Irritable Bowel Syndrome (IBS)

You may have heard of this condition and perhaps even been told you have it or have self diagnosed. But what is it really? does it really exist? what makes it a different condition to inflammatory bowel disorders?, why do you have it along side many other fellow suffers? and importantly what self care strategies can you put in place to help you manage it rather than perhaps as now it is managing you?!

I write from experience of being told I have IBS by numerous medical specialists. Sometimes a label of a condition can help you accept and move forward in what cards of life you have been dealt. Sometimes though a label becomes the very thing that obstructs your own and certainly the medical people in really being a detective and working out what’s going on in your body. We become blinded by the label and don’t seek out new information that may well help us in our journey of well big and good gut health.

So, what is IBS?
It is a condition that is the most common functional gastrointestinal disorder. It is generally agreed that bowel issues arise because of some chemical and neural mis information from the brain been sent to the bowel and the bowel sending back incorrect neural information to the brain. If this occurs enough times a neural pathway that is not correct is developed and incorrect neural wiring of the brain and large bowel can result, hence condition becomes chronic in nature. This also if we put our detective hat on tells us to treat IBS we must have a multimodal approach that incorporates dietary changes and just as important recognition of implementing a cognitive (re education) and relaxation plan.

In IBS, the clinical manifestations are limited to the large bowel as the primary effected area.
What it isn’t, is an Inflammatory Bowel Disorder. Such a disorder/ disease is a condition that can manifest from the mouth to anus, where there is severe chronic bowel inflammation that Is an autoimmune disorder and is chronic in nature, but can go into remission periods. There is an anatomical abnormality as well as a functional one. Examples are Crohns Disease and Ulcerative Colitis.

There can be some local inflammation in the large intestine with IBS but this would be due to reactivity of the colon rather than an auto immune disorder like Celiac disease or Crohns.
Around 5-12% of people in western countries are diagnosed or given the label of having IBS
It is stated that the cause is not known, but by doing your own detective work you can often isolate factors that have contributed to developing symptoms.
It is probably called Irritable Bowel because the bowel is very annoyed, holding in its feelings (constipation) or blurting out its irritation (diarrhoea).
The person whom is suffering with the frustration and discomfort is probably very irritated by their body! I know I have been!
To be called a syndrome the condition must have a minimum of three symptoms (called clinical manifestations)
The term IBS can be viewed as a general term that contains many different symptoms, some of which one person with IBS has and some they do not
The medical system requires at least three of the listed symptoms before they will diagnose IBS
The diagnosis relies on the presence or lack of symptoms as on examination of the large bowel through a colonoscopy no anatomical abnormality is seen but usually the Dr will note some irregular bowel motility functioning either under or over activity. It is important to note that some people can have both IBS and IBD.

Symptoms (what the person tells you they feel)/ Signs (what you can see)
Can be very variable but the accepted ones are:

• Abdominal pain
• Constipation
• Diarrhoea
• Alterations between the two
• Bloating
• Cramping in abdominal area
• Fatigue
• Excessive gas
• Headaches
• General feeling of being unwell

Psychological trauma
This is a very real and widely experienced symptom of IBS. There as we know a direct link from what you feel and what your body experiences physically. Also, if experiencing ongoing, chronic ill health that especially you feel you can’t manage will directly impact your emotional wellbeing, it is exhausting and your adrenals are often very stressed too.
It is difficult to have IBS as you to outsiders probably appear normal unless they are privy to your symptoms such as rushing to the toilet frequently or your daily pray to the universe is that you go to the toilet!
People were still often unsure if their bowel symptoms are normal, is everyone the same? does it matter if I have a problem? and they can be embarrassed to discuss with their health carers. Historically people reporting IBS symptoms to their Doctor have not been taken seriously and they are left feeling angry and ashamed when told “it’s all in your head just don’t worry about it, relax” or “going to the toilet once a week is fine” or they leave their appointment with a laxative or anti diarrhoea medication.
Many people won’t travel or limit their social outings because they know that they will get increased IBS symptoms, so the joy of life is less for them. Psychological assessments have been conducted on the participants of many studies on IBS and all people show an increase in their stress levels and report feelings of sadness or depression as they try to manage their symptoms. Pain when chronic in nature is debilitating and sets you up to be unable to cope with events or bodily sensations or emotions that when well you normally could. These leads the person to spiral downwards and can result in feelings of learnt helplessness. Meaning they feel they cannot change outcomes for themselves do just give up trying.

