Everything You Want To Know About Irritable Bowel Syndrome (IBS)
Even the stuff you don’t want to ask Google
What is Irritable Bowel Syndrome (IBS)?
Irritable Bowel Syndrome (IBS) is a digestive system disorder where the function of the gut is disturbed.
It is twice as common in females as males, and it usually first appears in teenagers and young adults. Throughout the world, about 10-20% of adults and adolescents have symptoms consistent with IBS.
How does it suddenly happen?
IBS has different triggers and can occur for the first time after gastroenteritis, food poisoning or other infection such as H. Pylori, parasites or SIBO.
Up to 84% of IBS is caused by SIBO - small intestinal bacterial overgrowth.
Think of it like this: if 100 people are in a room, 20 of those people will have IBS.
And at least 12 of those people will actually have SIBO.
SIBO is when there is too much bacteria in the small intestine (part of our digestive system).
Our small intestine is around 6 metres long, longer than the large intestine, and it’s where most of the food we eat is broken down and absorbed.
In a healthy, normal small intestine, there is almost no bacteria present. When
bacteria gets stuck in the small intestine (or flows back up from the large intestine) SIBO can occur.
IBS commonly flares in times of stress, times of change e.g. when travelling, starting a new job or change of routine, change in diet, or due to emotional upset.
What Are The Symptoms?
IBS involves a wide variety of symptoms and is often categorised by its effect on bowel movements. There is a set of diagnostic symptoms set out in a convention called Rome III.
These diagnostic symptoms are:
At least 3 months with onset at least 6 months previously of recurrent abdominal pain or discomfort* associated with 2 or more of the following
Improvement with defecation (pooing) and /or
Onset associated with a change in frequency of stool and /or
Onset associate with a change in form (appearance of stool)
*Discomfort means uncomfortable sensation not described as pain
As you can see the diagnosis criteria is centred around the person's bowel movements and so IBS has subclassifications based on these bowel movements
IBS- D - where there is diarrhoea or urgency to go
IBS - C - where there is constipation
IBS - A/M - where there is alternating or mixed diarrhoea and constipation
Red Flag Symptoms You Don’t Want To Ignore
If you are experiencing the above IBS symptoms and / or experiencing any of the following symptoms, please contact your doctor immediately:
Rectal bleeding
Night Sweats / Pain
Weight Loss
Fever
Vomiting
IBS And Back Pain
While diagnostic criteria really focus on bowel movements there are many other common symptoms associated with Irritable Bowel Syndrome including;
Maldigestion - not able to get vitamins or minerals from food as efficiently
Nausea
Appetite changes
Anxiety
Mood changes
Fatigue
Back pain
Back pain is common among those with IBS, though the exact reason is unknown. Studies estimate it affects between 28 and 81 percent of people with IBS. One explanation often given is that it may be referred pain, or pain that originates elsewhere in the body and is felt in the back. In research, gastrointestinal symptoms like gas and bloating have been linked to back pain.
Another possibility is that people with IBS often have other health conditions that are also frequently associated with backaches. Having hip or pelvic pain or displacement may also cause IBS symptoms or digestive issues. Studies have found that about 3 in 10 people diagnosed with IBS meet the criteria for fibromyalgia (a pain condition now recognised as an autoimmune disease) as well.
IBS sufferers may also have other inflammatory conditions, including arthritis, which could lead to back pain. If you experience IBS symptoms with back pain, speak to your doctor.
Why Does It Take So Long To Get A Diagnosis?
There are a number of factors leading to a long and often frustrating road to diagnosis. First in IBS there are no physical or structural abnormalities. Second, diagnostic criteria is based on people having onset at least 6 months of recurrent abdominal pain or discomfort with at least 3 months of consistent discomfort. Lastly, diagnosis is often made by eliminating other causes and may involve checks for
H. Pylori
Leaking gut
SIBO
IBD - Crohns, Colitis, Diverticulitis
Hiatus Hernia (you can have both)
Histamine intolerance / Mast Cell Activation
Coeliac Disease
Reflux / GERD
Food Allergies & Intolerances
Bowel and Stomach Cancer
Inflammation or infection e.g bacteria overgrowth, parasites
Typically examinations to eliminate other causes include endoscopy, colonoscopy and blood tests for coeliac disease, food allergy and intolerance particularly lactose intolerance, vitamin and mineral levels, inflammation markers etc.
