Tuesday 22 October 2019

How to manage your Irritable Bowel Syndrome (IBS)

If you’ve been diagnosed with Irritable Bowel Syndrome (IBS), then you’re probably coping with chronic abdominal discomfort or pain, bloating and much more. But there is help out there, writes our reporter. Professor of Medicine at UCC, Fergal Shanahan shares his advice on how to manage some of the symptoms associated with the condition

One in 10 people suffer from Irritable Bowel Syndrome. If you suffer from symptoms, see your GP for a diagnosis
One in 10 people suffer from Irritable Bowel Syndrome. If you suffer from symptoms, see your GP for a diagnosis
Thomas Clarke from Tipperary. Photo: Fergal Shanahan

Áilín Quilian

One in 10 people suffer from Irritable Bowel Syndrome (IBS) - however, they’re in excellent company, quips Professor Fergus Shanahan, Consultant Gastroenterologist and Professor of Medicine at UCC.

And he should know.

Professor Shanahan recently retrospectively diagnosed this very uncomfortable condition in the eminent scientist, naturalist and geologist Charles Darwin, who died in 1882.

Darwin, he explains, was “pestered” by gastrointestinal symptoms:

“Now in the modern age, we can look back and see that he had bloating, alternating bowel habits — diarrhoea and constipation — and episodes of nausea.

“He’s the most famous case of it,” says Professor Shanahan.

For people who have a long-standing condition like IBS, he says, they often fear they won’t be believed about the disorder. That’s because although they may experience deeply distressing and even debilitating symptoms, the body itself, he explains, displays no objective, physical signs of the condition.

“IBS is all about symptoms and a diagnoses is based on symptoms not on signs,” he says, adding that IBS is a disorder of the function of the bowel, and not of its structure, so there’s no visible physical disorder.

“One of the big problems about having a long standing, chronic condition like this is the lack of signs, which means that people think they will not be believed,” he says

Although IBS is a very common condition — he puts its prevalence at about 10pc of the population — he says, its impact actually ranges from very mild to severe and very debilitating.

Diagnosis, he emphasises, requires what he describes as “a very careful listening physician,” who will check for symptoms such as pain associated with disturbed bowel function, an alternating bowel function (shifting pattern of constipation and diarrhoea) and a mixed bowel function (both diarrhoea and constipation).

“The symptoms can and do vary within the same individual,” says Professor Shanahan, adding that these official three criteria — termed The Rome Criteria — do not include bloating, which he believes should be included because it is so common.

Another symptom reported by patients, he adds, is a sense that they have not completed a satisfactory bowel movement. This may not always be clearly explained by an embarrassed patient.

“The clinician has to listen very carefully to what the patient is saying. Although there are remedies to help with the symptoms of IBS, there is no cure for the condition,” says Professor Shanahan.

There are some things people can do themselves to help control the condition, he says — investigate the usefulness to you of over over-the-counter remedies, he advises, and eat a “very diverse diet:”

“We used to think a high-fibre diet was good but now we know it can make it worse, so we tend to recommend a very diverse diet with a little bit of everything in it,” he explains.

The low FODMAP diet, which is based around excluding certain foods can be difficult to adhere to and can also be very restrictive in the long term, he believes — FODMAPs are a family of fermentable carbohydrates such as fructose, lactose and fructans contained in ordinary foods such as onions, wheat or honey.

These, when consumed by people with IBS are not absorbed into the small intestine and instead pass into the large bowel, where they are fermented by bacteria, resulting in bloating, gas and pain. A Low-FODMAP diet is one of the recommended ways to manage IBS.

However, new research points to the impact of bacteria in the gut.

“People have been investigating IBS for decades and not getting any closer to the cause,” points out Professor Shanahan, adding however that recent research carried out at the APC Microbiome Institute at UCC, of which he is director, has had interesting results.

Studies by Institute researchers have shown that in some IBS patients, a disturbance of gut bacteria may be connected to the condition, and that certain probiotics may help some patients:

“Microbes control the contraction of, and the pain sensitivity in the gut. We know from some of our studies that a large proportion of people with IBS have different components of microbes to people without IBS,” he explains, adding that research at the centre has shown that some probiotics can help — but not cure the condition.

