Managing IBS is a Pain in the Butt!

What is IBS?

Irritable Bowel Syndrome (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) leading to abdominal pain, changes in bowel patterns and other symptoms. Although often disruptive, debilitating and embarrassing, it may be some comfort to know that IBS is not life-threatening, nor does it lead to cancer or other more serious illnesses.

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?

Irritable bowel syndrome (IBS) is thought to affect up to 18% of the Canadian population – having one of the highest prevalence of IBS in the world (1). IBS affects significantly more women than men and is one of the most common causes for work and school absenteeism. 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 is manageable 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 (2)

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

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

If you’re anything like us 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 diet and lifestyle changes can have a huge impact on gut health. Getting exercise and participating in managing stress through activities such as yoga or meditation can have a huge impact on a patient’s quality of life.

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. Many IBS patients of all types have benefited from experimenting with a low FODMAP diet. The low FODMAP diet is one of the most well-researched diets that shows significant symptom improvement for ~50-80% of those with IBS. (3) 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 Supplement. Your doctor will prescribe the necessary medications for you, however having a discussion with your doctor about effective over-the-counter products for IBS may help identify additional options to help manage your symptoms, and help you feel more in control and proactive about your diagnosis.  Products such as probiotics and/or peppermint oil capsules and may be helpful in easing overall digestive symptoms associated with IBS, including abdominal pain, constipation, and diarrhea. 

Click here to learn more ways to manage IBS.

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!

References:

1. Lovell RM and Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: A meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-21.e4.
2. Lacy, B. E., & Patel, N. K. (2017). Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. Journal of clinical medicine, 6(11), 99. https://doi.org/10.3390/jcm6110099
3. Altobelli, E., Del Negro, V., Angeletti, P. M., & Latella, G. (2017). Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients, 9(9), 940. https://doi.org/10.3390/nu9090940