Each April is “Irritable Bowel Syndrome (IBS) Awareness” month. Three Blackrock Clinic multi-disciplinary specialists have come together to offer their advice, information and professional perspectives on IBS awareness, symptom management and patient empowerment.

Highlighting Blackrock Clinic’s holistic approach to diagnosis, treatment and quality of life enhancement for IBS sufferers, you will find engaging content throughout the month on this page from:

Dr Deirdre O’Donovan (Consultant in Gastroenterology, Blackrock Clinic)

Ms Lorraine Maher (Clinical Dietitian, Blackrock Clinic)

Ms Regina Goode (Clinical Specialist Physiotherapy, Pelvic Health, Blackrock Clinic)

1. Dr. Deirdre O’Donovan – What is IBS?

Irritable bowel syndrome (IBS) is a chronic GI disorder resulting in symptoms that include bloating, abdominal cramp and an unpredictable bowel habit (constipation, diarrhoea and in some cases both). IBS can take a toll emotionally with many people feeling depressed, anxious and having low self-confidence.

Who gets IBS and why?

IBS affects approximately 20,000 people in Ireland. Females, especially younger females are twice as likely to be affected as males, IBS is a complex and debilitating condition for which there is no known cause. However, many doctors agree that symptoms can be triggered by psychological as well as physical factors. Stress is known to be a factor.

What can I do to mange IBS?

Diet

Depending on your symptoms think about adjusting your fibre intake. If you are feeling constipated then try adding more fibre to your diet. Foods like porridge and wholegrain cereals are high in fibre. However, if you are prone to dairrhoea then reducing your fibre content might be the answer so consider avoiding green vegetables and wholegain foods and replacing them with root vegetables and ‘white foods’ sich as white rice.

Some people have intolerances to certain natural sugars in foods. High on the list are onion, garlic and apples. Avoiding these can help with bloating and diarrhoea.

Try to limit red meat, and increase your intake of fish. Red meat is fine in moderation, but eat too much and you increase the likelihood of consuming too many nitrates. This can adversely affect long term gut health.

We all need at least six cups of water per day to stay healthy. While cups of tea and coffee are good in moderation, try and drink peppermint tea and camomile where possible.

Prebiotics and probiotics

Our gut is full of bacteria, making up what’s called our gut flora. Prebiotics are foods that can encourage the growth of good bacteria in the gut, such as asparagus, leek and artichoke. Probiotics are products that can directly add good bacteria to the gut to help it stay healthy. These can be particularly helpful for bloating and diarrhoea symptoms.

Vitamin D

Consider adding some vitamin D to your diet. Known as the sunshine vitamin, it interacts well with your gut flora. 

Alcohol reduction 

As well as taking on empty calories that add weight, alcohol consumption can affect your bowel, impact your liver function and increase the risk of serious illness, such as cancer.

Get active 

Exercise helps the whole body, and has been shown to improve the transit time for food through your gut. If you exercise regularly, such as walking or swimming, the odds are higher that your bowel will be regular.

Reduce Stress

Studies have shown that there is a link between the brain and the gut, called the gut-brain axis. Emotional stress can result in bowel disturbance.

Sleep 

Try and get a good night’s sleep. Those with irregular sleep patterns, such as shift workers, can experience a disturbance in their gut flora as their circadian rhythm is disturbed.

When to seek help?

If symptoms persist for more than 3 months seek help from your GP. Coeliac disease can commonly cause symptoms that mimic IBS; this can be diagnosed by a simple blood test. Most importantly don’t ignore red flag symptoms, these include unexplained weight loss, persistent heartburn, a change in bowel habit or any bleeding from the back passage. Should you experience any of these, seek urgent medical help from your GP. 

2. Regina Goode – IBS Awareness – A Better Quality of Life

Did you know? 

• 80% of our immune system lies in our gut, and
• there are some 100 million neurons (nerve cells) there.

This is more than in either the spinal cord or the peripheral nervous system. It is known as the second brain. Where do you think the saying “gut instinct” comes from? If we are under constant stress or pain, our immune system and nervous system get bombarded and fatigued. Failure of these systems can lead to a host of diseases and disorders, including Irritable Bowel Syndrome (IBS).

