south canterbury dietitian

How I Can Help You With IBS

Gut Health Is Important

Having a healthy digestive system is vital to good health. I have a special interest in gut health and have worked with many clients to resolve issues such as bloating, wind, constipation or diarrhoea, abdominal cramps and acid reflux.

I have attended training at Monash University and have experience at guiding and supporting clients with diet changes to improve their gut function including the Low FODMAP diet and other diet changes to help with food intolerances.

What is IBS?

IBS or Irritable Bowel Syndrome is a disorder of the digestive system. It is a very common disorder thought to affect around 15% of the population.

IBS is one of a group of bowel disorders known as “functional gastrointestinal disorders”. This means that they cause disturbances in the function of the gut but do not have any identifiable physical features. This means that when tests are done by your doctor or specialist they do not find any specific gut problems such as ulcers, inflammation, thickening of tissues, changes in structure of the gut or any abnormalities in blood tests, X-rays or scans.

Some doctors use the “Rome III Criteria” to help diagnose IBS. This criteria identifies IBS as a condition where there is abdominal pain and altered bowel habits (either constipation or diarrhoea or a combination of both), in the absence of any other identifiable disease that may be causing these symptoms.

This criteria states that people can be diagnosed with IBS if they have suffered symptoms for at least 6 months and have experienced mid or lower abdominal pain for at least 3 months, along with abdominal bloating or distension or both.

What are the Symptoms of IBS?

The symptoms of IBS can vary from person to person. Some of the symptoms are experienced in the upper part of the gut such as acid reflux or heartburn, excessive burping and indigestion-type pain. Other symptoms are experienced in the stomach such as nausea, fullness, mid-abdominal discomfort or pain, and bloating. Symptoms may also be felt in the lower abdomen and rectum such as constipation, diarrhoea, unsatisfied defecation (incomplete emptying), passage of mucous from the bowel, a noisy abdomen( also known as borborygmi), excessive wind and pain in the rectum.

Tiredness is also common and some people describe muscle aches and pains, low mood, headaches and poor energy levels when compared to other people of a similar age. Irritable bladder or urinary frequency and urgency may also be a part of the disorder for some people.

Overall you can see how IBS can be a very distressing and debilitating disorder affecting both lifestyle and enjoyment of many activities.

What causes IBS?

How and why some people get IBS is not yet known. However we do know that there are many potential triggers for IBS.

These include:

Genetic factors– it is thought that genes may play some role and we often find IBS occurs in families.

Gut Infections – having a past history of a gut infection that causes diarrhoea may be a trigger in some people. Gut infections may be caused by a virus, bacteria or a parasite.

Stress and other psychological factors – the gut receives signals from the brain via nerves and can be affected by stress and anxiety. In many cases the IBS can cause an increase in stress levels

Super-sensitive gut – some people seem to respond to normal gut sensations by experiencing pain and discomfort

Medications and some herbal supplements – these can cause IBS symptoms in some people

Imbalance of bowel bacteria – there are many reasons for gut bacteria to become unbalanced and this unbalance can cause IBS symptoms

Food and drink – the most common trigger of IBS symptoms are foods and drinks. Food intolerance is often the main cause of gut symptoms in IBS. Also how food and drinks are taken across the day is also important.

Food Intolerance in IBS

Many people with IBS are intolerant of a range of foods. When eaten individually or in combination these foods tend to increase the symptoms of IBS.

The most common food triggers include fatty and spicy foods, alcohol and caffeine. Eating large meals, eating too fast and not chewing food well enough is also a factor for some people. The fibre content of the diet is important as well with inadequate, excess or the wrong type of fibre contributing to symptoms.

It now known that there are a group of carbohydrates that are poorly absorbed in some people. They are now known as FODMAPs.

FODMAPs stands for Fermentable Oligosaccharides Dissacharides and Polyols. They are a group of short chain carbohydrates or sugars that are more likely to causes IBS symptoms. They can be poorly absorbed during digestion and can result in fermentation by bowel bacteria. The fermentation causes the symptoms of bloating, distension, wind and constipation or diarrhoea.

Diagnosis of IBS

If you suspect that you may have IBS it is important to see your doctor first to discuss the symptoms you are experiencing and what tests may be recommended. Your doctor will ask you about “red flags” which are symptoms that could indicate a more serious bowel disorder. These “red flags” include:  bleeding from the bowel, unexplained weight loss of 5kg or more, family history of bowel cancer, symptoms that wake you in the night and being over the age of 50 when the symptoms began.

Based on your symptoms your doctor may consider conditions such as bowel cancer, coeliac disease, Crohns disease, Ulcerative colitis and gynaecological issues. Your doctor may also organise some tests and refer you onto a specialist for further investigations.

It is important not to self-diagnose IBS as your symptoms may be caused by a more serious condition.

Treatment of IBS

There are various ways to treat IBS and the success of these treatment will depend on the person and the main triggers for their IBS symptoms.

Stress and anxiety: if this is a main trigger then stress management techniques may help. Research has also shown that meditation, breathing exercises, yoga/tai-chi/pilates exercises and even hypnotherapy are helpful for some people. Ensuring adequate rest and sleep each day is also important and taking time to relax with reading, music or gentle walking can also help to reduce symptoms.

Medications: if you suspect some medications may make your symptoms worse discuss alternatives with your doctor. Also consider any herbal remedies and teas/ drinks that me be contributing. Your doctor may recommend and trial of medication to help reduce symptoms such as diarrhoea, constipation, cramping pains, sleep disturbances or anxiety. Antibiotic may be used to treat suspected overgrowth of bowel bacteria.

Diet: Food intolerances often play a major part in IBS symptoms. Dietitians with expertise in gastrointestinal nutrition and many doctors now recommend the Low FODMAP diet as treatment for people with IBS. From scientific studies completed over the last few years we now know that up to 75% of people with IBS can experience greatly improved symptoms and reduced need for medications with this dietary modification. It is recommended that you consult with a dietitian who specialises in this area to get full assessment of your symptoms and current dietary intake. Diet and IBS is a complex area and it is important to get information that is individualised to your health, medical history and lifestyle. It is important that you eat a well-balanced diet with all the nutrients that your body requires. It is vital also that you are tested for Coeliac Disease before altering your diet to take out wheat or gluten. If someone experiments with a Gluten free diet before this testing is done the results may be inaccurate.

The Low FODMAP diet is a challenging diet to follow for many people. Many common foods need to be avoided such as cow’s milk, yogurt, and many fruits and vegetables. It is recommended that you seek guidance and support from a dietitian with experience in this diet. The diet itself is being constantly updated as new information emerges. Other dietary changes are recommended depending on individual circumstances. For example, types and amounts of fibre recommended will vary for each person as will the types and amounts of fats, sugars and snacks. At the completion of the Low FODMAP trial a controlled reintroduction of FODMAPs one at a time in undertaken. This will enable the person with IBS to determine which FODMAPs cause the most problems and helps them to work out what amount of each group they can tolerate.