How does IBS affect you?
If you know seven people, chances are that at least one of them has Irritable Bowel Syndrome (IBS). IBS is a functional bowel disorder that touches 1 in 7 adults1. The interesting (or frustrating) thing about IBS is that it is not the result of damage nor does it cause damage. Meaning it won’t shorten your life, but the symptoms associated with IBS are often debilitating and really disrupt your quality of life.
Fast facts about living with IBS2-3
- 90% of people with IBS identify what they eat as a major factor
- 2/3 of people who suffer from IBS are female
- 70% of people with IBS do not seek medical advice
- IBS is the 2nd most common reason for absenteeism from work
- IBS is more than the occasional tummy ache, it affects work, social life, family life and intimacy
- IBS is the most common condition diagnosed by a gastroenterologist
- The most common age for diagnosis is 25-45 years
IBS is a chronic condition that tends to wax and wane over the span of one’s life. It’s not unusual for people to have periods of time when they feel generally well and then go through other times when their IBS is like an evil monster just there to make life miserable.
So, what symptoms do we look out for when we suspect IBS?
- Abdominal bloating
- Abdominal pain
- Excessive wind
- Alternating bowel i.e. diarrhoea, constipation or alternating between the two.
We are learning a lot about IBS, but there are definitely some parts that we are still discovering. A really important thing to get your head around is that IBS is Multimodal. What I mean by this is that there is seldom one clear cause that can be treated. Instead there are multiple factors that are involved in triggering IBS symptoms. In my experience, people who have an IBS Toolbox that incorporates a range of strategies are the ones who get the most improvement in quality of life. So, let’s have a look at some of these:
We know that what you eat plays a role in IBS. The Low FODMAP diet is the most researched and well evidenced diet for treating IBS. It identifies four groups of carbohydrates that are poorly digested and can increase gas production and attract water into the intestines. This gas and water may be the catalyst for the bloating, pain and altered bowels that are typical of IBS. Approximately 3 in 4 people with IBS will get a significant and consistent improvement when following a Low FODMAP diet.
Gut brain axis:
What we know about IBS is that it is a disorder where the nerves in and around the gut are over sensitive and over communicate with the brain via the gut-brain axis. Now that’s not to say it is all in your head. However, things like stress can increase the sensitivity of the gut and stimulate the gut brain axis, worsening abdominal symptoms. You might be interested to know that things like Yoga, gut directed hypnotherapy and other strategies that calm the body and mind in general are shown to help reduce or even resolve IBS symptoms.
For the girls, we know that hormones influence digestion. Progesterone which rises the week prior to your period slows digestion and can make you feel bloated, backed up and uncomfortable. Prostaglandins that are released at the start of your period, can cause the gut to contract and speed up, even causing some diarrhoea. If you’re someone who finds your IBS is worse at that time of the month. Try eating some extra kiwifruit if you get constipated or increasing soluble fibre to soak up those looser poops.
The pelvic floor contains the muscles that control defecation. A successful bowel movement requires coordination and relaxation of these muscles. Certain toileting habits can make it more difficult or easier to open your bowels. If this is playing a role for you, it might be worth seeing a pelvic floor physiotherapist who can help with techniques and strategies to improve this.
Medications and supplements:
Ok, so this isn’t really how IBS affects your body, but it does deserve an honourable mention. All medications and supplements have side effects and gastrointestinal effects are common. These can improve or worsen IBS symptoms. Additionally, if you are not getting the right amount or type of fibre for your needs, this will impact your poop. Adding the right supplement can make a big difference to be being successful on the toilet. Your doctor pharmacist or dietitian can discuss your situation and what may or may not be appropriate.
Conditions that can mimic IBS
Symptoms of IBS can overlap with other more serious medical conditions. Of course, knowing what you are dealing with will determine the safest and the most effective treatment to resolve your symptoms. This means it is really important to exclude these conditions before settling on the diagnosis on IBS. Your GP can help you organise tests to rule out these conditions. Conditions to consider:
- Coeliac Disease – make sure you are eating gluten at the time of these tests, otherwise the results will not be accurate.
- Inflammatory bowel disease e.g. Ulcerative Colitis or Crohn’s disease
- Diverticular disease
- Gynaecological conditions
- Parasitic infections
- Bile acid malabsorption
- Bowel cancers
If at any time during your IBS journey you develop other symptoms, make sure to go back to the GP to discuss. The following symptoms are not associated with IBS and are red flags that tell us something else is going on and further investigations are needed:
- Unintentional weight loss
- Rectal bleeding
Once you know you have IBS and have decided to investigate food triggers, then it’s time to book in with a dietitian. Since IBS doesn’t damage the body, there is no test that can be used to identify food triggers. So, save your money on these. The gold standard to identify food related IBS triggers is an exclusion diet followed by re-introduction. The most common one being the Low FODMAP diet. Of course, any elimination diet can reduce your body’s access to certain nutrients and increase the risk of having an unbalanced diet and developing nutritional deficiencies. My tip: check in with your GP for a regular blood test to make sure you are not developing any deficiencies and keep any dietary restriction to a minimum and short term.
- Monash FODMAP (accessed 2022), “What is IBS”, online at https://www.monashfodmap.com/ibs-central/what-is-ibs/
- Monash University FODMAP Dietitians Course (2021) online https://www.monashfodmap.com/online-training/dietitian-course/
- About IBS (accessed 2022), “Facts about IBS”, online at https://aboutibs.org/what-is-ibs/facts-about-ibs/