Irritable Bowel Syndrome (IBS) affects around 1 in 10 adults yet there is still no definitive test to diagnose it or one specific cure. I’ve written a little bit a about my IBS journey in the past, but as its IBS awareness month and I’ve been seeing an increased number of patients in my Gut Clinic with IBS, I thought now would be a good time to share more!
It’s important to say from the start that any change in bowel habit should be flagged to your GP!
This photo is from May 2020, the bloated 'are you expecting a baby' belly!
Where it Started….
I find it a bit weird thinking back to my journey with IBS because its been a long time but also because now I specialise in gut health you would think I know how to ‘cure’ myself, but unfortunately its not that simple!
I first started having symptoms of IBS when I was 15 years old whilst struggling to ‘fit in’ at school and cope with the varying degrees of bullying that seemed to run through most of my adolescence. On reflection now I can see that prolonged states of stress were the trigger, but if we look back to 20 years ago there wasn’t much research in to what IBS was. I don’t think I was given a diagnosis until a few years later around the time of my A levels when I had also started to experience heart palpitations and feeling faint, another stress sign!
My symptoms have always been the same, generally not all there at once and they vary in severity - Abdominal pain that typically occurs at night and wakes me up with a sensation that someone is twisting my insides, intermittent bloating, loose bowel movements with increased frequency so I tend to go 2-10 times a day at its worst and mucus in the stools which is another common symptom of IBS. In the beginning it was put down to food intolerance or sensitivity as the evidence around the mind-gut link wasn’t as mainstream as it is today. I had blood tests with my GP to rule out inflammatory bowel disease and a stool sample to make sure there wasn’t anything nasty hidden in there but it was all normal. When I started university my symptoms continued but I now had the added impact of alcohol (has a laxative effect) and cooking for myself! I went down to 48kg in that first year, and that was partly down to urgency and needing the toilet after each meal. My GP at this stage sent me for a sigmoidoscopy which of course was normal. Over the next 3 years I managed my symptoms with antispasmodic medication, Buscopan being my chosen one, Imodium on a regular basis as the pre match nerves at hockey always triggered symptoms, Co-codamol for the abdominal pain when it occurred in the night and then Amitriptyline 10mg as new evidence came out as it being effective in helping with IBS abdominal pain. Now many of you will know Amitriptyline as an antidepressant, but taken in very low doses it is actually a nerve painkiller and can be very helpful for some people, just sadly not for me.
By the end of University, so 2009, I saw a GP who happened to have an interest in IBS (yes they do exist!) and she talked me through the link between my high levels of stress and gut symptoms alongside my university diet and lifestyle …..
She advised mindfulness which I didn’t do and suggested I stop taking on so many extra work shifts and have more time to unwind, which again I didn’t do. We can all be given great advice but if we aren’t in the headspace to take it on board and implement change then nothing happens! I actually spent from this point up until 3 years ago continuing in the same pattern of intermittent flair ups and just managing the symptoms when they occurred, so a bit like fire fighting. As an idea for you as I know this will resonate with many, my symptoms for this period varied from going to the toilet 3 times a day, always a softer stool, to having urgency and diarrhoea after eating meals or drinking anything caffeinated. This was tricky at work as I would have regular urgent calls to go when I was midway through treating patients during those bad flair ups and it really began to worry me that one day I might not be able to hold it. I had succumbed to the fact that eating out with rich food would lead to a rough night but that was ‘just how it is’. Holidays were planned for with my ‘tummy bag’, I had learnt my lesson in my 20's not to travel to far flung places without one (think Bali belly…) this was especially important for when I went to India on my first big holiday with my now fiancé. I was a tad panicked about the idea of going to a country that was known to trigger upset stomachs when I already had one! So I loaded my bag up with Imodium, Pepto bismal chewable tablets (absolute life saver) as they can help firm up your stool, buscopan, peppermint capsules, prebiotic and probiotic tablets started a month before going and a varity of pain killers. The irony here is that I ended up taking so many things alongside a ridiculous amount of breads and rice that I became constipated and triggered my first haemorrhoid! May you learn from my mistakes!