“We are now investigating whether a microbial transplant could help the most severe cases, but this is a purely research-based undertaking,” he emphasises.

There is increasing public awareness of Irritable Bowel Syndrome, says GP Dr Mark Murphy, Chair of Communications with the Irish College of General Practitioners, and lecturer with the Royal College of Surgeons.

“It’s very common — we could see a new case of it every day in the clinic,” he says, adding that the condition typically affects younger adults and tends to be more common in women.

“People present with quite typical symptoms of abdominal discomfort, pain, bloating, constipation, diarrhoea or fatigue.”

Generally an examination by the GP will reveal no physical signs of anything amiss, and blood tests may be scheduled to rule out other conditions such as Coeliac Disease.

“In some people, particularly if they are over 55 or have a family history, we might consider an endoscopy or camera test but usually the diagnosis will be IBS, based on the history.”

Symptoms can vary from mild to severely incapacitating, he says, adding that treatment can involve a combination of lifestyle and dietary treatment — he recommends keeping a symptom diary and writing down what you are eating, drinking, exercise, water intake and even stress levels to identify triggers.

Dr Murphy also advises consulting a dietitian for relevant dietary advice covering everything from fluid intake to the importance of having regular meals and fluid intake, to the possible exclusion of a certain food which the patient believes may be triggering symptoms, or discussing a low-FODMAP diet.

Living with Irritable bowel syndrome

Thomas Clarke from Tipperary. Photo: Fergal Shanahan

Arlene Harris

Thomas Clarke from Tipperary developed IBS in 2013 after returning from holidays with his wife, Catherine. The 36-year-old initially believed his symptoms were just down to over-indulgence of rich foreign food and too much alcohol, but as the discomfort continued, he realised that something wasn't quite right.

"My wife and I visited southern Spain for a two and a half week holiday and during that time I began to experience stomach cramps and diarrhoea which I thought was due to a combination of different food and tasty beer," he says.

"However when I returned home, the symptoms continued and a few months later I was still having problems - luckily I was never caught short, but whenever I would go to the toilet, my body felt completely empty."

After suffering for months in silence, Thomas, who works as a primary school teacher, went to his doctor for advice as he began to worry that he may have a serious health problem. But fortunately tests proved negative and he was referred to a dietitian for advice on how to deal with his digestive problems.

"About two months after I got back from Spain, I went to see my GP as I was beginning to think there was something seriously wrong," admits Thomas, who has a 10-month-old son. "The doctor arranged for me to have a scope (colonoscopy) and luckily the results ruled out anything sinister so I was referred to a dietitian.

"She looked through the results of my tests and said suggested I try a FODMAP diet which basically eliminates all the foods which usually cause digestive issues for six weeks and then they are re-introduced one at a time as this will tell which type of food is causing the problem."

The Tipperary man started the diet by cutting out 'trigger foods' such as dairy products, certain types of vegetables, grains, meats and fruits - and within days all his symptoms had disappeared.

"I started the FODMAP diet and boom everything was sorted straight away," he says. "Within two days all the symptoms were gone and after six weeks I was able to re-introduce all my regular foods apart from dairy as the diet showed that I was lactose intolerant.

"I was surprised by this as I never had any issues in the past despite drinking up to two litres of milk a day but I was told that I might have picked up a bug which started the intolerance. But I was happy to give it up as I was feeling so much better."

Since eliminating lactose from his diet almost four years ago, Thomas has never felt better and would encourage others to seek help rather than suffering needlessly.

"I haven't had any problems with IBS since cutting out dairy," he says. "I have lactose free milk and yoghurt and am allowed 125ml of milk every day if I really want it. Sometimes I do have lactose as there are times when you can't avoid it, but even though it starts to disagree with me within a few minutes, the symptoms only last for a few hours.

"I also cut out fizzy drinks and chewing gum as I felt that both of these increased my symptoms and so far I have been really well. So my advice to anyone suffering with IBS is to go and get help as I was sorted within a couple of days and have been fine ever since."


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