Irritable Bowel Syndrome (IBS) affects 1 in 10 adults around the world yet there is still a lot of confusion around diagnosis and management. This is partly down to the symptoms varying from person to person but also the symptoms can mimic those of other problems such as lactose intolerance or inflammatory bowel disease. The Rome Criteria can be helpful in guiding diagnosis and ruling out other disorders. IBS is categorised in to 3 sub-types:
IBS-D (Diarrhoea predominant)
IBS-C (Constipation predominant)
The research in to IBS is generally focused on the mind-gut connection whereas back when I was diagnosed it was thought to be predominantly caused by food intolerances or sensitivities. The mind-gut connection is about how your brain and gut are connected or communicate together. These channels of talking can get a bit mixed up leading to faster gut transit time (IBS-D) or slowed down (IBS-C). We think of the gut as a second brain in the way that how our gut behaves will affect how we feel and how we feel will affect the gut function. If we are anxious or under prolonged stress this can cause the gut to misbehave which in turn worsens the anxiety and stress!
I developed symptoms of IBS when I was 15 years old but didn't get a formal diagnosis until a few years later when I was sitting my A-levels and the signs had increased. My symptoms have always been the same but are not all present at once and vary in their intensity and affect on my daily life. I fall in to the IBS-D category and my predominant features are:
Loose bowel movements
Going to the toilet 4+ times a day
Abdominal cramps and pain
During a nasty flair up I tend to have diarrhoea daily, spend a lot of time in and out of the loo unless Ive taken imodium and be woken at night with severe abdominal pain that is always central and gripping and makes me feel like Ive been kicked in the stomach for 24 hours after. The bloating I tend to ignore these days as it happens most of the time, especially if I eat anything too quickly (I tend to engulf food!) and it tends to be on the mild side; I only look 20 weeks pregnant after certain drink and foods.
It can be tricky to identify why your symptoms flair up, however the research suggests that prolonged levels of stress at a low to moderate level lead to chronic high levels of cortisol production and this has been found to be higher in IBS sufferers and associated with altered gut motility. I know that for me, stress is the key trigger and also affects my sleep patterns which again have an impact on general well being and gut health. For the majority of patients I see with IBS, when I mention that stress is a common factor the answer is always "Im not stressed". Yet we aren't talking about big life events, its the daily rush of life that can create prolonged low level stress so its worth taking the time to reflect on your lifestyle and whether there are aspects you can change.
Now Im sure many of you will have tried lots of different medications to help manage symptoms but what works for one person may not work for another so the list below are a range of options depending on symptoms!
Imodium - Loose bowel movements this is best taken 30mins before food or as soon as the symptoms start. You can get prescribed a liquid form that can be taken in a really tony dose daily if you are always on the loose side.
Buscopan/Antispasmodics - for abdominal cramps, these can work well for some but do nothing for others. I take buscopan along with a painkiller when I get nasty abdominal pain, along with a hot water bottle this give some relief
Diet - Bloating is a common symptoms of all types of IBS and can be managed well with good diet habits. This doesn't have to mean the full FODMAP diet but working out your triggers can make a bit difference!
Laxatives -If you suffer more with constipation and you have maximised your diet to help get things moving then medication can help. I tend to start with suppositories to try and stimulate a movement from the bottom end otherwise senna is a natural laxative and the place to start before you progress up to Movicol (stool softening and increases water uptake in the gut) or dulcolax (stimulator).
Exercise - This can be great for reducing stress, improving sleep and stimulating regular bowel movements
If you have symptoms of intermittent bloating, diarrhoea or constipation or both, abdominal pain and cramping then you may be suffering from IBS. Any change in bowel habit for more than a few weeks should be discussed with your GP to ensure that other conditions are ruled out as there are many other gut disorders that have similar symptoms.