The runs, the trots, the green apple Quickstep. You’ve heard all the nicknames for it, but even hearing something as cute as “bubble guts” doesn’t improve diarrhea, especially during pregnancy or breastfeeding.
Just last week, I got a call from someone in a panic: “Leah, this is so bad. I’m so uncomfortable. I thought you must have been constipated during pregnancy.”
The caller was not wrong – constipation can be common during pregnancy. Hormones like prostaglandins – which help signal your gut that it’s time move things around – tend to slow down during pregnancy. Even still, constipation does not always happen.
Food poisoning, viral illnesses (like COVID-19), and chronic conditions (like IBS or Crohn’s disease) can all cause diarrhea, even during pregnancy or breastfeeding. No matter where it comes from, everyone asks the same question, “How can I stop it?” Before we answer that question, let’s talk about what actually happens when you have diarrhea.
Diarrhea: What Really Happens?
What makes diarrhea different from your normal bowel movements? Diarrhea is when you have loose or watery stools (poop). Diarrhea may appear brown, but sometimes it can appear yellow, slimy, or mostly clear. Some other symptoms of diarrhea may include abdominal cramps, feeling like you want to “go,” or gas. Diarrhea can be caused by many different things. Sometimes, diarrhea can be caused by food or drink (such as food poisoning, contaminated water, or food allergies such as lactose). Diarrhea can also be caused by other conditions (such as viral infections, conditions affecting the gastrointestinal system, or medications). When you have diarrhea, your body gets rid of water and electrolytes much faster than usual. It’s always important (but especially when you have diarrhea) to wash your hands for at least 20 seconds with soap and water after going to the bathroom. This helps prevent the spread of infections.
What does this mean if I am pregnant or breastfeeding?
One of the main concerns with diarrhea is the risk of dehydration. If you are severely dehydrated during pregnancy, this can increase your risk of certain pregnancy-related problems, such as oligohydramnios (not having enough amniotic fluid). If you are severely dehydrated while breastfeeding, this can reduce the amount of breast milk you produce. Yellow or dark urine, inability to urinate, dizziness or fainting, and thirst are some signs of dehydration. Usually, rehydration involves giving yourself more water and more electrolytes to replace the water and electrolytes you lost from diarrhea. If you are experiencing dehydration, you should consult your healthcare team about what you can do to stay hydrated.
OTC options
Over-the-counter medications can be a helpful way to treat diarrhea, depending on the situation. Let’s explore what we know about common over-the-counter antidiarrheal medications: loperamide (Imodium) and bismuth hyposalicylate (Pepto-Bismol). For more information on these types of medications or any others, please contact a MotherToBaby specialist.
Loperamide
Loperamide is a common over-the-counter antidiarrheal. Loperamide works by attaching to certain receptors in your intestines to say, “please don’t move things around so much.” Taking loperamide slows the movement of your bowels, which slows down how often you have a bowel movement.
When you take loperamide as directed, most of the drug stays in your intestines, and you are not expected to absorb a large amount of loperamide into your bloodstream, where it can then reach the baby. Loperamide, however, has not been well studied in pregnancy, and it is not known whether taking loperamide as directed during pregnancy changes the chance of miscarriage or pregnancy-related issues, such as preterm birth (birth before 37 weeks) or low birth weight (weighing less than 5 pounds, 8 ounces at birth). One study showed that taking loperamide during the first trimester of pregnancy may increase the chance of birth defects, and another study found no increased chance.
Because there is not much information about using loperamide during pregnancy, you and your healthcare provider may need to decide what is best for you. Treating diarrhea is important especially to prevent dehydration, but it is also important to consider the limited information we have about this drug in pregnancy.
Loperamide passes into breast milk. If you decide to take loperamide while breastfeeding, your infant will have very little exposure. Exposure to loperamide through breast milk is not expected to result in adverse effects in the infant.
Bismuth subsalicylate
Bismuth hyposalicylate is another over-the-counter medication commonly used for diarrhea. Some common names for bismuth subsalicylate are Pepto-Bismol, Kaopectate, and BisBacter. Bismuth hyposalicylate works by slowing down prostaglandins (which helps reduce inflammation and slow down bowel movements) and by encouraging your body to reabsorb water from the intestines (which helps make bowel movements less watery). Bismuth hyposalicylate is converted into two components in the body: bismuth and salicylate.
Most of the bismuth stays in your intestines, and you are not expected to absorb much of the bismuth into your bloodstream, where it can reach the baby.
However, salicylate can be absorbed into your bloodstream. Taking something containing salicylate during pregnancy (such as bismuth hyposalicylate or NSAIDs such as aspirin or ibuprofen) can cause problems with the way the baby’s heart works or the way the baby’s kidneys work which can cause oligohydramnios (not enough amniotic fluid around the baby) and poor lung development. It may also cause bleeding concerns for you. Because of this, it is generally recommended that you avoid any medications containing salicylate, especially in the second and third trimesters of your pregnancy.
If you take something containing salicylate while you are breastfeeding (such as bismuth hyposalicylate or NSAIDs such as aspirin or ibuprofen), there will likely be some salicylate in your breast milk. There is concern about administering salicylate directly to an infant. Infants tend to metabolize (or process) salicylate more slowly than adults. Reye’s syndrome, a rare condition involving brain swelling and liver damage, can occur if an infant is recovering from a viral infection and is directly exposed to salicylates.
For more information on bismuth hyposalicylate, see the Managing Abdominal Problems During Pregnancy blog.
The Bottom Line – No pun intended
Diarrhea is uncomfortable, tiring, and when you’re pregnant or breastfeeding, it often brings stress to a whole new level. You don’t have to choose between feeling better and worrying about your baby.
Staying hydrated is always a priority, but when symptoms don’t improve, medications may be helpful, depending on your situation. As always, if you notice changes in your body during pregnancy or in your baby while breastfeeding (such as an increase in stool or a change in stool color or consistency), you can contact a healthcare provider for guidance on what to do next.
And remember, if you ever feel unsure about an exposure, medication, or symptom during pregnancy or breastfeeding, you don’t have to figure it out on your own. Evidence-based guidance can bring peace of mind — even on days when your stomach has other plans. Contact a MotherToBaby specialist to talk to someone about your concerns.
Good luck and I hope your tummy feels better soon!