What Is The Typically Treatment For IBS?
Treatment recommended by your GP or specialist will typically depend on the type of symptoms you have. These typically work to relieve symptoms include antispasmodics, pain relief, laxatives, stool softeners or imodium and antiflatulents to reduce gas. If you also experience gas or burping you may be given Nexium or a similar product.
In addition to these medications, dietary modifications may also be recommended such as the Low FODMAP diet or a high fibre diet.
From a nutritional therapy or functional medicine approach, I would typically look for the root cause so that we can reduce symptoms and eliminate the root cause to prevent a recurrence of symptoms.
How Do I Get Relief From My IBS Symptoms?
If you are experiencing a flare, there are some things that can bring relief such as
Stay hydrated
Avoid wearing tight or restrictive clothing which can increase bloating
Eat simple meals
Avoid sugar, processed foods and high salt foods
Apply heat e.g. a hot water bottle to ease discomfort
Try gas reducing teas such as lemon balm, peppermint & ginger
Rest and prioritise sleep
Be gentle with yourself and understand your body’s need to rest
IBS: Foods To Avoid
In addition to trigger foods, these foods are most commonly associated with worsening IBS symptoms:
alcohol
chocolate
drinks that contain caffeine, including coffee and tea
dairy products
sweets/processed sugars
fatty or greasy food
certain sweeteners, such as fructose and sorbitol
Smoking also worsens IBS as it has a negative effect on the cells in the digestive system and the gut bacteria that work to break down foods.
Nicotine results in an overproduction of stomach acid increasing reflux and heartburn as well as disrupting digestion, and decreases the production of sodium bicarbonate, resulting in a significant worsening of certain IBS symptoms. Smoking may also increase the chances of developing peptic ulcers.
Do My Periods Affect My IBS?
The simple answer to this is yes.
You have hormone receptors throughout your digestive system and it responds to the levels of hormones (oestrogen and progesterone) in your body.
This can mean a change in your IBS symptoms e.g. loose bowel movements, increased bloating, fatigue, pain, sleep disturbance and insomnia, greater food sensitivity and PMS.
Research has found that the different phases of the menstrual cycle put people at risk for unwanted digestive symptoms - even those who don’t have IBS. In the days of the month immediately following ovulation, all people are more likely to experience bloating and constipation.
Irritable Bowel Syndrome and Sex
Pelvic pain, pain during sex and sexual dysfunction are recognised symptoms in females with IBS. One recent study did show that men with IBS have an increased risk of erectile dysfunction.
Even if you do not experience these issues, fatigue, stress, bloating constipation, diarrhoea and gas can put you off the very idea of being intimate - particularly with a new partner.
IBS doesn’t have to derail your dating and sex life, experts recommend applying relaxation techniques, open communication and counselling can help.
What Is The Best Diet For IBS?
A Low FODMAP diet is considered the ‘gold standard’ for IBS.
FODMAPs are a group of fermentable carbs that aggravate gut symptoms in sensitive people. They’re found in a wide range of foods.
Many foods are naturally low in FODMAPs. That said, many processed foods have added FODMAPs and should be limited.
There is convincing evidence for the benefits of a low-FODMAP diet. The diet appears to improve digestive symptoms in approximately 70% of adults with IBS.
I’ve shared Low FODMAP meal plans here, this also includes a plant based meal plan.
It typically follows a number of stages:
1. Removal
2. Repair
3. Restore
4. Reintroduction
5. Rebalance
There are variations on this depending on symptoms and current eating styles. It can be modified to suit a paleo, pescatarian or plant based diet.
Is A Low FODMAP diet the only diet that works?
No, there are other dietary protocols that are recommended such as a modified Mediterranean diet, an elemental diet and elimination diets.
An elemental diet for 1-2 weeks has been shown to eliminate SIBO and IBS. This must be supervised and is not something you can do yourself. Your nutritional therapist or doctor can guide you through this process.
