Irritable Bowel Syndrome - My Thoughts
April is IBS (Irritable Bowel Syndrome) Awareness Month in which we try to bring more awareness and understanding regarding this syndrome that affects at least 10-15% of the worldwide population. I think it is likely to be more as many people suffer with painful abdominal pain/ bloating and chronic constipation and/or diarrhoea without seeking or getting proper help.
What is IBS?
A proper diagnosis is based on the ROME IV criteria:
Recurrent abdominal pain (at least 1 day each week in the past 3 months) associated with at least 2 of these symptoms:
pain related to bowel motion
a change in the frequency of your bowel motions faeces
a change in the consistency or appearance of your faeces
Symptoms must be present for 6 months before a diagnosis of IBS is made.
There are 4 types of IBS:
Constipation dominant – IBS-C
Diarrhoea dominant – IBS-D
Mixed (both diarrhoea and constipation present equally) – IBS-M
Unspecified – where bowel patterns are irregular or unknown – IBS-U
Furthermore, other issues should be considered and ruled out such as but not limited:
Inflammatory Bowel Disease
Thyroid Conditions
Diet
Nutrient Deficiencies
Hormonal imbalances
Stress
To make things just a bit more difficult, these conditions can exist with, contribute to and/or result from IBS.
IBS is a syndrome which means that it is a suite of symptoms with no understanding of the cause. Which also means there is no one cure. Instead, you need to work out:
1) What triggers your IBS
2) How to manage your IBS
3) How to manage a flare of IBS
I suffered from IBS for many, many years. Although I experienced gut issues since I was a baby, it was not until my early 20’s that I started to suffer quite painful and debilitating IBS. Days off work, hospital visits, scopes, and blood tests were my norm. It was not until I started to work with a naturopath, that I finally learned how to mange my IBS. What used to be weekly flares lasting days now only take place once or twice a year and last for hours. Here is more about My Story.
Understanding IBS
After suffering myself and working with many others that have IBS, there are few things I have learned. I am sharing these as I see so many suffering with no real answers, no real guide, no real relief.
Being a syndrome, I recommend starting with the basics:
A blood test to make sure your iron, thyroid and liver are working optimally. These are pretty basic tests but a good place to start.
Ideally, a coloscopy to rule out IBD and other structural issues. These are not done so often anymore as it was found that only around 3% of those suffering from IBS had IBD. Instead, you may be better to ask for a faecal calprotectin test which can provide indications of IBD which may allow you to access a coloscopy. For more on calprotectin, please see this article from the Mayo Clinic.
Analyse your intake to ensure you are getting enough fibre (25gm daily), water (2 litres) and healthy fats (this will vary depending on your height, weight, activity level and nutritional objectives but around 25-35% of your total caloric intake is a good place to start.)
Check your alcohol intake as I find that alcohol can either speed up or decrease bowel transit time due to alcohol’s effects on the liver.
IBS – Diarrhoea:
o Check your medications and supplements for side effects that may lead to diarrhoea. Here is an article I wrote on how magnesium can lead to diarrhoea.
o The probiotic Saccharomyces boullardii can be really helpful for firming stools.
o Psyllium husk can be another way to firm stools. As this is a fibre and prebiotic, it is best to start slow and build up to the 1-3 tablespoons daily.
· IBS – Constipation
o Ensure you are moving your body daily – a sluggish gut loves movement so a 30 minute walk each morning can do wonders for constipation.
o 2 kiwi fruit, with the skin on, can be helpful in certain cases of constipation.
o The probiotic Lactobacillus reuteri (DSM 17938) can be helpful for certain types of constipation, especially in children.
Issues with Traditional IBS Treatment
Most of my clients have been suffering with gut issues for years with little or no benefit. The treatments available clearly work for some but rarely all people who suffer from IBS. Here are my top three issues with the current treatment for IBS:
A “first up” diagnosis – I see so many people how are diagnosed with IBS without any investigations – the diagnosis is given on symptoms only. IBS is a by-default diagnosis; this is means that there is nothing else wrong so IBS is the diagnosis that is left. It is not meant to be a first diagnosis – instead, other issues are ruled out and then IBS is diagnosed.
Treating all cases of IBS the same – there are four types of IBS yet there is very little difference is treatment approaches for each type. Instead, each person tends to receive the same advice; stress less, try the FODMAP diet and alter your fibre intake.
Find the one thing – the gut is an incredibly complex area of the body that is impacted by and impacts pretty much all other aspects of our health. Therefore, the treatment must include more than just a single medication, a single diet, etc.
Instead, IBS treatment should:
Be customised to each individual based on, not just their symptoms, but also their family history, genes, lifestyle and personality.
Evaluate the many various factors that determine gut health. (This is exactly why I have three stage approach to gut health that looks at the various factors impacting your gut health as well as stress resilience.
Include a mental health aspect - my favourite being hypnotherapy. The Nerva App is a great place to start.
It truly breaks my heart to see so many people suffering from IBS and not getting meaningful supportive exhaustive help. Is it a quick fix? Not always, but by working with me, there is clear plan, a way forward. And considering the impact of stress on the gut generally, IBS specifically, a way forward can a significant part of your healing journey.