Irritable Bowel Syndrome

Let's talk about POO... Or more specifically, IBS

What is IBS (irritable bowel syndrome)?

IBS is a functional bowel disorder, i.e. there is nothing wrong with the gut itself (e.g infection, tumours, inflammation - although ppl with bowel disease CAN get IBS too). Rather in IBS the bowel is not working properly. It may be assoc. with other functional disorders of the gut (e.g. reflux) & outside the gut (e.g. irritable bladder, fibromyalgia, chronic fatigue). In each of these functional disorders, the symptoms come from abnormal functioning of the organ/ body system rather than a disease.

Symptoms (sx) of IBS: > intermittent abdominal pain (most common) > bloating > nausea > diarrhoea, constipation or alternating episodes of both

Characteristically, the abdominal pain comes with a change in frequency &/or consistency of poos & going to the toilet relieves the tummy pain. There may also be a feeling of urgency or feeling like you having completely emptied your bowels.

NOT symptoms of IBS:

> anaemia sx (light-headed, tiredness, breathlessness) > blood in the poo > tarry black poo > unexpected weight loss > fevers > pain that wakes you from sleep > sx first starting after age 50

> family history of bowel disease such as Crohn’s disease, ulcerative colitis, bowel cancer

These are 🚩RED FLAGS🚩 indicating you should see your GP to rule out more serious disorders.

Is IBS serious?

IBS is not serious in that it is NOT life threatening & ppl with IBS have a normal life expectancy. IBS can be serious, however, in the effects it has on ppl’s lives. IBS sx can be quite severe & have a big impact on ppl’s lives. Because the pain in IBS can be quite bad, it can cause lots of anxiety that there is something serious like cancer. I get it. I have had attacks of IBS that have been so bad that if I didn’t know it was just IBS I would have been worried I was dying. And it is this very anxiety caused by the pain, that in turn worsens the pain of IBS.

How is IBS diagnosed?

IBS used to be a diagnosis of exclusion. A typical scenario:

You see your Dr for episodes of bad tummy pain & diarrhoea & they send you for some tests. Blood tests. Normal. Ultrasound. Normal. Xray. Normal. Colonoscopy. Normal. You come back to your GP & you are told everything is NORMAL, you just have IBS. But how can everything be NORMAL when you are in so much pain. This is often the pnt that ppl turn to less evidenced-based practitioners for help because they listen & ofter solutions (albeit often snake oil). IBS can actually be diagnosed on clinical history alone. I take a careful history to identify the characteristic pain of IBS & to rule out red flag sx. I then take time to explain what IBS is, how it causes sx. & how stress/ anxiety turns the volume up on IBS sx. I then order a LIMITED panel of tests as req’d, explaining that we EXPECT these to be normal, because they are to rule out serious disease which we don’t expect to find. Understanding that IBS is not a serious or life threatening condition, helps reduce anxiety around sx. which in turn can play a part in improving them.

What causes IBS sx?

It is not really known but there are several theories. Here is how I like to conceptualise IBS:

Your gut is surrounded by nerves forming the enteric nervous system. These nerves monitor & respond to what is happening in the gut & communicate with the brain. In some ppl, this is white noise in the background for the brain. In other ppl, the brain pays more attention to the signals from the gut bringing your attention to the pull & stretch of the contents which can be felt as pain. Stress & anxiety will turn up the volume of the signals from the gut to a cacophony. In response to this loud nerve ‘noise’ from the gut, the brain sends abnormal signals back down leading to bloating & change in the poos.

How is IBS treated?

Please note this is a discussion of treatments. Do not take this as personal medical advice. See your GP.

Diet: > most ppl can identify a trigger, mine is chilli. > lactose - common trigger. note that not all diary contains lactose & many lactase deficient ppl can tolerate lactose in small dose; sometimes ppl are reacting to the fat/ caffeine content, e.g. in a coffee, more than the lactose > gluten - this is controversial; true gluten sensitive is coeliac disease; other ppl may actually be reacting more to the FODMAPS which are types of food which ferment thus stretch the gut; up to 70% of ppl with IBS will respond to a low FODMAPs diet > It is important to see an Accredited Practicing Dietician before cutting out more than one specific food.

Psychology: > psychological state plays a big role in IBS & therapy can treat any underlying mental health disorder & help with coping with sx.

Placebo: > just as functional disorders are very responsive to stress /anxiety, they are very responsive to the expectation that a treatment will work > just cos its placebo doesn’t mean it doesn’t work, rather, it means you body is healing itself so if I replaced your vitamin/ fermented drink/ magic tea with water without your knowledge it would be as effective; in some ppl this effect is zero, in some ppl this effect is 100% > if something works for a pt, it is safe & it is not causing financial stress, then it is often ok to continue but best to check with your GP

Complementary meds: > peppermint oil capsules - evidence shows v. effective for sx. relief, may cause some burning on the way out > evidence for the rest is mostly of poor quality > some probiotics - highly variable, low risk so reasonable to trial, if effective usually need to keep taking > other herbal remedies have been poorly studied, likely low harm but often ingredients are unknown

More info:

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