It’s uncomfortable and distressing — and you may even avoid situations because of it. Discover what sets off your Irritable Bowel Syndrome so you can develop strategies to ease the pain.
Around one in five of us are likely to suffer from Irritable Bowel Syndrome (IBS) during our lives. For some, the symptoms are mild and short-lived; for others, IBS can be a chronic, debilitating and painful condition affecting their confidence and general enjoyment of life.
The actual causes are unclear, although a bout of gastroenteritis and issues with digestion are thought to help kick-start the condition.
We do know there are two main triggers for IBS symptoms: stress and diet (‘mood and food’). The good news is that by recognising what brings on the symptoms, many people can find ways to both relieve and manage their condition.
Do I have IBS?
IBS causes a spectrum of symptoms ranging from abdominal pain, diarrhoea and constipation, to an urgent need to go to the toilet.
It’s known as a ‘functional disorder’ of the bowel, which means that while you may experience even severe symptoms, there is no damage to your intestinal tract. Pain is eased by a bowel movement.
“People with IBS have a gut that’s quite sensitive to distension,” explains Dr Jane Muir, a nutrition scientist in the Department of Gastroenterology at Monash University. A proper diagnosis of IBS must be made by a GP.
Signs and symptoms
If you suspect you may have IBS, ask your GP for a diagnosis. Your doctor will then look for at least two of the following indications:
Abdominal bloating (more common in women than men), distension, tension or hardness
Symptoms made worse by eating
Other symptoms may include: lethargy, nausea, backache and bladder symptoms.
What you can do
If your symptoms are mild, these simple lifestyle changes may help:
Reduce alcohol, fatty foods and caffeine-containing drinks
Make sure you eat three small meals a day
Avoid skipping meals — you’re more likely to overeat later and therefore get IBS symptoms
When the trigger is… DIET
If you’ve already made the simple lifestyle changes listed on the previous page but your symptoms persist, then your GP may suggest you trial a low-FODMAP diet, with the guidance of a dietitian.
The name FODMAP is simply an acronym for a group of carbohydrates (see far right) that have been shown to bring on IBS symptoms in some people.
Foods high in FODMAPs include wheat, some pulses, milk, and even certain fruits and vegetables. Alcohol, fizzy drinks, fatty foods, caffeine and processed ready-made meals are also high in FODMAPs.
To find your food triggers, you’ll need to follow a strict elimination diet for four to eight weeks where all FODMAPs are excluded. But this isn’t a life-long diet. After eight weeks, foods are then reintroduced systematically to find out which, if any, are causing your symptoms. It’s very important that this is done under the supervision of a dietitian, or you risk missing out on vital nutrients.
I feel so much better...
Many people begin to feel marked improvements once they’ve eliminated FODMAP foods, but it’s really important not to stop there. Foods must be reintroduced, under guidance, to identify the culprits, and ensure you’re following a healthy, balanced diet that doesn’t eliminate any foods, or whole food groups, unnecessarily.
The reintroduction of each food is done over a three-day process. So you might be OK with a small amount of cooked onion in a soup, for example, but eating lots of raw onion may bring on symptoms. After pinpointing the foods that upset you, you can then follow a less stringent FODMAP-aware diet, and just restrict the known culprits.
How successful is the diet?
The diet is effective in over 75 per cent of IBS sufferers. “It really is life-changing. We get emails from people every week saying ‘Thank you! I have been in pain for decades and the problem has been solved in a matter of weeks’. It’s such a simple thing once you figure it out,” says Dr Muir.
How to do it
An official diagnosis by a GP is the first step, eliminating any other possible causes. Then your GP can refer you to a dietitian who will supervise you on a personalised low-FODMAP diet. You can also download the Monash University Low FODMAP Diet app to help with your diet and food shopping.
What are FODMAPs?
FODMAP is an acronym for the following group of carbohydrates that are poorly digested in our intestines. For people with IBS, this causes bloating and tummy discomfort.
Fermentable – the following groups of carbs become sugars which ferment in the large bowel during digestion. (Each group has a different name because they have a different molecular structure.)
Oligosaccharides – such as galacto-oligosaccarides (GOS) and fructans. Main food culprits: garlic, onion, wheat, inulin, leek, lentils.
Disaccharides – such as lactose. Main food culprits: milk and milk products (ice cream, custard, evaporated milk)
Monosaccharides – such as fructose. Main food culprits: honey, mango, apples, pears.
Polyols – such as sorbitol and mannitol. Main food culprits: apricots, nectarines, mushrooms, cauliflower and some artificially sweetened gums and lollies.
When the trigger is… STRESS
Daily stressors can play a major role in triggering IBS symptoms.
“Things as simple as being late picking up the kids or having back-to-back meetings can be enough to cause abdominal pain, bloating and changes in stool consistency in many people,” says Dr Simone Peters, a psychophysiologist at Monash University who specialises in this brain-gut connection.
