What is irritable bowel syndrome (IBS)?

What is irritable bowel syndrome (IBS)?

IBS is a condition that affects the digestive system. Although anyone can develop it, the condition is more likely to affect young people and women. Furthermore, severity varies. As a result, some people suffer from minor symptoms, while others suffer from symptoms that play havoc with daily life.

Unfortunately, 7-21% of people suffer from IBS. Furthermore, women are twice as likely to have this condition compared to men.(1) 

Usually people with IBS have typical bowel movements some days and abnormal ones on others. Moreover, the 3 types of IBS depend on the abnormal bowel movements experienced:

• IBS with constipation (IBS-C). Hard stools more than 25% of the time and loose stools less than 25% of the time.
• IBS with diarrhoea (IBS-D). Hard stools less than 25% of the time and loose stools more than 25% of the time 
• IBS with mixed bowel habits (IBS-M). Hard stools more than 25% of the time and loose stools more than 25% of the time 

Fortunately, IBS doesn’t damage your digestive tract or raise your risk for colon cancer, however it is a chronic condition that requires long term management.(2) 

What causes irritable bowel syndrome (IBS)?

Scientists don’t know the definitive cause, however they think a combination of factors can lead to IBS:

Dysmotility: Irregularity with how gastrointestinal (GI) muscles contract and transport food through the GI tract. The walls of the intestines are lined with layers of muscle that contract as they move food through your digestive tract. Strong long lasting contractions can cause bloating, diarrhoea and gas. Meanwhile, weak contractions can slow food passage and lead to constipation

Brain-gut dysfunction: As a functional GI disorder, IBS is caused by disruptions in the way your brain and gut interact with one another. These problems cause your digestive tract to be very sensitive. Moreover they change how your bowel muscles contract. Poorly coordinated signals between the brain and the intestines can cause the body to overcompensate to changes that normally occur in the digestive process, resulting in pain, diarrhoea or constipation.

Visceral hypersensitivity: When the abdomen stretches, extra-sensitive nerves located in the digestive system may cause you to experience a significant amount of discomfort.(3) 

You may also be at higher risk of developing IBS if you have:

• Family history of IBS
• Stress or anxiety
• Food intolerance
• History of abuse
• Severe digestive tract infection

What are the symptoms of irritable bowel syndrome (IBS)?

Symptoms of IBS aren’t necessarily persistent. They can resolve, only to come back. However, some people report having continuous symptoms.

In general, the colon muscle contracts more than in people without the condition. As a result, these contractions cause pain. Occasionally pain associated with IBS can feel like cramping. In general, this cramping causes the following symptoms:

• Pain relief post bowel movement 
• Inconsistent frequency of bowel movements
• Varying stool consistency (e.g. diarrhoea and constipation)
• Abdominal cramps
• Bloating
• Excess gas
• Mucus in the stool (4) 

In people with IBS, it’s not uncommon to have episodes of both constipation and diarrhoea. Fortunately, symptoms such as bloating and gas typically go away after a bowel movement.

Women’s symptoms often flare up during their periods. Unfortunately, these symptoms commonly happen repeatedly, which can cause high levels of stress. However, learning management techniques helps to gain control over flare-ups, leading to improved physical and mental health.

If you suffer from GI discomfort, have a persistent change in bowel habits, or show other signs/symptoms of IBS, please see your doctor. The first step of diagnosis is a medical history and a physical exam. Additionally, it’s important to pay close attention to your symptoms as your doctor will ask about them.

Treatment of irritable bowel syndrome (IBS)

There is no ‘one size fits all’ treatment for IBS, however most people can find a treatment that works for them. Moreover, doctors personalise treatment plans based on individual needs.

A few people with IBS suffer from significant symptoms. As a result, some people can manage them by using typical treatment options such as dietary and lifestyle changes. However, people who suffer from more significant symptoms may require counselling and medication.

Low FODMAP diet 

The role of food allergies and intolerances in IBS isn’t fully understood. Moreover, food allergies rarely cause IBS, however many people have worse symptoms when they eat or drink certain foods or beverages. This includes wheat, dairy, citrus, legumes and carbonated drinks.

