What is IBS and how can it be managed?
What is IBS?
Irritable bowel syndrome (IBS) is the most diagnosed condition by gastroenterologists. It’s estimated to affect 5-20% of the population. Around two thirds of IBS sufferers are women, and it mainly affects young people (aged 20-39).
IBS is a chronic digestive disorder which can significantly impact quality of life. It is characterised by symptoms such as bloating, stomach cramps, diarrhoea, and constipation. It is a life-long condition but can be usually managed well with medication and/or changes to diet and lifestyle.
How is it diagnosed?
If you have been experiencing digestive symptoms for at least six months and your doctor has ruled out other conditions such as inflammatory bowel disease (IBD), coeliac disease, and bowel cancer, it is possible you will receive an IBS diagnosis.
There is not currently a valid test to diagnose IBS but testing to rule out other digestive conditions may include a stool test to check for markers of inflammation (which could indicate IBD) and a blood test to check for antibodies (for coeliac disease).
During diagnosis, you may be told you have one of three main sub-types of IBS:
IBS-C (IBS-constipation) - with this type more than 25% of stools are hard and lumpy
IBS-D (IBS-diarrhoea) - with this type more than 25% of stools are loose or watery
IBS-M (IBS-mixed) – this type alternate between diarrhoea and constipation
What’s next when you receive an IBS diagnosis?
Once you have been diagnosed with IBS, you may be offered medication such as anti-spasmodic drugs (which help relieve cramping), Imodium (which contains loperamide to relieve diarrhoea) and antidepressants which can help with pain.
These medications can be useful in relieving symptoms however, they do not deal with the underlying cause of digestive problems. Getting to the root cause of symptoms can be life-changing for people with digestive issues. Some reasons why people may experience symptoms include:
Stress – IBS is now considered to be a disorder of the gut-brain axis (the two-way communication between the gut and brain).
Gut motility problems – slow or fast movement of food through the digestive tract can result in digestive symptoms. For example, an underactive thyroid may result in slow digestion and constipation.
Parasitic infection – parasites can be picked up through foreign travel or contaminated food/water and take up residence in the intestines, altering the environment.
Gut dysbiosis – an imbalance of microbes in the colon.
SIBO (small intestinal bacterial overgrowth) – too many microbes in the small intestine, which can cause bloating and pain.
Insufficient digestive enzymes – a condition known as pancreatic exocrine insufficiency results in an inability to digest food properly.
Bile acid malabsorption – when bile acids are not properly absorbed in the small intestine, excess bile acids can pass into the colon resulting in watery stools.
Food intolerance – people with IBS can be sensitive to certain foods such as the natural sugars, lactose and fructose. Lactose intolerance is very common and increases with age.
Sedentary lifestyle – lack of physical activity can slow down bowel movements and make it harder to pass stools.
Putting together the different pieces of the puzzle and investigating the underlying factor(s) contributing to IBS symptoms can make all the difference. This is best done with a registered nutritionist, nutritional therapist or dietitian who can guide you through the process and ensure you are meeting all of your nutritional requirements throughout the process.
If you’re wondering how best to get started with managing IBS, here are a few simple tips to try…
My 10 top tips to manage IBS symptoms
Manage stress – Finding ways to manage stress can be one of the most effective ways to manage IBS. If you are stressed your digestive system will not be functioning optimally which can lead to bloating or constipation. Stress can also have the opposite effect causing diarrhoea. Talking therapies such as cognitive behavioural therapy (CBT) are now used successfully to manage IBS symptoms.
Stay hydrated – this is very important to support the passage of food through your digestive tract (dehydration can lead to constipation).
Limit spicy foods, alcohol, and fizzy drinks – these can worsen symptoms of bloating and diarrhoea.
Eat slowly and mindfully – taking time to eat meals away from distraction can help the body prepare for a meal and stimulate digestive juices which are crucial for proper digestion of food and absorption of nutrients.
Chew your food properly – the process of digestion starts in the mouth. One of the best ways to support digestion is to chew food well before swallowing. This gives the rest of your digestive system less work to do. Chewing a minimum of 10 times per mouthful is a good starting point, more if possible.
Pay attention to portions – overeating at mealtimes can lead to bloating and discomfort as your body struggles to digest excessive amounts of food. People with IBS can be particularly sensitive to distension or pressure in the gut (known as visceral hypersensitivity).
Identify food triggers – certain foods can cause bloating in some people (particularly those containing FODMAPs), but don’t avoid these foods indefinitely as this can be detrimental to gut health and can make matters worse. Always speak to a qualified healthcare professional before eliminating any foods.
Find a way to move that suits you – walking and yoga are excellent places to start if you’re not used to exercising. They are known to support healthy digestion.
Eat a rainbow of fruit and vegetables – fruit and vegetables are packed with fibre and nutrients to support digestive health, so it’s important to aim for 7+ portions per day (5 veg, 2 fruit). Fibre can be a confusing topic for IBS sufferers as, despite its undisputed health benefits (feeding beneficial gut bacteria and supporting digestion and heart health), it can cause bloating and wind for some people. This can mean they end up avoiding lots of healthy foods which can be detrimental to health long-term. Sadly, only around 5% of us are meeting the daily target of 30g of fibre. For those with IBS, it’s particularly important to increase fibre slowly and monitor for symptoms. This is best done under the guidance of a qualified healthcare professional.
Keep a food and symptom diary – recording your meals, snacks, bowel movements and symptoms for a couple of weeks can help you to pay attention to your digestion and help you tune in to the foods/habits that may be causing problems for you.
What if you feel you’ve tried everything and nothing is working for you?
If you’ve tried all the general recommendations and you’re still experiencing symptoms, it might be time to speak to a nutritional therapist or dietitian who can offer you more personalised support. Everyone is unique, so what works for some people may not be the right approach for you.
If you have any questions or would like to find out more, please book a free call with me to discuss how I can help. I offer in-person consultations in Cambridge and video calls if you are further afield.
Alternatively, if you are not local to Cambridge and would prefer a face-to-face consultation, click here to find a registered nutritional therapist in your area.