The purpose of an elimination diet is to identify food triggers should other causes of IBS be eliminated.
New research has shown that the introduction of a milk derived prebiotic called GOS can be as effective in reducing IBS symptoms and may improve lactose intolerance.
For those who experience IBS A or IBS M, evidence shows that this may be caused by poor bile acid digestion and so dietary and other changes will be designed to support this in your body.
IBS & Testing
As functionally trained and holistic nutritional therapist, I offer a wide range of testing for people with IBS so that they can get to the root cause of their symptoms this includes
Stool testing for parasites, bacteria and other digestive health markers
Food allergy and intolerance testing
SIBO testing
These allow me to provide tailor-made plans incorporating dietary and lifestyle changes and nutraceuticals (vitamin and herbal supplements) that can remove harmful pathogens, support gut health and restore balance.
Why Is Stress Management Important?
Having IBS is stressful. IBS sufferers experience worry and anxiety around common social situations plan, for example
Food sensitivities and allergies when dining out - can they get food, will they be considered a ‘Karen’ for requesting changes
Availability of toilets when out
Loud noise, burping, belching or gas at work or socially
Meeting new people and having IBS symptoms
Choosing outfits for special occasions in case of bloating
Staying over in a new partners home due to symptoms
Missing out on social activities or turning down invitations due to symptoms
Having to explain symptoms and the perception that it’s ‘just’ IBS or that IBS isn’t real
Sudden need to go in formal, work or social situations that are already stressful - interviews, weddings, running
In addition to this change, travel and stress can impact gut function and increase IBS symptoms.
Short-term stress can cause you to lose your appetite and your digestion to slow down.
Long-term stress can trigger gastrointestinal (GI) issues, like constipation, diarrhea, indigestion, or an upset stomach.
Stress also affects our gut microbiome - the gut bacteria that helps us to digest and absorb nutrients from our food.
Chronic stress over extended periods of time may lead to or trigger more serious issues, like irritable bowel syndrome and other GI disorders. Having these conditions can also be very stressful.
As a meditation teacher, I work with clients with IBS to help them to reduce stress and anxiety around their IBS through visualisation, guided meditation and diaphragmatic breathing.
Diaphragmatic breathing is also useful for those with Heartburn/Reflux/GERD and IBD as it works to strengthen the sphincters at the entrance and exit of the stomach which can stop the movement of intestinal bacteria into other areas of the gut (SIBO) and stop acid travelling up into the oesophagus (heartburn/reflux).
Other ways to reduce stress include socialising, spending time in nature, yoga, mindfulness and creative hobbies such as painting, colouring, gardening, knitting.
Cognitive Behavioural Therapy (CBT), Reflexology, Yoga, Acupuncture and CranioSacral work can also help to reduce IBS symptoms.
How Do You Support Someone With IBS?
IBS can really impact your quality of life and many sufferers experience symptoms they consider too embarrassing to talk about or TIMI.
Many IBS sufferers describe:
Feeling like you have no control of your own body
Worrying about eating out with friends or looking pregnant after a meal
Living in fear of passing wind in public or loud stomach gurgles
Being afraid to go to unfamiliar places in case you don't have easy access to a bathroom
Spending time and energy trying to figure out what is going to set symptoms off next
It is time we speak about this more, and for awareness of what IBS actually means to grow.
Some are afraid to start new relationships for fear of being in an unfamiliar place or eating unfamiliar food, being labeled a picky eater or staying over and revealing the full extent of their excess gas and complex routine.
It's never just IBS.
So, give them a break, be sound, ask questions.
Don't tell them what worked for your aunt/sister/granny/work colleague.
Just listen.
Get Support With Your IBS
Can you imagine a day where you don't have to worry about what and when you will eat? What if your 'tummy rumbles' no longer had control over your day? Are you ready be free of digestive distress?
Together we'll create a bespoke programme support your gut health and allow you to start feeling like yourself again!
I will guide you through each step so that you can feel informed and in control of your health. Let's put food and eating back in it's place in your life and help you regain energy for family, friends, work and more.
