Have debilitating digestive problems been ruling your life for longer than you care to remember?
The chances are that you've been told that it's Irritable Bowel Syndrome (IBS) but what is it? What causes it? How is it diagnosed? And most importantly, what can be done to help?
According to the National Institute for Health & Care Excellence (NICE), the prevalence of IBS is estimated to be between 5–20% and the breadth of this percentage gives us an insight into the vagaries of receiving an IBS diagnosis. So here we aim to demystify IBS and share some practical ways that you can cope with your symptoms.
What is IBS?
IBS is an umbrella term used to describe various digestive symptoms that have occurred for more than six months such as abdominal pain, bloating, flatulence, or nausea, often relieved by a bowel movement with no structural abnormalities. IBS is a diagnosis given by the medical profession when most other diagnoses have been ruled out.
What causes IBS?
The exact cause of IBS is not clear because the underlying issues are varied and complex. It is more common in females, thought to be due to fluctuating sex hormones, and is most often reported in those between the ages of 20 – 40 yrs.
Evidence suggests that there might be a genetic predisposition, triggered by events disrupting the gut microbiome. These events could include a sedentary lifestyle, poor diet, a bout of food poisoning which is known as post-infectious IBS, or the use of certain medications including antibiotics.
The thinking is that this could lead to various conditions arising within the gut such visceral hypersensitivity where the nerves in the gut become overly sensitive. This can cause food to pass through the gut either too quickly or too slowly, hence diarrhoea or constipation.
Stress and anxiety are also thought to play a role in IBS via the "gut brain connection", which involves, among other things, the Vagus nerve, a major nerve that sends signals between the gut and brain, the endocrine system that produces stress hormones, and the microbiota, a community of microorganisms in the gut, that influences the signals between the gut and brain. When this goes wrong and communication between the gut and brain become disrupted, this can lead to digestive issues and a host of other chronic health conditions.
What are the symptoms?
The most common symptoms are stomach pain or cramps which usually start after eating and are then relieved by a bowel movement, bloating, diarrhoea or constipation, mucus in the stool, flatulence, nausea, bladder symptoms, back ache and fatigue.
These symptoms can vary in severity and frequency and can significantly impact quality of life.
What do you do if these symptoms sound familiar?
If you are have been experiencing these symptoms, go and see your GP who will usually run some basic tests such as a full blood count and possibly a stool test, to rule out things like Inflammatory Bowel Disease (IBD), bowel cancer or Coeliac Disease.
Negative test results are good news but now you are left with a puzzling diagnosis of IBS, whether that is with diarrhoea, constipation, both or neither of these.
So what next?
First of all, proceed with caution! There is so much advice online and on social media offering conflicting and often anecdotal advice which might even claim to ‘cure’ IBS. If you are considering a restrictive or elimination diet to ease your symptoms, please do not do this without proper guidance from a qualified nutrition professional. Elimination diets, unless properly managed, can result in serious nutritional deficiencies and we cannot emphasise strongly enough that you should seek professional nutrition advice if you are considering this type of regime.
It is really important that you don’t suffer in silence – IBS can be isolating, embarrassing and emotionally draining and so you should not hesitate to seek guidance from charities such as Guts UK or from a properly qualified nutritionist.
Please do your research and make sure that the advice you are receiving is from those who are qualified to give it. These simple tips will give you a head-start.
Be Prepared
Going out when your tummy is unpredictable can be a stressful experience, which can exacerbate symptoms, and so being prepared for all eventualities will remove some of that stress.
Make a 'going out kit' to keep in each of your bags containing a spare set of underwear, wipes and a pair of leggings or shorts, for peace of mind.
Get yourself a 'can't wait' card which will allow you quick access to a toilet. This is a really valuable part of your 'going out kit' and is available here from Guts UK. You might also consider a Radar Key which will allow you access to toilets that are not available to the general public and you can learn more about the Radar Key here.
If you know that certain foods are a trigger to your symptoms and you're going to be eating out, call ahead to the restaurant and ask if they are able to cater for you. This will take the stress out of trying to find something to eat and you will find that most are more than happy to help.