So, what can you do to help yourself manage your symptoms they may be greatly impacting on your life?
Firstly, you need to make sure your symptoms aren’t something else. So, a visit to a sympathetic Dr is a good start so for example if you need a colonoscopy (should as part of your health management especially if over 50 years). It is very important that celiac disease is ruled out as this is a serious condition that requires specific ongoing management. Often a full blood examination will be done to check for any undiagnosed anaemia.
Studies indicate that children with IBS statically are more likely to have a greater risk of celiac disease.
Is everything ok you now can become a detective and with people like Sue Wilde’s support and experience you can navigate your way through the maze of self care

Diet:
Always a great place to start. Keep a food diary and notice which food stuffs tend to increase your IBS symptoms. Also, notice what you drink and how that makes you feel.
Be prepared you list of foods and drinks that are increasing your symptoms will (for sure!) include some of the stuff you love and have daily.
This does not mean you will forever have to take them out of your diet but maybe not consume daily or in smaller portions or have a break then slowly return to reintroducing the food or drink
You may need to ask yourself the question “how much pain and suffering am I willing to endure so I can eat that cheese” (or whatever)? Only you can decide on the consequences and health outcomes for yourself.

The obvious foods that may cause increases end symptoms are likely to be dairy and wheat plus food and drinks containing a lot of sugars.

What I would like you to consider is to be more lateral in your thinking and management.
In 2014 I was part of a world first study into the management of IBS with a multi modal approach. It was a very significant experience for me as I was assigned dietary changes and hypnosis as my management. The specific diet I was placed on is called the FODMAP diet
F- ferment able
O-oligosaccharides
D- disaccharides,
M- monosaccharides
P- polyols

You may not know but nearly all the foods you consume at each meal contain various amounts of FODMAPS which are indigestible and slowly absorbed carbohydrates
Scientific work mainly in Australia has shown a very strong link that FODMAPS in people with IBS induce gut symptoms and increase any currently being experienced.
This occurs due to mainly because of there poor and very slow intestinal absorption. This causes (due to osmosis, remember your biology lessons at school?) a ‘drive’ increase in small intestinal water content and this results in the large colon/ intestine producing more gas and more dysfunction with bowel motility
This and other studies have shown in people with IBS symptoms can decrease them by up to 70% by following a low FODMAP diet.
In my case, it has helped me so much manage my health.

So, what are common FODMAP foods?
It is an extensive list because each food has its own level and is often volume dependent, which means if you eat a lot of it you will get IBS symptom increase, but there are other foods that it is pretty much guaranteed you will suffer if you eat even small amounts if you are very gut reactive that day or eat more than once a day that food or eat too large volume in one meal. Some foods on the list you can have small measured controlled amounts.
The main general reactive foods are: apples, pears, onions, leeks, watermelon, wheat, mannitol (artificial sugars)
I would strongly suggest you do your detective work about what FODMAPS maybe affecting your bowel. Dr Sue Shepherd an Australian dietician was a pioneer in this research and she has great easy to understand information available on the web.

Routine
When talking about the bowel it is important to recognize that the bowel loves routine. So, set yourself the intention to contribute to your bowel health. For me I never waver from these elements in my day to ensure my bowel functions. Of course, some days are better than others and travel is difficult but not impossible as I felt it once was. I have had to be my own advocate with my family and when I eat out but I refuse anymore to be so miserable.

So, I include a daily green fibre drink and once had I rest for 30 minutes and breath and meditate and my bowel then will relax and work
I have regular colonics and without a doubt these have been health enhancing
Breath work so my body’s nervous system is more relaxed (gut brain axis)
I take magnesium that helps nourish my nervous system
I try (but fail often!!) to get enough sleep as I know a tired body will directly lead to a tired sluggish bowel
When travelling, I ensure good hydration pre, during and post flight. I have colonics before flight and after
I make sure I take probiotics daily and ensure a supply while travelling
Some airplanes are designed to fly at a lower altitude and having been on several my IBS symptoms are greatly lessened as altitude can directly effect your bowel pressue. Notice how you get bloated, swollen feet, fatigued and clothes feel tight after long haul flight, all due to cabin air pressure
I monitor each meal what I eat and ensure it is low FODMAP
I exercise to keep my body well
I ensure I drink enough water daily
I do regular abdominal massage
I try to squat over the toilet when possible rather than sit and not allow my bowel to relax and open
I read and research constantly for new research about bowel management
All of these factors support my perception that I am contributing to my health care and not replying on others to ‘fix’ me.

Good luck with your detective work and remember the effort will be worth it

Reference:
Study Randomised clinical trial: the efficacy of gut –directed hypnotherapy is similar to that of the low FODMAP diet for treatment of IBS
Authors: S. Peters, C.K Yao, H. Philpott, G. W. Yelland, J.G. Meir and P.R. Gibson