The Near End (because there never really is an end) ….
So around 3 years ago when I was still working in the NHS, I was under a lot of stress at work for many reasons and found my IBS symptoms were the worst they had ever been. The difference this time was I now specialised in gut issues and knew things had to change, especially when I was studying for a masters in psychology and the first term focused on our bodies stress response and mind-gut link! I saw my GP to discuss the change in my bowel habit as I was now going around 8 times a day and had developed some bleeding. They took bloods again which were normal but declined to refer me for a colonoscopy and said I could see a colorectal doctor if I really felt that was necessary. Now I feel incredibly lucky at this point that knowledge is power and I knew the system; I was disappointed in my GPs response when I was clearly worried that there might be something else going on. My grandad passed away from rectal cancer and even though I knew deep down it was probably ‘just IBS’ it played on my mind which just added to my stress levels and therefore my symptoms. Please if you feel that you aren’t being heard by your GP, ask for a second opinion, push to have a referral to see a specialist because it isn’t always nothing, but also because there are people like me, doctors, dieticians and psychologists out there who can offer help with managing your symptoms. We no longer live in a world where IBS means no support!
I actually pushed back with my GP and had a colonoscopy that was essentially normal, a few diverticular but nothing to worry about and a hole chunk of peace of mind which I believe is very important. So there I had it, the levels of stress in my life and my pick up and carry on attitude were causing me physical symptoms. It was around a decade since the GP had suggested that was the issue and only now was I ready to face that fact. It also turns out that getting older doesn’t mean less life stress! Now my steps from here were very personal to me and you will need to look at your own life and triggers to work out what is best for you. I left the work environment that was triggering a large portion of stress and tried to establish some barriers in to my work and home life such as not checking or replying to work emails out of working hours and ensuring I had time to exercise as this has always been my form of mindfulness. I have also found during the pandemic when we were all forced to step off the fast paced treadmill for a bit, that my body doesn’t like breakfast at 6am (or 7am actually!) and this was a big trigger for me with regards to bloating and urgency. I now use intermittent fasting if it’s an early start as I feel better for it and then when I’m not working till a bit later in the day I have breakfast around 8:30/9am and this seems to work for me. This is very individual to me and I can’t say we should all be using intermittent fasting, its just something on this long journey that I have now found works and I can go to the loo 1-2 a day with a normal formed stool, which is unheard of! This is also combined with a significant reduction in day to day stress through work, and although I do still get stressed (planning a wedding in a pandemic will do that), it isn't to the same degree and I have more control over how I spend my time to ensure a balance.
I see so many patients with IBS symptoms and it can be hard to hear that the mind-gut link is the likely cause because there isn’t a tablet or operation you can have to make that better. There is no easy way of sorting it. When I say stress is a trigger I don’t mean big traumatic events, but the everyday low grade stressors that we carry around with us. We know from the evidence that prolonged levels of low to moderate stress lead to chronic high levels of cortisol which impact gut motility either speeding it up as is my case or slowing it down for those of you who have more constipation IBS features. For those of you who suffer with bloating and increased wind production there is good evidence to support the FODMAP diet or a variation of it and this is best set out by a dietician alongside keeping your gut microbiomes happy with fibre rich foods and probiotics; for me I prefer kefir as a live culture and you can ferment your own. You do not need to spend fortunes on over advertised and influencer endorsed products for probiotics or gut health supplements. As I have said, there is no one thing that will cure IBS, it takes a good look at the triggers for you as an individual to determine where to start, but you have to be ready to make the changes needed.
For more information on tips and helpful advice I can recommend the following:
Instagram: @theguthealthphysio (obviously!), @theguthealthdoctor, @theguthealthclinic @thegutstuff
Websites: IBS network and the bladder and bowel society