Have you noticed changes to your gut health after pregnancy and childbirth? The Gut Experts Professor Barbara Ryan and Elaine McGowan explain all. 

Are you amongst the approximately 1 in 6 women in the UK who have Irritable Bowel Syndrome (IBS)? It’s a common gut condition that affects the digestive system and is up to 2.5 times more common in women than it is in men. IBS causes uncomfortable gut symptoms like constipation, diarrhoea, an alternating between the two, bloating, excessive wind, cramps and more. The symptoms of IBS tend to fluctuate over the course of a woman’s life and female hormones play a big role. Pregnancy is a time of major hormonal changes, and these can have significant effects on the gut (think of the heartburn and constipation you suffered from during your pregnancy). Childbirth then comes with its own challenges; the pelvic floor muscles undergo stretching during a vaginal delivery, and the abdominal wall muscles are affected if you’ve had a Caesarian section.

The effect of pregnancy on IBS varies from woman to woman. Some women will say that they felt a lot better during pregnancy, whereas others find that the symptoms become more problematic than ever. Women with IBS-D (diarrhoea-predominant IBS), may feel better as the hormonal effects of pregnancy tend to be a bit constipating, whereas women with IBS-C (constipation-predominant IBS) may feel worse. If bloating has been a significant problem, then that too may worsen during pregnancy. So, what can you do to pre-empt, manage and support your gut after childbirth?

Your gut after childbirth

It’s common for women to experience a change in their bowel habit after childbirth; labour, birth, surgery, pain, medications, hormonal changes, stress, lack of sleep and injury to your pelvic floor muscles all have an impact on your bowel and gut function. Up to 25% of women report having digestive problems after childbirth. Fortunately, most women will see these symptoms improve after a couple of months and unless there has been significant pelvic floor injury, gut function tends to return to its pre-pregnancy pattern within a few months.

Constipation after childbirth

Constipation can be a problem for many women post childbirth, particularly after a vaginal delivery, and even more so if associated with a tear or episiotomy. Rapidly fluctuating hormone levels can also contribute to constipation.

Haemorrhoids (piles) are another common problem during pregnancy and can become a lot worse after labour and or if you are constipated. Women who have constipation predominant IBS (IBS-C) are likely to experience a particular worsening of their symptoms post childbirth, so taking proactive steps to reduce this is really worthwhile – we’ll share some below.

So what practical steps can you take?

Constipation relief

Fibre and fluid are key when it comes to reducing constipation. Aim for 1.5 – 2 litres of fluid per day with water making up the majority of this. Herbal teas and decaffeinated tea and coffee can also contribute to this. Caffeine is a bowel stimulant and a cup of coffee can help with constipation, however this should be limited to about 150-200mg per day (1 large mug of filter coffee or 2-3 cups of tea per day) if you are breastfeeding as it can cause restlessness and irritability in your baby.

Try to eat 20 – 35g of fibre each day from high fibre foods such as whole grains, fruit and vegetables that you know your gut tolerates well.

Some simple and convenient sources of fibre include:

  • 2 kiwi fruits or 2 small oranges (clementines) per day
  • Linseed/flaxseed – add one – two tablespoons of whole or ground linseed/ flaxseed to porridge, cereal, yogurt, soup or salads. They need to be taken with plenty of fluid otherwise constipation might worsen
  • Psyllium husk/Ispaghula is available as a powder, in capsules or whole and can be added to porridge and smoothies
  • Gentle laxatives such as lactulose or polyethylene glycol may also be useful – talk to you your health visitor about these

Loose stools and incontinence

While constipation is a more common problem after childbirth, some women will experience loose bowel motions. Distressingly, some women may also experience faecal incontinence (leakage of stools) if they’ve experienced injury to their anal sphincter during a vaginal delivery, typically due to a tear or episiotomy. For women with IBS-D (diarrhoea predominant IBS) faecal incontinence can be particularly challenging and distressing.

