Irritable Bowel Syndrome, IBS

Irritable bowel syndrome (IBS) affects around 1 in 6 people. Around half the people who visit a gastroenterologist (bowel specialist) leave with a diagnosis of IBS. A diagnosis of IBS is based on a group of symptoms known as the Rome III criteria. Rome, huh? It makes IBS sound rather romantic. Criterion I, you have a Botticelli bottom. Tick. Criterion II, the tinkling sounds in your belly reminds one of the Trevi Fountain. Tick and Criterion III, your bowel movements resemble a perfectly filled cannelloni. Errr, tick. Actually, the Rome criteria for IBS states a diagnosis depends on your having abdominal pain or discomfort for at least 3 days a month for the last 3 months, associated with 2 or more of the following symptoms: a change in the frequency of bowel movements, a change in the appearance of bowel movements and your symptoms improve with a bowel movement. On second thoughts, Venice sounds nice.

IBS – In depth

IBS is known as a ‘functional disorder’ rather than the other option, an ‘organic disease’. The difference is that an organic disease is where there is damage or change to an organ or body part, whereas, with a functional disorder, a change has occurred to the normal functioning of a body process. This means that when IBS is investigated via a colonoscopy (a scope up the rear), there is no discernible damage to the bowel wall, unlike ulcerative colitis or Crohn’s disease (both organic diseases), where there is often inflammation and ulceration to be seen. With IBS, it is thought that peristalsis (the wave-like movement which occurs throughout the bowel) is disrupted which causes the symptoms of IBS that include abdominal pain, diarrhoea, constipation, abdominal pain, flatulence and lack of appetite. Peristalsis is a common movement throughout the digestive tract, whereas there is a smaller movement, known as the MMC (Migrating Motor Chain) which only affects the small intestine. This can be disrupted by Small Intestine Bacterial Overgrowth (SIBO).

Symptoms

• Diarrhoea.
• Constipation.
• Alternating diarrhoea and constipation.
• Abdominal pain.
• A feeling of fullness.
• Bloating.
• Flatulence.
• Symptoms improve with bowel movement.
• Lack of appetite.

What causes it?

• Some people carry their stress in their neck, some suffer headaches, while others feel tight knots in the muscles of their shoulders. People with IBS experience stress in their bowels. Worry is the enemy of the intestine. IBS is very often a visceral sign of stress. The physiological explanation of this process is the close connection between the nervous system, the digestive system and the brain. When you experience stress of any kind, it causes a commotion in the nervous system, and this hubbub is then relayed to the bowel. Around 95 per cent of the body’s ‘happy’ neurotransmitters, serotonin, are located in the digestive system. Stress causes a decrease in serotonin. Alterations in serotonin affect the movement of the bowel and vice versa.
• Food sensitivity may cause or trigger IBS. Wheat, dairy, fructose, alcohol and spicy food are some common culprits.
• Infection. One interesting theory is that IBS is initiated by a bacterial or viral infection. Although the infective agent may have left the building, its presence caused major disruption to the microflora within the bowel and in the ensuing months or years can result in the presentation of IBS symptoms. It’s the same sad lament one hears with so many conditions. Unhappy microflora; unhappy bowel; unhappy you.
• Hormones may not be the cause, but many women suffer an increase in IBS symptoms prior to menstruation.
• SIBO.  Small Intestine Bacterial Overgrowth is a strong contender for being the cause, or at the very least part of the problem of IBS. The Fodmap diet, mentioned below, is an important part of treating SIBO, and vicariously IBS.
• Dysfunctional diaphragm.  The diaphragm is the muscle that separates the chest (thorax) from the belly (abdomen). The diaphragm is supplied by the phrenic and vagus nerves, also important for digestion. If diaphragmatic function is poor, this can influence the function of the bowel.

