Q. I suffer with abdominal pain, bloating and constipation. It's been going on years. I've been told I have irritable bowel syndrome. I'm quite worried about it as it's just not going away and I have tried every diet possible. Have you any advice?
Nina says: Many people worry when they are told they have irritable bowel syndrome (IBS). However, it's important to note that IBS is not actually a disease but rather a collection of symptoms which are due to altered function of the gut. We all experience occasional abdominal discomfort or upset from time to time but for those who suffer with IBS these symptoms can be prolonged and problematic. IBS is thought to affect between 5pc and 20pc of the population. It is suggested that it has only been diagnosed in about 5pc to 7pc of those who suffer.
IBS can occur at any age but is most commonly diagnosed in those under 50. It is nearly twice as common in women than in men. Symptoms include abdominal pain, bloating, and altered bowel habits causing either constipation or diarrhoea. These can occur for days, weeks, months or years. It may flare and settle at different times. Importantly, IBS symptoms don't usually occur during the night or disturb sleep. IBS isn't caused by stress but can get worse in times of anxiety and stress. In women hormones may have some effect and a flare-up may occur pre-menstrually. Bloating and passage of mucus can occur. However, weight loss, fever, bleeding and persistent severe pain are not features of IBS. As IBS can mimic other bowel problems, many people attending their doctor with symptoms then undergo blood tests and in severe cases may be referred for a colonoscopy. There is a lot we don't know about IBS and no distinct cause has been found.
A lot of the symptoms are due to spasm of the bowel leading to a trapping of wind and change in the movement of stool and the absorption of fluids. Research also suggests that brain hormones may play a role. Alteration in these may lead to change in the motility of the gut. Think of the classic "butterflies in the stomach effect". The immune theory suggests that IBS may occur due to a previous bowel infection causing an upset in the normal bacterial and immune flora.
IBS cannot be cured but needs to be managed. A good first step is keeping a diary of symptoms and diet. By definition those with IBS should have pain for at least 12 weeks a year (these do not have to be consecutive). This pain results in a change in the frequency and consistency of stools and is often relieved by a bowel motion.
Keeping a diary will not only help you track your symptoms but may also help you identify some triggers. Various dietary factors get a lot of bad press when it comes to IBS. Many blame dairy, gluten, yeast and wheat and then try to follow diets that exclude these foods. I would say if you are able to identify a type of food that causes a flare-up in you then it makes sense to reduce or avoid this, but blanket exclusion diets have not been proven to be of any benefit.
It is important to have enough fibre in your diet to bulk up stool and encourage its movement through the bowel. If you are increasing fibre, do it slowly as sudden changes can make symptoms worse. In recent years, the FODMAP diet has gained some popularity. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. It is based on the theory that certain carbohydrates when broken down to these compounds in the gut can draw fluid into it and cause fermentation which leads to poor digestion, wind and bloating. It was first developed in Australia and has shown some success in studies.
Many of the foods commonly associated with IBS, such as breads, milk and fructose-containing drinks, are high FODMAP foods. The initial phase of the diet is quite restrictive as all high FODMAP foods are eliminated. They are then slowly reintroduced one at a time and a person can then identify what their own personal sensitivities are.
Diet is one way of managing IBS but there are other options to help reduce symptoms. These involve managing stress and anxiety, and using medication during flare-ups if required.
The medication prescribed usually involves combining drugs that encourage gastric emptying (reduce bloating), bulk up stool and reduce spasm in the bowels. Peppermint can also be helpful as it's felt to reduce trapping of wind and soothe the bowel. Aloe Vera has not been proven to be of benefit. Some find alternative therapies such as acupuncture and Yoga helpful, although again their benefit is not proven.