If you are experiencing loose stools or faecal incontinence, the following steps should help:

  • Reducing your fibre intake to 18-20 grams per day
  • Avoiding foods containing artificial sweeteners ending in -ol, these are often found in low fat products and chewing gum
  • Avoiding onion and garlic
  • Limiting fruit to three portions per day and spread these across the day
  • Avoid caffeine-containing drinks

It’s never too early to start doing pelvic floor exercises (kegel exercises). These help to strengthen your pelvic floor muscles which in turn give you more control of your bowel function. Whilst your pelvic floor is unlikely to return to its pre-labour strength these exercises can make a significant difference.

If your symptoms don’t improve after 6-8 weeks, contact your GP as you may need more tailored treatment that might include medication or referral to a specialist such as a pelvic floor physiotherapist.

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Bloating and excess wind

These too can be a problem for some women after childbirth and can be very uncomfortable, more so if you have IBS because of the overly sensitive nerve endings in your gut. Bloating is not just about how big your tummy looks, it’s about comfort, or rather discomfort. During pregnancy, your abdominal muscles relax and weaken, and if you have a Caesarian section this effect is more marked. These weakened muscles coupled with some abdominal weight gain, possible changes in your gut bacteria and potential constipation can also worsen the feeling of bloating and, or excess wind.

So, what can you do if you have IBS and you’re experiencing uncomfortable bloating and wind? Some of the advice is similar to that for constipation, and indeed loose stools / faecal incontinence.

  • If you have IBS-C you may need to increase your fibre take – do this gradually and by 5 grams a week, as otherwise, constipation may worsen
  • If you have IBS-D you may need to reduce your fibre intake a little
  • Focus on foods that you know you tolerate well and avoid those that particularly ferment in the gut like onion, garlic, pulses, beans and stone fruits to name a few – the fermentation of these foods in the gut often leads to bloating and wind
  • Avoid carbonated drinks

Your gut and your mood

Whilst wonderful in so many ways, we also know how difficult it can be adjusting to life with a newborn. The physical and emotional challenges of recovery and your new day-to-day life will inevitably shape your mood and in turn your gut health. Try to ensure that you get sleep when you can and some gentle exercise also, both of which are very important for your mental health.

What’s the good news?

A lot of women aren’t made aware that they may experience a significant change in their bowel habit after childbirth but now you have been – forewarned is forearmed. Gut-related changes of pregnancy and after giving birth are usually temporary and your bowel function will generally return to your pre-pregnancy baseline within a few months. If you are currently pregnant and are preparing for your new arrival you may have time to do some planning to try to pre-empt some potential problems e.g. meal prepping, ensure that you are eating adequate fibre and drinking enough fluid, keep up some gentle exercise and start your kegel exercises.

Do remember that it’s important that you raise any health concerns that you may have with your midwife or GP and start asking them whilst pregnant if you can.

Most new mums and couples will have little time or energy for cooking and may not have the benefit of friends or family bringing them meals. So, below are some simple IBS friendly snack ideas that will give you energy, keep stress to a minimum and give you plenty of time with your new baby. You can also find some IBS friendly recipes on our website here.

Snacks:

  • Cheese & crackers
  • Fresh fruit- firm banana, 10-15 grapes, strawberries, 2 kiwis, 2 mandarins
  • Greek yoghurt, 100-150g & chopped nuts
  • Olives
  • Veg. “sticks” e.g. carrots, red peppers, cucumber
  • Wholemeal toast with peanut butter and/or jam
  • Banana with peanut/almond butter
  • Hard boiled eggs
  • Popcorn
  • Flapjacks
  • Dark chocolate
  • Nuts- handful of walnuts/brazil nuts/almonds
  • Wholegrain biscuits

Article by Professor Barbara Ryan and Elaine McGowan, The Gut Experts (@thegutexperts) and authors of What Every Woman Needs to Know About Her Gut, published by Sheldon Press. 

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