IBS is a functional bowel disorder, a disruption between the colon (enteric nervous system) and the brain (central nervous system). The ABC & D of IBS is:

• Abdominal Pain,
• Bloating,
• Constipation and/or
• Diarrhoea, and it is largely diagnosed based on these symptoms.

What is not associated with IBS is inflammation, infection, rectal bleeding, vomiting, persistent pain not relieved by a bowel movement, weight loss, diarrhoea at night, and fever. These symptoms should be investigated by a medical practitioner.

Pelvic Physiotherapy

Pelvic Physiotherapy can be an important part of the team which helps you manage the symptoms associated with IBS. We can help with symptoms often found with this digestive discomfort.

Symptoms can include

Bloating, pain, sleep disruption, painful intercourse, pelvic pain, interstitial cystitis, stress and anxiety, defecation difficulties, continence issues and back pain.

We are the only member of the team that will assess the muscles of the pelvic floor which support the digestive system. Pelvic physiotherapy incorporates various different techniques:

• viscero fascial mobilisation,
• trigger point release,
• abdominal massage,
• exercise,
• diaphragmatic breathing, and
• correct toilet posture, to name but a few.

Pelvic Physiotherapy can be a part of your team that helps to make you feel better and live a better quality of life!

3. Lorraine Maher – A Dietitian is the diet detective you want in your corner!

When I hear about people’s stories of living with Irritable Bowel Syndrome (IBS), it is obvious that they all share many common experiences: frustration, confusion and embarrassment. This stems from ‘living’ with discomfort and pain, being confused or restrictive regarding food choices, worrying about embarrassing symptoms in social situations and fearful of needing to be near a toilet at all times.

Figuring out what provokes and curbs gut symptoms can make a massive difference in managing this condition. The following recommendations make a big impact for most people:

• Keep a food and symptom diary. This can help reveal how your food habits are related to symptoms.
• Improve overall digestion: Keep meal-times consistent: Try not to be in the habit of skipping meals or leaving long gaps between meals, eating large meals, or eating late at night. Reduce swallowing any extra air by chewing your food well, avoiding chewing gum and drinking fizzy drinks. Include gentle exercise such as walking in your day.
• Drink plenty of fluids. Choose water as the main fluid, aiming for 2-3L per day.
• Reduce high-fat foods: Eating too much fat at one time may trigger symptoms e.g. fried or greasy foods, processed meats, chips, cream and ice cream.
• Find you fibre sweet spot: This can be tricky and very individual as one contends with fibre’s wonderful yet possibly symptom provoking properties e.g. soluble and insoluble fibre, as well as the viscosity, fermentability and resistant starch content. It is more beneficial for long term symptom management to aim high on the fibre ladder rather than low, but sometimes not too high! A dietitian is the diet detective you want in your corner to help unravel this for you.
• Be mindful of total alcohol intake: Alcohol can be a gut irritant, affect gut motility and intestinal permeability. Its best to try and work out how alcohol affects you as it is usually taken in social situations and with food, so symptoms may be affected by food and/or stress too. Binge drinking is obviously not a good idea!
• Adjust your caffeine based on your symptoms: It’s worth determining whether or not caffeine agrees with you. You are more likely to benefit from reducing your intake if you have IBS with diarrhoea or urgency. On the other hand, if you have IBS with constipation you might find a cup of coffee helps you to open your bowels.
• FODMAP’s are groups of certain carbohydrates that are poorly absorbed, and may also trigger IBS symptoms. However not all people with IBS need to follow a strict low FODMAP Diet! The recommended process to determine how these foods affect you, is a dietitian supported 4–8 week FODMAP restriction followed by a reintroduction phase. Don’t forget this second step!

Finally, make stress management non-negotiable. People often put their all their eggs in the diet basket but being better equipped to cope with or lessen stress is equally important. Abdominal or diaphragmatic breathing, mindfulness meditation and yoga are all supported with credible evidence. A mere 10 minutes per day can do the trick.