Managing IBS is a Pain in the Butt!

What is IBS?

IBS is a common chronic gastrointestinal disorder that involves problems with motility (how the bowel moves contents through our intestines) and sensitivity (how the brain interprets sensations in the bowel). Those affected by IBS may experience recurrent abdominal pain and irregular bowel patterns that are often painful. Symptoms are often chronic and intermittent and may last for months or years.

Canada has one of the highest rates of IBS in the world with five million Canadians currently suffering. IBS affects significantly more women than men and is one of the most common causes for work and school absenteeism.

IBS is defined by the presence of:

Recurrent abdominal pain or discomfort 1 days/month in the past 3 months associated with two or more of the following:

• Increased defecation
• Onset associated with a change in frequency of stool
• Onset associated with a change in form (appearance) of stool

So, who has IBS?

In Canada, IBS prevalence has been found to be 13.5% and 12.1% respectively. While IBS does not cause any permanent damage to the bowel or lead to cancer or any other major illnesses, living with IBS is painful, and puts a great deal of stress on people who suffer symptoms. The good news is, that even though IBS is a chronic and long term condition, it ismanageable over time. The symptoms of IBS typically do not get worse, and with an effective treatment plan, as many as one-third of IBS patients may eventually become symptom-free.

Often, symptoms alone can provide doctors with the information they need to diagnose IBS. Your doctor will perform a physical examination and take a complete medical history that includes a careful review of your symptoms. For this reason, it is important to be candid and specific with your doctor about the problems you are having. A set of specific symptom criteria (referred to by physicians as the Rome Criteria) has been developed to help physicians diagnose IBS. The Rome Criteria is as follows:

Rome IV Criteria

In May 2016, the Rome Foundation released the new Rome IV criteria for diagnosing IBS. All around the world, physicians follow this organization’s lead when diagnosing IBS.

According to the Rome IV diagnostic criteria, IBS is characterised by recurrent abdominal pain for, on average, at least one day per week in the last three months, associated with two or more of the following:

• Symptoms related to defecation
• Symptoms associated with a change in stool frequency
• Symptoms associated with a change in form (appearance) of stool

Everyone is different. So are your poops. It’s important to note that the change in your stool could be constipation for some people, diarrhea for others, or alternate between the two. Subtypes of IBS are recognized by the Rome IV criteria based on the person’s reported predominant bowel habit, when not on medications, as follows:

Symptoms:

• Abdominal pain (cramping)
• Constipation
• Diarrhea
• Gas
• Heartburn
• Bloating
• Nausea
• A feeling of incomplete emptying of the bowels
• Whitish mucus (a fluid made in the intestines) within or around the stools
• Motility (movement of contents through the intestines)
• Sensitivity (how the brain interprets signals from the intestinal nerves)
• Brain-gut dysfunction

I’ve been diagnosed with IBS.. now what?

If you’re anything like me and skipped right to the part of the post where we tell you how to fix it, we mentioned above that IBS is manageable, and there are many different ways that it can be treated, Often the first step is changing your diet.

Food intolerances have been linked to IBS symptoms for many years, however conflicting information often creates confusion and frustration as to what foods IBS patients should include, or avoid, in their diet. Recent research has identified key strategies for the successful dietary management of IBS.

• Rule out lactose intolerance. The symptoms of lactose intolerance (an inability to digest the sugar in milk) and the symptoms of IBS often overlap.
• Limit insoluble fibre.  Insoluble fibre (cannot dissolve in water) which is found primarily in wheat bran, brown rice, seeds, nuts, dried fruit and whole grain breads, adds bulk to the stool and can aggravate IBS symptoms in some people. Peeling fruits and vegetables to remove the high insoluble fibre skin or peel can be beneficial.
• Increase soluble fibre. Poorly fermentable, soluble fibre remains an evidence-based treatment for IBS. Try slowly increasing dietary fibre by 2 to 3 grams per day to prevent discomfort and to promote soft, painless stools.
• Try the low FODMAP diet. Fermentable carbohydrates (also known as FODMAPs), are small carbohydrate (sugar) molecules found in everyday foods that may be poorly absorbed in the small intestine of some people. FODMAPs are fermented (digested) by intestinal bacteria, which can lead to symptoms of abdominal pain, excess gas, constipation and/or diarrhea.
• Try a probiotic. Probiotics are live microorganisms that, when taken in adequate amounts over sufficient time, may provide a health benefit. They are natural, ‘healthy’ bacteria that may help with digestion and offer protection from harmful bacteria in the intestines. Studies have found that, in some cases, probiotics may help to improve symptoms of IBS. If other dietary strategies have not been successful, a 4-week trial of a probiotic (in the dose recommended by the manufacturer) may be helpful. Probiotics are not medicine. They are available to purchase as capsules, tablets or powders, and can also be found in some fortified yogurts and fermented milk products. However, not all probiotics are the same. It is important to choose a product that is reliable, proven to be safe and offers benefits for the specific symptoms you want to relieve. Speak to your doctor, dietitian, or pharmacist about which probiotic may be right for you. It is important to take the probiotic in the dose and duration recommended by the manufacturer to achieve the best results.

Peppermint Oil

The newest treatment option out there has recently been confirmed in a clinical trial, and it comes in the form of peppermint oil. Peppermint can relax muscle, ease hypersensitivity in the bowels, and modulate pain in IBS.

IBgard is a new clinically tested capsule filled with tiny beads of peppermint oil, using a technology called SST (Site Specific Targeting). It is the only product of its kind on the market that has gone through a clinical trial. It has been proven to be effective and safe in relieving symptoms in patients with moderate to severe IBS-M and IBS-D.

This product is easily attainable and available at most drug stores. Patients tested saw relief in symptoms over the course of 24 hours and continued relief over a 3-4 week period.

You’ve got this!

IBS can be stressful as you struggle each day to manage your symptoms, so be sure to ask for help if you’re feeling mentally bogged down and lean on your personal support systems when you need them. Remember, you can do this!