Everything you Need to Know about Irritable Bowel Syndrome (IBS)
by Marisabelle Bonnici
An estimated 10 - 15% of the global population suffer from some form of IBS, making it the most common gut disorder in the world, while approximately 2 out of 3 sufferers are women. Some people with IBS have minor symptoms, however, for others, symptoms are significant, may disrupt daily life and may have a notable impact on their social life. Furthermore, it is estimated that there another 10% of the population actually go undiagnosed, meaning that many people are dealing with debilitating symptoms like diarrhoea, bloating and cramps but have no idea how to manage their condition.
Have you been suspecting that your unpredictable bathroom habits could be IBS? Here we delve into the symptoms, the dietary changes that could help improve the severity of your symptoms, mind-body practices that you could find useful, as well as supplements that can boost your chances of success.
What is IBS?
Also known as irritable colon, spastic colon, mucous colitis and functional bowel disease, IBS is a condition defined by discomfort surrounding your gut and bathroom habits. It can affect your large intestine, also known as your colon and it can cause a variety of uncomfortable and potentially embarrassing symptoms, ranging from bloating and gas to constipation and diarrhoea.
The severity of the disorder varies from person to person. Some people experience symptoms that come and go and are relatively mild, whilst others have such severe daily bowel problems that their quality of life, sleep and even work is affected. In addition, symptoms may change over time. A person may have severe symptoms for several weeks and then feel well for months or even years or get relapses in different seasons or because of travelling.
Once you start suffering from IBS you will never be cured of it. You may be symptom-free for several years, but it could still show up when you least expect it. At the same time, it's important to note that the disorder is not related to any other disease. People with IBS do not have an increased risk of colon cancer or colitis as most people seem to believe.
What causes IBS?
Even the term IBS is an indication that mainstream gastroenterology doesn't have a handle on what exactly causes it or how exactly to treat it. It's not a 'disease' but a 'syndrome' or a collection of symptoms under the catchall umbrella term of IBS.
The problem with IBS is that so many things can cause it or at the least contribute to it — from allergies, sensitivities or intolerances to certain food to an overactive gut immune system to stress. Stress does not cause IBS. But stress can increase the frequency and severity of symptoms. What's more, the drugs that doctors have been using to treat IBS have had only limited success.
Some studies suggest that the nerves of the large intestine may be more sensitive than usual in people who suffer from IBS. The natural movement of food and gas through the colon causes pain, intestinal spasms and an irregular pattern of bowel movements.
Symptoms of IBS
- Mild or severe abdominal pain
- Periods of diarrhoea or constipation or alternating between these two symptoms
- Severe constipation (often with incomplete bowel movements)
- The feeling of having a distended abdomen
- Mucus in bowel movements
- Feeling as though a bowel movement is incomplete
Although the symptoms of IBS can vary, patients tend to develop their own pattern. For example, some people have mostly diarrhoea, some have mostly constipation and others have abdominal pain and cramps without a major change in bowel movements. Some have stool changes when eating particular trigger foods.
How do you treat IBS?
If you suspect you may be suffering from IBS, make an appointment with a qualified gastroenterologist. This is very important so you can rule out the possibility of a more severe disease.
What you eat (and what you don't) has the biggest impact on the symptoms of this condition and hence the quality of life you lead. Start by making a list of foods that you feel may trigger the syndrome. In my experience, many people get triggered by dairy or green vegetables, caffeine-containing products and fried and fatty foods.
People who suffer from IBS may find that adopting a low-FODMAP diet will help them identify what is triggering them. FODMAP means fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are food with short-chain carbohydrates that are poorly absorbed in the gut and can cause problems like diarrhoea, bloating, abdominal pain and flatulence.
Examples of certain foods and drinks to avoid whilst on a low-FODMAP diet are beans, lentils, wheat, dairy products with lactose, high fructose corn syrup and artificial sweeteners. A list of examples of foods and drinks to eat include hard cheeses, meat, fish, chicken, eggs, rice, and oats. You may want to research what FODMAP foods are in more detail as this is just a quick overview.
Studies have shown up to 85% of patients suffering from IBS benefit from switching to a low-FODMAP diet. The diet works in two phases. First, you eliminate all FODMAPs from your diet for approximately two to four weeks. Then, you slowly start eating specific FODMAPs one by one over a period of six to eight weeks, according to your tolerance. You may want to keep a food diary to help identify problem foods and quantities according to what symptoms you develop.
You may also want to eliminate high gas foods. If you experience bloating or gas, you might avoid items such as soft drinks, sports drinks and fruit juices as well as alcoholic beverages, caffeine, raw fruit and certain vegetables such as cabbage, broccoli and cauliflower.
