Irritable Bowel Syndrome (IBS) affects people of all ages, however females, and young adults are most likely to be diagnosed. Symptoms can range from cramping, bloating, diarrhea, constipation, incomplete voiding, mucous, nausea and heartburn. Canada and other more well-off countries tend to have much higher rates of IBS, representing a major quality of life burden. While many people are told that they have IBS (and that's that), they might not realize that there's more to it than a bathroom crisis.
1. IBS is not a diagnosis, it is a catch-all.
In medicine, we call this a diagnosis of exclusion. This means that before IBS is diagnosed, we need to rule out more serious pathology like Ulcerative Colitis, Crohn's Disease, Colorectal Cancer, Celiac Disease and other immune related conditions. If you are suddenly experiencing a change in bowel patterns, including mucous or blood in your stool, have unexplained weight loss, fever and family history of colon cancer, this merits a thorough medical workup.
In the absence of these things, IBS is considered a functional disorder, wherein you experience the symptoms (which can sometimes be very severe) but very little can be seen via labwork or exploratory imaging.
2. Irritable bowel syndrome can include constipation, diarrhea or both.
The Rome-III Criteria are used to identify most cases of IBS.
This includes recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months, associated with 2 or more of the following:
3. You are what you eat - and what you eat matters!
Many people with IBS know one or two foods that set them off, and are careful to avoid it. What you may not know is that your body might actually be having a full-on immune reaction to some of the foods you eat on a regular basis - causing the digestive upset and bathroom angst. Food sensitivities are quite common amoungst people with IBS and it is worth doing a trial elimination diet where you remove the typical offending foods such as gluten, dairy, eggs, soy, citrus, and pork for a period of time and then slowly reintroduce them back into your diet. There are tests to help determine which foods your body is reacting to as well - and these can be quite effective and simple to run. Processed foods, particularly those containing a lot of trans fats, sugars, salts and additives like MSG are the culprit for many people. A diet focused on lots of cooked vegetables, good quality lean protein and some healthy fats like coconut oil, ghee and olive oil can help decrease the severity of IBS.
Likewise, a history of multiple rounds of antibiotics can predispose towards IBS as your own natural bacteria gets altered. Probiotics containing Lactobacillus can be helpful for increasing the amount and types of good bacteria in the gut and decreasing IBS symptoms. See a Naturopathic Doctor to decide which strains of probiotics are most appropriate for you.
4. Trust your gut
Our guts are extremely sensitive to changes in hormones, including stress hormones like cortisol, and adrenaline and those related to mood like serotonin and dopamine. In fact, we also have a nervous system in our gut - the Enteric Nervous System - that also responds to the same chemicals that influence our brain. This means that when we are stressed out, it can definitely affect our digestive system on a molecular level such that we may feel the urge to go to the bathroom, lose our appetite or get unexplained stomach aches. When working with IBS, it is important to address the mind-body connection via stress management, like exercise, deep breathing, meditation as well as perhaps some botanicals and supplements to improve both your mood and belly.
If your gut has been compromised by parasites, Candida, mould, bacterial or viral infections you may be more likely to have IBS either temporarily or in the future. A good treatment plan addresses the cause of your IBS and works on healing the gut.
5. Fibre might be the the answer - or your frenemy.
People with IBS are often told by their family doctors and dieticians to increase fibre in their diet. The rationale is sound: more fibre = slower bowel transit time = less diarrhea. Fibre can also help to bind excess hormones, lower cholesterol, stabilize blood sugar and feed the good bacteria in the gut. On the other hand, too much fibre without large amounts of water to accompany it can easily sit like a lead weight in your gut and make you feel like you've swallowed a brick. It can also impair your absorption of vitamins and minerals - not to mention prescription medications - as it literally absorbs things around it. For people tending towards constipation, fibre can cause even more difficulty with bowel movements. The type of fibre needs to be considered as well. While wheat bran is readily available, many people are also sensitive to gluten and will feel worse taking it.
The Bristol Stool Chart is a commonly used visual to help people describe how their bowel movements look to their physicians.
Here's the low-down:
Type 4 is considered the "perfect poo" - soft, easy to pass, very few/no wiping needed. No cracks, or lumps, even in consistency and color.
Type 1-3 equals varying degrees of constipation and dehydration.
If we are dehydrated, our body will absorb water wherever it can. Given that our stool is mostly water, you can guess where our body gets some of that liquid. Gross. The longer stool stays in your colon, the more water gets reabsorbed, the drier it gets and more difficulty to pass.
Type 5 is typical of people eating a mostly veggie based diet.
Type 5-7 points towards malabsorption, food sensitivities or infection. If your stool is loose, runny or very frequent, it is likely that it is passing too quickly through the colon. Dehydration is also a concern as we can lose massive amounts of fluid via diarrhea. Eliminating foods that cause inflammation, treating infections or parasites, adding fibre, proper hydration and some botanicals to slow absorption can be very helpful in these cases.
If this looks a little more familiar to you, great, I'm all for everyone being on the same page. We may have also found out why you have IBS since processed foods like these often worsen IBS.
If you or someone you know is experiencing Irritable Bowel Syndrome, please book a consultation with me to discuss your options. I have worked with many people experiencing a range of digestive issues using a blend of nutritional medicine, supplements, stress management techniques and acupuncture to help them experience lasting relief.
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Dr. Keila Roesner is a Naturopathic Doctor. When not treating patients she is also an enthusiastic barefoot-strolling, music-loving, yoga-doing kitchen wiz - who also happens to be a wrestling fan.