IBS: What Is It?
Irritable Bowel Syndrome (IBS) is a group of symptoms that primarily affect your digestive tract. It is estimated that ~10-15% of the US adult population suffers from IBS at some point in their life (1), with symptoms including abdominal pain, bloating, excess gas, diarrhea, constipation, mucus in poop, nausea, early satiety (feeling full quickly), and loss of hunger cues. While most IBS symptoms are felt in your gut, IBS can cause problems outside of your digestive tract as well, such as arthritic pain, headaches, runny/stuffy nose, fatigue, lightheadedness, and bladder spasms. (2) Until recently, IBS symptoms were diagnosed as being “all in your head,” leaving patients feeling unsupported and with few treatment options other than increasing fiber intake. Fortunately, due to some amazing research by doctors and scientists around the world, IBS is now recognized as a Disorder of Gut-Brain Interaction, meaning that IBS reflects a problem with how your brain and digestive system are communicating. As a result of this miscommunication, there are changes in the way your nerves sense things in your gut and the way your muscles control movement in your intestines. As those of you with IBS know, these changes in your digestive function can make you very sensitive to food, emotional distress, general stress, lack of sleep, medications, and hormone changes. While these very real symptoms are uncomfortable and can interfere with your quality of life, the good news is that IBS is not dangerous and does not lead to more serious conditions such as cancer or IBD (Crohn’s disease and ulcerative colitis). IBS is, however, generally a life-long problem in which symptoms (and their triggers) need to be managed regularly.
How Is IBS Diagnosed?
IBS is diagnosed by a doctor based on a set of established standards called the Rome IV criteria. The Rome IV criteria are as follows:
Recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following criteria:
· Related to defecation (issues pooping)
· Associated with a change in frequency of stool
· Associated with a change in form (appearance) of stool.
Criterion fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis. (3)
In sum, this means that to be diagnosed with IBS, a patient must have abdominal pain at least 1 day/week for the past 3 months. The pain must also be associated with at least 2 of the following: defecation (pain is increased, decreased, or stays the same with pooping), frequency (how often a person goes to the bathroom), and/or a change in the appearance of stool (hard, soft). See the link to the Bristol Stool Chart for stool types. https://med.stanford.edu/content/dam/sm/ppc/documents/General_Primary_Care/Bristol-stoll---simple.pdf Lastly, the symptoms need to have started at least 6 months ago.
Types of IBS
IBS can be broken down into 4 sub-types, depending on the changes you are experiencing when passing stools.
Constipation predominate IBS (IBS-C): when more than 1 in 4 bowel movements is Bristol stool form type 1 or 2 (small, hard, and difficult to pass stools) and less than 1 in 4 stools is classified as type 6 or 7 (watery, mushy stools). (4)
Diarrhea predominate IBS (IBS-D): when more than 1 in 4 bowel movements is Bristol stool form type 6 or 7 (watery, mushy stools) and less than 1 in 4 stools is classified as type 1 or 2 (small, hard and difficult to pass stools). (4)
IBS with mixed bowel habits (IBS-M): when more than 1 in 4 bowel movements with Bristol stool form types 1 or 2 (small, hard, and difficult to pass stools) and more than 1 in 4 bowel movements with Bristol stool form types 6 or 7 (watery, mushy stools). (4)
IBS unclassified (IBS-U): when patients meet diagnostic criteria for IBS, but their bowel habits do not meet any of the above IBS classifications. (4)
It is important to see a gastroenterologist if you notice any changes in your bowel pattern. While IBS is not dangerous, it is important that you discuss your symptoms with a doctor who specializes in GI disorders to rule out any other medical conditions and rule in IBS.
What are Some Treatment Options for IBS?
While there is no cure for IBS, there are treatment options that can help improve your symptoms over time.
1. Diet: Meet with a registered dietitian (RD) who specializes in gastrointestinal issues to discuss which dietary options are best for you. Sometimes, a simple review of your diet for foods that may be triggering your IBS can be enough to lead to symptom improvement. More often, however, it is helpful to begin a therapeutic diet such as the Low FODMAP diet, the Specific Carbohydrate diet, or the Low Histamine diet to give your gut a rest and then systematically determine which foods may or may not be triggers for you. Remember, the goal is always to find the broadest diet possible so that your nutrition needs are met while minimizing your IBS trigger foods.
2. Exercise: Regular movement with activities that you enjoy can help regulate your bowels and decrease stress to improve bowel movements.
3. Relaxation techniques: Deep breathing exercises and mindful meditation can significantly reduce stress levels and IBS symptoms. Try this simple box breathing exercise for 2 minutes 3 times per day: Breathe in for a count of 5, hold for a count of 5, breath out for a count of 5, hold for a count of 5. Repeat. Note how your body feels before and after you complete a 2 minute box breathing cycle.
4. Sleep: Have you ever noticed how your IBS symptoms feel worse after a bad night’s sleep? Or how you tend to make poor food choices on the days that you feel like you’re dragging? Sleep is a must when managing IBS! It gives your body the time to recover and repair from the day, and your mind the break it needs from stress.
5. Eating smaller meals: For some people, eating smaller, more frequent meals allows them to get the nutrients that they need without overburdening their digestive tract.
6. Chewing food thoroughly: You would be surprised at how simply slowing down mealtimes and chewing your food more thoroughly can make a big difference in IBS symptoms. It’s easy to do and has the added benefit of moving toward being a more mindful eater!
7. Review of medications and supplements: Some medications and supplements can trigger IBS symptoms. Reviewing all medications and supplements that you are taking can help reduce IBS symptoms.
8. Probiotics: There is a lot of hype around probiotics, and research shows that they can be very helpful for some people. However, they can also be very irritating for other people, exacerbating symptoms and making IBS sufferers feel worse. It is important to work with a knowledgeable professional like a gastroenterologist, naturopathic doctor, or RD to determine if a probiotic is appropriate for your IBS symptoms.
9. Gut mediated hypnotherapy: Research shows that “gut mediated hypnotherapy can improve gastrointestinal symptoms of people with IBS by 70-80%, and these improvements are maintained long-term.” (5) By guiding a patient into a deeply relaxed state, a trained therapist uses suggestion, imagery, and relaxation to address the miscommunication between the gut and the brain. (6) Gut mediated hypnotherapy aims to calm the digestive tract and prevent unnecessary focus on the discomfort of the body. (7)
10. Medications to help treat IBS: Always speak with your doctor before starting any new medications or supplements.
At Nu, LLC both Meg and Ava have dedicated large portions of their continuing education to learning about IBS and other functional gut disorders so that they can guide their patients to a better quality of life! Reach out to us to schedule your consultation and see how the nutrition experts at Nu, LLC can help you!