during pregnancy or breastfeeding entails addressing the symptoms when necessary. In principle, no drug should be used unless absolutely necessary and only then after all nondrug therapies have been tried.

For the treatment of diarrhea, calcium polycarbophil and psyllium are unabsorbed and safe and compatible with pregnancy and breastfeeding. Colesevelam may be used for diarrhea due to bile acid malabsorption during pregnancy when benefits exceed risks; supplementation with fat-soluble vitamins are recommended due to reduced absorption.​ 

Although loperamide (Imodium) has not been associated with teratogenic effects, its safe use during pregnancy has not been established. Small amounts of loperamide are transferred to breast milk but is unlikely to affect the breastfeeding infant.​ Diphenoxylate with atropine should not be used during pregnancy or breastfeeding since it has been found to be teratogenic in animals and its active metabolite is probably transferred to breast milk.​ There is insufficient safety data evaluating the use of eluxadoline and rifaximin during pregnancy and lactation.​

Encourage nonpharmacologic treatment options for constipation due to IBS during pregnancy; options include adequate hydration, exercise and increased dietary fibre. Because they are not systemically absorbed, bulk-forming agents such as psyllium are considered first-line in pregnancy while stimulant laxatives such as senna or bisacodyl may be recommended for short-term use; all options are compatible with breastfeeding.​

 The use of linaclotide, prucalopride, pinaverium or trimebutine during pregnancy or breastfeeding are not recommended based on insufficient human safety data.​ Dicyclomine has been used safely during pregnancy but studies evaluating use during breastfeeding are lacking.