It is also believed by some physicians that gluten may worsen symptoms of IBS in some cases. Research shows that some people with the syndrome report improvement in diarrhoea symptoms if they stop eating gluten even if they are not suffering from celiac disease.
Don't skip meals and try to eat around the same time each day to help establish a regular pattern of bowel function. In fact, it is sometimes noticed that shift workers tend to suffer from IBS more because of their erratic eating patterns. If you have diarrhoea, you may find that eating small, frequent meals makes you feel better, but if you're constipated, eating larger amounts of high-fibre foods may help move food through your intestines.
The relationship between our gut and our mind
Most of the dietary fibre we eat ends up being fermented or broken down by bacteria that live in the colon or large intestine - this is often referred to as the gut microbiome. Too much fermentation results in the bloating, gas and disordered bathroom habits that are the hallmark of IBS. But, researchers say that the right amount of fermentation helps ensure that we have a healthy gut. That's why nutritionists say most people need to eat more fibre. The bacteria in our gut may actually be out of balance because as time goes by, our diets have become much lower in fibre and we are eating much more junk food.
In the past couple of decades, people suffering from IBS were always told that the symptoms were in their head or were thought of suffering from depression. Yet, the traditional view of IBS being 'in your head' wasn't entirely wrong. Latest research has replaced this notion with a new understanding of gut function as forming part of a two-way conversation between the brain and the gut.
Yes, stress and anxiety can generate hormones that can upset the gut (we've all experienced butterflies in our stomach before a big event or when we fall in love or knots in our stomach when we are anxious). But the gut's nervous system, which produces the same neurochemicals as the brain, can also influence our thoughts and emotions in ways researchers are only just beginning to understand.
The microbiome plays a kind of middleman here - a gut which has a flora imbalance can throw off the production of the hormones generated there and can result in the gut's immune system to overreact to what would otherwise be harmless food components, like gluten or sugar. This then triggers inflammation that may produce symptoms like depression or brain fog.
We are a long way from decoding the exact gut-brain crosstalk that's responsible for IBS in all of its various forms, but we can explore therapies that calm both mind and body and smooth out the conversation between them.
We live in a high string society and as a result, our stress levels are continuously on the rise. Learning to manage your stress or finding ways to limit your emotional response to stressful life events can have a beneficial effect on your IBS and also improve the relationship between the mind and the gut. Stress not only triggers your symptoms but often make them worse.
Effective methods of stress relief:
Yoga - the combination of yoga postures and breath control exercises and stretching will help to alleviate stress and reduce anxiety related to IBS.
Meditation - is proven to help reduce anxiety. This means you will be less stressed and also less likely to stress eat junk food which causes IBS attacks. There are many online instructions that teach you the basics of meditation, while local yoga studios also offer classes.
Mindfulness training - can ease anxiety and also improve symptoms. This has become increasingly popular nowadays and courses in mindfulness are also available locally.
Exercise - working out is a well-known method of reducing anxiety and stress management. Exercise can help people living with IBS cope better with the emotional and physical triggers and symptoms of IBS. For IBS patients who experience frequent constipation, exercise offers an added benefit. In addition to improving your overall fitness level and reducing stress, exercise has been shown to help keep your digestive system working properly and may even decrease the occurrence of constipation. Here are a few tips on how to choose the right workout plan for your body type.
Aromatherapy uses essential oils. Peppermint oil can be quite beneficial at easing colon discomfort, while rosemary is said to aid constipation. Certain types of oils may help with other symptoms of IBS. The oils are used to increase the well-being of the mind and are absorbed both through the skin and by breathing in the vapours. Massage is an important part of the therapy because it is relaxing and eases physical and mental stress.
Some oils can cause side effects though. You should not use basil, lemon, hyssop, sage and thyme oils if you are pregnant, so consult a registered aromatherapist for advice.
Medication and supplements
Your pharmacist may recommend over-the-counter remedies like fibre sachets and herbal laxatives to help with constipation or probiotics to help with diarrhoea such as those containing Saccharomyces Boulardi which will help relieve diarrhoea. Depending on your symptoms, your doctor may prescribe other medications to help ease and control symptoms which would require a prescription.
You may also want to consider yoghurt products, especially those labelled as containing 'live and active cultures'. Probiotics are thought to help with intestinal problems by restoring bacterial balance in the gut and possibly enhancing the immune system.
Finally, peppermint oil containing products are also well known for relaxing and smoothening the muscles of the intestine, while they can help reduce the abdominal pain associated with IBS. Always speak to your pharmacist or doctor for dosing and for interactions with other medication you may be taking.
Do you think you're suffering from IBS and are in need of advice on your diet? Visit these nutritionists to find out more about the FODMAP diet and what you should or shouldn't be eating to alleviate your symptoms.
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