WHAT IS IBS?
IBS affects up to 15% of people worldwide. While we don’t really know what causes IBS, we know that it is an undisputable medical condition. Although symptoms can vary from person to person, they commonly include abdominal pain, excess wind, bloating, and altered bowel habits i.e. constipation, diarrhoea or alternating between the two.
IBS is a considered a “functional” condition. This means that the bowel appears to be medically healthy and doesn’t show structural or anatomical abnormalities. For this reason, there is no blood test or diagnostic procedure that can identify it. Instead, it is diagnosed by evaluating symptoms in comparison to the ROME IV criteria. However, in the real world, the diagnosis is often given when someone has chronic digestive complaints without any identifiable cause.
ROME IV criteria for IBS diagnosis:
Recurrent abdominal pain on average at least 1 day per week in the last 3 months, associated with two or more of the following:
- Related to defecation
- Associated with a change in a frequency of stool
- Associated with a change in form (consistency) of stool
At this time, there is no cure for IBS, and since it doesn’t cause damage, the treatment is aimed at minimising or preventing symptoms and improving quality of life.
There are a number of factors that play a role in IBS symptoms. Common triggers include food choices, eating behaviours, gut microbiota, hormones, medications, intestinal infections and stress. Most people find that a mix of interventions that addresses their personal triggers and symptoms, provides optimal relief and improves their overall health and wellbeing.
DIETARY TRIGGERS FOR IBS
FODMAPs are certain types of carbohydrate molecules that are not well absorbed in the small intestine. These carbohydrate molecules stay in the digestive tract and travel to the large intestine. During this process two events occur:
- FODMAPs are osmotic and draw water into the bowel. This water stretches the bowel and increases the speed that it moves, potentially causing diarrhoea.
- When FODMAP arrive in the large intestine they become food for the healthy bacteria that live there. When these bacteria consume FODMAPs, they ferment them and create gas as a side effect. This gas leads to bloating, cramping, excessive wind, and irritating nerve endings around the bowel.
A diet low in FODMAPs is proven to alleviate IBS symptoms in 75% of people with IBS. You can read more about the low FODMAP diet here.
Food Intolerances can also trigger IBS type symptoms is people who are sensitive to them. These can include intolerances to a variety of molecules e.g. salicylates, amines, glutamates) or whole foods e.g. dairy, soy, wheat. Food Intolerances do not involve the immune system or cause damage, so there are no reliable diagnostic tests to identify them. The gold standard for diagnosis is an elimination diet followed by food challenges. If you think this might be you, it’s best to speak to a specialised food intolerance specialised dietitian.
Gut irritants like caffeine, alcohol, excessive fibre, spicy or fatty foods, chewing gum or carbonated drinks are all well documented to contribute to IBS type symptoms. In most cases, if you have a sensitive gut, moderation is the key with these types of foods.
BEHAVIOURAL TRIGGERS FOR IBS
How much you eat, how fast you eat and how you space your meals can all play a role. In most cases, eating small regular meals, that are evenly spaced and in pleasant surroundings makes meals more enjoyable and easier on the digestive system.
- Large meals that leave you feeling “overfull” put pressure on the digestive tract.
- Eating too fast or talking a lot while eating can cause you to swallow extra air
- Going for long breaks between meals and being very hungry can trigger people to eat larger meals and eat faster.
Visceral hypersensitivity is the hallmark characteristic of IBS. The viscera refers to the inner organs, particularly those around the abdomen like your stomach and intestines. Being hypersensitive in this area, means that when something occurs your nerve endings are more responsive and you feel more pain than someone with low visceral hypersensitivity.
Relaxation techniques can help quieten down the nerve endings throughout the body, including those in the gut. It doesn’t matter so much what you do, as long as you find it relaxing and are able to do it regularly. Ideas might include:
- Meditation, mindfulness techniques, deep breathing and taking time out to wind down and relax the entire nervous system.
- Light exercise like yoga, Pilates, swimming or just a walk in the fresh air.
- Engaging in activities you enjoy like baking, reading or colouring.
- Limit distractions during meal times and eating slowly and mindfully in a relaxed environment.
MEDICATIONS & SUPPLIMENTS
Medications and supplements can be used to help manage IBS. Peppermint oil, fibre supplements, Iberogast and certain medications (both prescription and over the counter) can be a great addition to your IBS toolbox. Your doctor or dietitian can discuss which options are best suited for your needs.
Certain medications and supplements may also have side effects that can upset the gut. In some cases, these side effects are transient and in others they may hang around. If necessary, it may be worth taking stock of non-essential medications or chatting with your doctor about managing side effects or alternative options.
IBS is seldom straight forward, but there are many techniques that can help to manage it and keep it from interfering with your day to day life. Working with a specialist dietitian to find the right management strategies for you is a great way to combine techniques and develop an individual symptom management plan.