April is Irritable Bowel Syndrome (IBS) awareness month. As an IBS sufferer myself, I thought I'd share five quick facts about the condition that all of us should know. Believe it or not, but IBS is actually pretty common and affects between 10-15% of the general population. It causes symptoms like abdominal cramps, bloating, diarrhoea, and constipation, and usually affects people throughout their life. Although more and more research is being conducted to help us better understand the condition, it remains a severely underfunded area of study which means that IBS is still often misunderstood. This amazing video (below) does a great job of raising awareness around the experience of IBS as a patient and highlights the need for more funding in future.
1. IBS is not a joke
IBS is a very real problem that can significantly affect the quality of life of those that suffer from it. Funnily enough, historically IBS was thought to be a psychosomatic/mental disorder, and that the symptoms experienced by patients were just made up. Although there is a definite link between the gut and the brain that plays a role in the pathophysiology of IBS, it is actually a functional gut disorder that results in unpleasant symptoms because of how it affects the way that the muscles in the gastrointestinal tract (GIT) work. Some may that find that IBS is just a bit annoying or embarrassing, whilst others experience debilitating symptoms that have a serious impact on work, social activities, and life in general. The pain and discomfort that IBS patients experience is rather unpredictable and highly variable depending on the individual, time of day, and circumstances. Although sometimes it's misunderstood by those who don't suffer from it, for IBS patients the condition is not a joke at all and can be incredibly uncomfortable when symptoms flare up.
2. IBS is tricky to diagnose
Unlike other gastrointestinal-related conditions, there are actually no specific clinical diagnostic tests that can confirm IBS. Firstly, practitioners need to rule out 'red flags' by screening for things like Crohn's disease, ulcerative colotis, colon cancer, and stomach ulcers before moving onto diagnosing IBS. Following this screening, the Rome IV Criteria is used to diagnose IBS in patients. For an IBS diagnosis, this set of specific criteria requires that patients:
- Have experienced recurrent abdominal pain on average 1 day per week during the previous 3 months
- That is associated with ≥2 of the following:
- Increased or unchanged abdominal pain related to defecation
- Associated with stool frequency
- Associated with stool form or appearance (see the Bristol stool chart for more information about this)
3. Various things can trigger IBS symptoms
Although IBS sufferers can often identify certain foods as triggers for unpleasant symptoms such as gassiness, bloating, constipation, and diarrhoea, the condition has actually been shown to be influenced by a number of other factors. Alterations in the gut microbiome, intestinal permeability, gut immune function, visceral sensitivity, gut motility, psychosocial status (e.g. stress), and brain-gut communication all play a role in IBS. FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) are poorly digested carbohydrates that have been shown to cause discomfort in many IBS patients, however I know that personally, stress and anxiety are key triggers for my IBS (even more so than any specific foods). There has been some amazing research conducted that has shown that various psychological therapies including cognitive behavioural therapy, hypnotherapy, and psychotherapy are actually as (if not, more) beneficial than dietary changes in a significant portion of the IBS population.
4. IBS and IBD are different
As I've already mentioned, IBS is a functional gut disorder. It results when the GIT does not function as it should, but does not affect the structure of the GIT in any way. Inflammatory Bowel Disease (IBD), which includes ulcerative colitis (UC) and Crohn's Disease (CD), involves severe chronic inflammation and structural damage to the GIT. There are some symptoms that overlap in both IBS and IBD patients, such as abdominal pain, cramps, constipation, and diarrhoea. However, IBD patients also often experience severe weight loss, rectal bleeding, malnutrition, joint pain, intestinal scarring, eye inflammation, and extreme fatigue. Whilst IBS is diagnosed according to the Rome IV criteria already discussed, IBD diagnosis requires an examination of the gut lining for inflammation and damage using x-ray, endoscopy, surgery, or biopsy. This webpage has a great table summarising the characteristic differences between IBS and IBD if you would like a bit more information about this.
5. Fibre can be a friend or foe of IBS
Although many GPs recommend increasing fibre intake to help manage IBS symptoms, particularly in patients with constipation-dominant IBS, there isn't much evidence to support this. In each IBS patients, different types of dietary fibre can either cause harm or help manage symptoms. Some types of fibre undergo partial or total fermentation by microorganisms in the colon, which can lead to the production of gas that can affect GIT function and cause unpleasant bloating. Other types of fibre, such as psyllium, can help improve bowel movements and thus can be very beneficial for constipation-dominant IBS patients. There is no single diet that works for all IBS patients though, so often trial and error is required to figure out what foods containing different types of fibre work for each IBS patient.
Some general advice
The first line of advice here in the UK for IBS patients includes some of the following tips:
- Do cook homemade meals using fresh ingredients at home where you can
- Do keep a record of what you eat and the symptoms you experience for a week or two to try and identify recurrent triggers
- Do try to find ways to relax and curb stress
- Do regular exercise, making sure that the type of movement is enjoyable for you
- Do try a probiotic for a month to see if they help (there isn't clear evidence at this point regarding the exact strain(s) of bacteria that are most beneficial for IBS, but this blog post does a great job of explaining what we do currently know about probiotic use for IBS)
- Don't delay or skip meals
- Don't eat too quickly
- Don't eat lots of fatty, spicy, or highly processed foods
- Don't eat more than 3 portions (80g each) of fresh fruit a day
- Don't drink more than 3 cups of tea or coffee a day (caffeine can be a trigger for IBS symptoms)
- Don't drink lots of fizzy drinks or alcohol
For bloating, cramps, and gassiness:
- Eat oats regularly
- Eat up to 1 Tbsp of linseeds each day, preferably soaked overnight or ground and added to a smoothie, porridge, or yoghurt
- Avoid foods that are difficult to digest, such as brassica vegetables (cauliflower, Brussels sprouts, broccoli, cabbage), onions, leeks, and beans
- Avoid artificial sweeteners ending in '-ol' (sorbitol, xylitol)
- Try using a peppermint oil supplement to ease symptoms when they flare up
- Cut down on high-fibre foods such as wholegrains, nuts, and seeds
- Avoid artificial sweeteners ending in '-ol' (sorbitol, xylitol)
- Drink plenty of water to help make your stool softer
- Increase your intake of soluble fibre, which is found in foods like linseeds, oats, carrots, pulses, and peeled potatoes
- Ask your GP or pharmacist about fibre supplements like Fybogel and psyllium husk
- Chey WD, Kurlander J, Eswaran S. Irritable Bowel Syndrome A Clinical Review. JAMA. 2015 Mar 3;213(9):949-58.
- Schmulson MJ, Drossman DA. What is New in Rome IV. J Neurogastroenterol Motil. 2017 Apr;23(2):151-63.
- Eswaran S, Muir J, Chey WD. Fiber and Functional Gastrointestinal Disorders. Am J Gastroenterol. 2013 Apr;108:718-27.
- Moayyedi P, Quigley EMM, Lacey BE, Lembo AJ, Saito YA, Schiller LR, Soffer EE, Spiegel BMR, Ford AC. The Effect of Fiber Supplementation on Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. Am J Gastroenterol. 2014 Jul;109:1367-74.