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Unravelling the complexities of Irritable Bowel Syndrome

Did you know April is Irritable Bowel Syndrome (IBS) Awareness Month? This very worthwhile initiative aims to educate, inform and remove the stigma around this often misunderstood disorder. IBS is an extremely common condition that is thought to affect around 10-20% of people living in the UK. It refers to a collection of different symptoms that affect the digestive system. These include stomach cramps, bloating, abdominal pain, constipation and diarrhoea.

IBS is a chronic condition that needs long-term management, as it’s usually a lifelong issue. There is no one precise cause – and no magic cure. Unfortunately, due to the delicate nature of their symptoms, many sufferers feel embarrassed or ashamed. This means that they find it difficult to discuss their condition, and don’t always seek help promptly. However, IBS Awareness month aims to address this.

Irritable bowel syndrome woman on sofa

Signs and symptoms

As explained, IBS encompasses a range of different symptoms, which can vary considerably. All of them can make everyday life a stressful experience. Flatulence is a common problem, as is stomach pain or cramps. These are usually worse after eating, and better after a visit to the loo. Sudden onset bouts of diarrhoea are another common symptom, as are alternating bouts of diarrhoea and constipation. Unfortunately IBS can also cause incontinence, backache, tiredness and lethargy.

irritable bowel syndrome stomach ache

What causes IBS?

The precise cause of IBS is still unknown. However, there are a number of factors that play a role – and most involve the intestines. Muscle contractions appear to be key. The walls of our intestines incorporate layers of muscle, whose role is to move food through our digestive tract. Weak contractions can slow the passage of food (leading to hard, dry stools). Long and strong intestinal contractions mean food moves too quickly, resulting in wind and diarrhoea.

Similarly, oversensitive nerves in the gut can cause digestive problems, as can inflammation in the intestines. Some people develop IBS symptoms after an episode of gastroenteritis; other during periods of increased stress. Family history suggests that genes may also play a role. Lastly, while not a cause per se, food allergies and intolerances can also exacerbate certain IBS symptoms.

Prevention & treatment

Due to the nature of IBS, prevention and treatment are not always straightforward. Because there are so many variables in terms of causes and risk factors, one size does not, alas, fit all. So it is obviously useful for individuals to identify what causes their IBS, and act accordingly.

A food diary is a good place to start. Noting which foods aggravate or alleviate symptoms can help sufferers to make sensible meal choices. Many sufferers report good results from temporarily following a low-FODMAP diet. FODMAP stands for fermentable oligo-, di-, mono-saccharides  and polyols. These are basically poorly absorbed simple and complex sugars found in certain fruits, vegetables, milk and wheat.

How much is eaten (and when!) can be just as important as what is consumed. For some people, eating little and often can bring huge benefits. For others, three meals a day, with no snacking, works better.

irritable bowel syndrome Chicken tikka masala spicy curry meat food with rice and naan bread

Helpful hints

Some general guidelines, however, appear to be widely beneficial. Don’t delay or skip meals. Don’t eat too quickly and chew food thoroughly. Try to limit foods that are spicy, fatty or processed – and drink well. Alcohol, fizzy drinks and caffeine should all be consumed in moderation.

Lastly, there’s some evidence that taking probiotics (live bacteria and yeasts) can restore the natural balance of the gut. Consequently, they may help to ease certain IBS symptoms, although it’s difficult to pinpoint how effective they really are.

Unfortunately, it’s not always so simple to treat IBS symptoms that are linked to stress and anxiety. The continual cycle of worry can develop into a vicious circle that’s difficult to break. But there are effective ways to deal with stress, including mindfulness and progressive relaxation exercises. Professional counselling is another option that can help IBS sufferers to modify or change how they respond to stress.

Alternative therapies, such as acupuncture, may improve IBS symptoms. Hypnosis has also been shown to be an effective treatment for IBS in a number of clinical studies. Yoga and meditation can relieve both physical and mental tension. Gentle exercise – and plenty of sleep – are also recommended.

When to see your doctor

There is no exact test, and no magic pill, to cure IBS, but that doesn’t mean your doctor can’t help. A definite diagnosis is always useful (knowledge is power). And ruling out something more sinister – that has similar symptoms – could literally save your life. So if you’re suffering, make an appointment to see your GP, and tell him about your symptoms. Make a note of what they are, when you get them, and how frequently they occur. Your doctor may examine you, or arrange for blood/stool tests. They will then be able to offer advice and, if necessary, prescribe medication. They may even refer to you a specialist dietician.

Antispasmodic medication can be very effective at relieving abdominal pain and cramping. Some, such as Buscopan, are available over-the-counter (i.e. no prescription needed). Anti-motility medication is effective at treating diarrhoea. Most people are familiar with Imodium (the brand name for loperamide) but again, your GP can advise on dosage. If constipation is a problem, a laxative may provide relief.

Irritable bowel syndrome young girl in pain

Pain that does not respond to antispasmodics is sometimes treated with low doses of anti-depressants. These work in two ways. They can alleviate the pain directly. And they can ease any anxiety or stress that is exacerbating IBS symptoms in the first place.

It’s worth stating, however, that treating one symptom of IBS may make another worse. And of course, all medication has possible side effects. That’s why it’s vital to see a doctor and get proper medical advice. For more information and support visit national charity The IBS Network or https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/

Are you concerned you may have an eating disorder or do you think you may know someone who has one? Then read my post on Eating disorders: causes, prevention and treatment.

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