What to do

Diet

• IBS responds well to good eating habits. So, sit down to eat. Don’t eat standing up. Don’t eat while working at your desk. Don’t watch TV at dinnertime. Eat meals at regular times and don’t miss any. Like small children, bowels respond best to routine. Chew each mouthful well. Peristalsis begins the moment you start to chew, so wolfing down your food sends a similarly rushed message to the bowel.
• Eat lightly when stressed. Keep to soups, steamed vegetables, chicken breast or white fish.
• Avoid foods that trigger your IBS (which may include wheat, dairy, onions, brassicas, legumes, sugar, coffee and alcohol).
• Avoid artificial sweeteners, particularly sorbitol which interferes with peristalsis.
• Stick to a low-fat diet. Avoid deep-fried foods.
• Don’t chew gum. It is one of the worst things you can do to your digestive system. When you start chewing anything, hormonal and nerve messages are swiftly sent to other parts of the digestive system to prepare for food. When no food arrives, there is understandable confusion. If you have to, chew gum immediately after a meal to clean your teeth, but not at any other time.
• Prebiotic and probiotic foods can help restore and maintain healthy bowel flora. Prebiotic foods include asparagus, Jerusalem artichokes, leeks and onions, and legumes such as baked beans, chickpeas and lentils. Probiotic foods include yoghurt, miso, sauerkraut, kefir, natto, tempeh and the kimchi.
• Fructose malabsorption is the most recent food sensitivity on the nutritional scene. Known as FODMAPs, pioneered (and marketed) by Australian dietician Sue Shepherd, fructose malabsorption is where you have difficulty in digesting fructose, a sugar found in fruits and vegetables. If not adequately digested, fructose (and fructose-like molecules) travel down the intestine where they ferment, releasing gas and creating havoc with peristalsis. Many people with IBS respond well by decreasing fructose foods from their diet. Fructose malabsorption can be detected by a hydrogen breath test. High-fructose foods include fruit juice, tinned and dried fruit, grapes, guava, apple, coconut milk and cream, honeydew melon, mango, nashi fruit, papaya, pear, quince, star fruit, tomato, watermelon, Lebanese cucumber, sweet potato, tomato paste, relish, sweet and sour sauce, BBQ sauce, fructose corn syrup, fructose, honey, fortified wines, globe artichokes, asparagus, garlic, green beans, onions, leek, shallots and wheat.  The FODMAP diet will often help to reduce the symptoms of IBS, but it is important to get to the cause behind fructose malabsorption… which may well be SIBO, Small Intestinal Bacterial Overgrowth.

Remedies

• Effective in tablet or extract form, ginger, lemon balm, chamomile, valerian, aniseed, peppermint and fennel are excellent for treating the symptoms of IBS. Also, try one or more as a herbal tea such as Digestivo, sipped throughout the day.
• Very often bowel flora is disturbed. Take probiotics including a single or variety of lactobacillus fermentum, lactobacillus plantarum, lactobacillus acidophilus and bifidus. Take 1 teaspoon or 3 capsules every morning before breakfast.
• Take a large dessertspoon of psyllium along with a glass of water each evening. Psyllium is a prebiotic that helps with diarrhoea and constipation.
• Magnesium helps muscle spasm, including the muscle of the bowel. Magnesium in bisglycinate form is best.
• If bloating is a major symptom of your IBS, take a digestive enzyme tablet before or with each meal.
• Enteric-coated peppermint oil capsules ease many IBS symptoms. ‘Enteric-coated’ means that the medicine is coated with a substance that allows it to pass through the stomach and into the intestines where it is needed. Many substances are changed by stomach acid.

Other

• Stress is almost always a trigger with IBS and can be a sign that you are internalising your stress. Learning relaxation techniques and how to manage your stress is paramount to controlling this uncomfortable condition. Meditation, yoga, counselling, whatever rocks your boat – and bowel.
• The Bach flower that helps stop incessant thoughts is White Chestnut, Pine is for those who feel guilty and never good enough, Vervain is for those who have too much on the go at the one time.
• Breathing retraining may be key in treating IBS. In particular reinstating diaphragmatic breathing. Poor diaphragmatic function is thought to behind a large percentage of IBS.  This type of breathing relaxes smooth muscle (which lines the bowel), and switches on the relaxing parasympathetic nervous system. Exactly what is required. Get to it.
• Regular exercise is important. Swimming, in particular, can be helpful for IBS, perhaps due to the stretching of the abdominal muscles, particularly from overarm and breaststroke.

Aromatherapy

Blend the following oils into a 20 ml base oil. Use in a soothing clockwise abdominal massage or as a warm compress on the abdomen and lower back. Mixed with some Epsom salts, can also be used as a bath soak.

• 4 drops of sweet marjoram oil – soothing on the digestive system, can relieve cramps, indigestion, constipation and cleanse the gut
• 4 drops of black pepper oil – strengthening effect on the stomach, aids with flatulence and calms in cases of nausea, tonifying to the smooth muscles of the colon
• 2 drops of peppermint oil –soothing, antispasmodic effect on the smooth muscles of the stomach helping to alleviate pain, colic, diarrhoea, indigestion and nausea

At a glance

Diet

• Focus on acquiring and maintaining good eating habits. Chew each mouthful wel. Don’t rush your meals and sit down to eat.
• Avoid foods that trigger IBS. Common offenders include wheat, dairy, onions, brassicas, legumes, sugar, coffee and alcohol.
• Eat more prebiotic and probiotic foods. Improving your microbiome, or bowel bugs, often sorts out IBS.
• If you suspect SIBO is behind your IBS, trial the FODMAP diet.

Remedies

• A probiotic supplement can be helpful to overcome IBS. Take 1 daily. The strains of bacteria shown to be of most help include lactobacillus fermentum, lactobacillus plantarum, lactobacillus acidophilus and bifidus.
• Herbs such as ginger, lemon balm, chamomile, valerian, aniseed, peppermint and fennel are good friends to the bowel. Digestivo tea contains several of these tummy friendly herbs.

Other

• As stress is a major factor in most cases of IBS, it will serve you well to attend to reducing and learning techniques to cope with your stress.
• Breathing retraining reduces anxiety, relaxes the bowel and helps reinstate diaphragmatic breathing.