“Stress can trigger gastrointestinal symptoms and vice versa. Which shows the relationship between stress and IBS is complex and bi-directional,” she explains.
How the stress response causes pain in the gut is down to our primitive fight-or-flight response. “This response slows down digestion. And in extraordinary situations, our digestion stops so that the body can divert all its energy to the stressor.
“Of course, it can also work the other way, where persistent gastrointestinal complaints can heighten stress. Notably, people diagnosed with IBS tend to have an above-average incidence of anxiety and depressive disorders.”
And that starts to make sense when you realise that 90 per cent of the body’s mood-controlling hormone serotonin is made in our gut, not our brain. “The two systems are incredibly linked,” says Dr Peters.
What will help?
Finding tools to soothe mental stress can be an effective treatment for IBS. “Gut-directed hypnotherapy and cognitive behavioural therapy have the most evidence to support their use,” says Dr Peters. Recently, she conducted a study that compared the benefits of hypnosis on IBS symptoms with a low-FODMAP diet.
During their sessions, the hypnotherapy group was given visual suggestions to help them relax and gain greater control over their digestive issues.
The results of the study were surprising. After just six weeks, hypnotherapy was found to be just as effective in easing IBS symptoms as the low-FODMAP diet. And after a six-month follow-up, the hypnotherapy group showed improvements in anxiety and depression.
This shows how closely IBS can be linked to our emotions.
To undergo hypnotherapy, it is important that you see a specialist gut-directed hypnotherapist, who will have extensive knowledge of IBS.
Accepting that stress and how you are feeling can be a trigger, as well as possible dietary causes, is key to helping you overcome your symptoms. So instead of blaming yourself when symptoms strike, it can be beneficial to talk about what is troubling you with someone who can help, whether it is your partner, a friend or a counsellor, so you can begin to get better.
Manage your stress
Take part in a creative or absorbing activity, such as cooking, painting or reading — or anything that takes your mind off your condition and brings you enjoyment.
Use exercise to help you unwind — swimming, walking and yoga are all relaxing activities.
Prepare well in advance of a stressful situation such as a work meeting or family gathering. Get a good night’s sleep and try to fit in some exercise before the event.
Write it down
Keeping a food, mood and symptoms diary can help you identify any triggers.
So next time you have a flare-up, you’ll be able to isolate what’s been happening by simply looking at your diary. Just look at what you’ve been eating and if there have been any big changes in your life.
It could be happening whenever you go on holiday, when a family member comes to visit, or even every Monday morning.
Hayley Lewis: My IBS journey
Former world swimming champ, Hayley Lewis, laments that her passion for food means it can be tricky to manage IBS, as well as her lactose and gluten intolerances.
“I’ve always struggled with my weight and always felt bloated. When I was swimming, I was anxious a lot. I felt a lot of pressure and I had a tricky tummy. I didn’t know if the stress was partly the cause, but my mum knew that some foods would make me unwell.
I was doing four hours in the pool every day from the age of 10 until I retired at 27, so my food intake was insane. I ate a lot of junk food but I would also eat four apples a day as a snack, because I thought they were good for me. No one ever said, “that’s way too much fructose, Hayley”.
After I had my second child, (Kai, now 13), I had a colonoscopy that showed I had Irritable Bowel Syndrome (IBS). But I didn’t do anything about it.
Last year, I felt ill every day. It was a busy time at home and at work and I was feeling stressed. Then I had the worst month with my tummy. Normally, I run at least 10km five times a week, and it makes me feel good about myself. But now I was only going one kilometre before I’d have to come home and go to the toilet. I thought, it has to be my diet. So I had a test and was diagnosed as lactose and gluten intolerant, and was put on the low-FODMAP diet.
I realised so many things in my diet weren’t good for my bowel, like my favourite fruits, or the prunes I ate thinking they were good for my bowel, when it turns out they trigger IBS.
It’s hard because I really love food. My husband loves to cook and I hate saying to him, ‘I can’t eat that’. He made a soup for us on the weekend with onions and garlic and I didn’t think anything of it, but by Monday morning I was so bloated that I looked nine-months pregnant!
My favourite meal is breakfast. I love my avocado on gluten-free toast, which I can safely eat. But I’m still re-educating myself. I have a very sweet tooth. I took my son to the local Doughnut Time recently and halfway through eating one, I thought ‘I have to stop, it’s not worth how I’m going to feel tomorrow.’ You can stop bad habits if you train yourself. I haven’t stopped all my bad habits yet, but I’m on my way.”
Check with your GP
If you’re suffering from the symptoms associated with IBS, it’s important that you visit your GP rather than self-diagnose. This will rule out coeliac disease and other possible illnesses.