Chew your food, and then chew it some more.
There is a wonderful Chinese proverb that says ‘the stomach has no teeth’ but we do have teeth in our mouths and we should be using them to chew our food thoroughly, ideally around 20 times per mouthful before swallowing. Food should be reaching the stomach in a state that allows it to be properly digested as unchewed food will take longer to digest and in fact, some of it may not be digested at all, causing it to ferment in the gut resulting in unpleasant symptoms such as bloating and flatulence. Take a look at your poo - more about that later - and if you can recognise anything that resembles something you've eaten, peas and sweetcorn alert, then you're not chewing properly.
You may have a delicious and healthy meal on your plate, but unless each mouthful is chewed properly, it's likely that some of those nutrients will be heading straight for the toilet!
An easy way to remind yourself to chew properly is to put cutlery down between each mouthful and don't pick it up again until you have swallowed.
Feed yourself, feed your gut bugs
We've already mentioned that microorganisms in the gut influence the signals between our gut and the brain. These microbes outnumber cells in the human body and they play a crucial role in digestive health, aiding in the production and absorption of vitamins and minerals and are crucial for keeping the structure of the gut intact.
There is a lot of discussion (and confusion) about food and drinks that are advertised as being high in or fortified with pre and probiotics that "help to maintain a healthy gut" and some of these might be attractive if you are suffering with IBS symptoms. But let's take a closer look.
Prebiotic foods are essentially those that contain plant based fibre that helps to feed the gut bacteria. Probiotics are found in fermented foods that contain useful bacteria to populate the gut microbiome.
Both pre and probiotics can be found in a balanced daily diet consisting of a variety of fruit and vegetables and in foods such as natural yoghurt, kefir, and fermented vegetables like sauerkraut. And so the key, without resorting to expensive and often not very useful "pseudo healthy" foods is to maintain a diet that is as diverse as possible. Of course if you are experiencing a flare, it would make sense to blend your fruit and vegetables in a smoothie or a soup so that digestion has already begun in the pan! And if you have never eaten fermented foods before, start gently and build up slowly.
Hydrate
Whichever type of IBS you have, whether you experience diarrhoea or constipation or a mixture of the two, it is important to stay well hydrated to replace lost fluids and to help keep the bowel moving properly. It's a fact that a lot of us struggle to remain hydrated and so here's some ideas to try.
To get a head start, put a glass of water by the side of the bed and drink it upon waking.
Use a bottle that has markers on it so that you can see at glance how much you've drunk.
Set an alarm on your phone to get a drink - you’ll be surprised how much time will pass without a drink and it's always best to have a drink before you feel thirsty.
Check the colour of your pee - if it's tending towards a darker shade of yellow, take a drink.
If you're not fond of plain water, try herbal teas or fruit infusions that can be served hot or cold or add cucumber, mint, berries or rosemary sprigs to your water bottle.
If you are experiencing a flare, warm bone broths are a soothing way to hydrate
Keep a food, lifestyle and symptom journal
This is a great way to identify links between particular foods or stressful events and uncomfortable symptoms. This Food Journal & Symptom Log allows you to record food, sleep, exercise, energy and bowel movements with lots of prompts and trackers.
Keep an eye on your poo by looking in the loo!
Yes, we're serious and we understand that it’s not the most pleasant of tasks but it helps to identify your 'normal' - the shape, consistency and frequency of your stools on a daily basis - enabling you to notice any changes that might be worth a chat with your GP.
To help you, here's a link to ‘The Bristol Stool Chart’. It categorises stools into seven types, making it simple to identify any changes in your poo and to discuss this without embarrassment.
Print it out and put a copy in your bathroom at home for everyone to refer to as it’s an excellent way for the whole family to easily monitor their digestive health.
If you have IBS or are suffering from any other digestive complaint and would like to get to the bottom of it once and for all, we are qualified and able to discuss your diagnosis and support your symptoms, so please do get in touch to book a call.
Sources: NICE, NHS, Guts UK charity, The IBS & Gut Health Clinic, bladderandbowel.org, Oka et al. 2020, Mullin, 2021, Creed, 2019
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