The low FODMAP diet is part of the therapy used for those with IBS. In addition, research has found that it reduces symptoms in up to 86% of people.(5)

This therapy proposes single food avoidance and exclusion diets e.g. low fermentable oligo-saccharides, di- saccharides, monosaccharides and polyols. These are non-digestible small carbohydrates that force water into your digestive tract. Furthermore, because they’re non-digestible, gut bacteria ferment them, increasing gas and short-chain fatty acid production.(6) 

FODMAPs are found in a wide range of foods. Some foods contain just one type, while others contain several. Examples of foods that fall into the four groups of FODMAPs are:

• Oligo-saccharides: wheat, nuts, legumes, garlic, onion
• Di-saccharides: milk, yogurt, soft cheese, cream (foods containing lactose)
• Monosaccharides: apples, pears, watermelon, mango, honey, agave (foods containing fructose) 
• Polyols: cauliflower, stone fruits, mushrooms, peas (foods containing mannitol and sorbitol) (7) 

The total daily intake of FODMAPs in an average diet ranges from 15-30g per day. All FODMAPs are potential triggers. Fortunately, not all FODMAPs aggravate abdominal symptoms in a person with IBS.

To summarise, the low-FODMAP approach is not simply an exclusion diet. It is also a tool used to diagnose a person’s tolerance to certain foods. Therefore, this allows the individual to eliminate these foods from their diet and to make positive changes towards their lifestyle.

Related readings

• 11 delicious low FODMAP vegan recipes
• How to test for gluten intolerance

Exercise 

Exercise is an activity that enhances/maintains fitness, and overall health and wellbeing. In terms of health benefits, the amount of recommended exercise depends upon the goal, the type of exercise, and the age of the person. Even doing a small amount of exercise is healthier than doing none. The UK government recommends that adults take part in at least 150 minutes of moderate intensity physical activity each week, in bouts of 10 minutes or more. In addition, this should include a mixture of aerobic, flexibility and strength exercises. 

Scientists discovered that exercise decreases the severity of IBS symptoms. Moreover, less physical activity is associated with more severe symptoms.(8) 

Furthermore, symptoms such as impaired quality of life, depression and fatigue can accompany the GI symptoms. Exercise is used in medical care in both treatment and prevention of these. As an intervention exercise is manageable in a clinical setting in both primary and secondary care, with low costs and a low risk of potential harmful effects.(9) 

Scientists are still researching how exercise manages IBS symptoms, however it’s likely due to:

• Reduced stress: Exercise has a positive effect on stress. Additionally, stress triggers symptoms, which may be explained by the brain-gut connection.(10) 
• Improved sleep: Exercise has a positive effect on sleep. Moreover, a bad night’s sleep can trigger a flare up.(11) 
• Reduced bloating: Exercise may improve your body’s ability to get rid of gas. This decreases bloating, along with any associative pain and discomfort.(12) 
• Improved bowel movements: Exercise can promote bowel movements, which may ease symptoms.(13) 

Stretching 

Stretching is a form of exercise in which a specific muscle or tendon is deliberately flexed or stretched. It can also be used therapeutically to alleviate cramps and as a result, improve function in daily life by increasing range of motion. 

Furthermore, stretching can have a positive effect on symptoms of IBS. As a result, massaging digestive organs, reducing stress, and improving gas clearance, can help decrease pain and discomfort associated with IBS.

In particular, studies have looked at the effects of yoga on IBS. Although results indicated favourable changes in related physical and mental outcomes, data only supports yoga as beneficial in a small sample size. Therefore, the ability to make specific recommendations about the use of yoga as therapy for patients with IBS is limited.(14)

Sleep 

Sleep is a naturally recurring state of mind and body. It is the very thing we need to keep us going. 

A good night’s sleep is vital for our health. Therefore, not getting the recommended amount can raise a whole host of issues. Alarmingly, over 30% of adults report sleeping less than the recommended seven hours per night.(15) 

There is little research on the link between sleep and the GI system. However, IBS has been linked with lower sleep quality, reduced light sleep, and significant sleep disturbance.

Around 50% of people who have IBS suffer from sleeping disorders such as insomnia. Furthermore, poor sleep-quality may worsen symptoms the following day.(16) 

Unfortunately, the effects of poor sleep quality extend beyond the bowel. It can also lead to a worse mood and greater and greater somatic pain in individuals.(17)

While it’s unlikely that sleep will be the singular cause of IBS, it’s apparent that sleep can play a role. 

Vitamin D and sleep

Several studies have found that vitamin D receptors are expressed in brain areas that regulate sleep. Therefore, this indicates that vitamin D deficiency is associated with a higher risk of sleep disorders.(18) 

Even though the human body produces vitamin D when exposed to sunlight it does come with its limitations. Depending on where you live in the world, it may not be feasible to come by enough sunlight exposure all year round. Furthermore, exposure to the sun can increase the risk of developing skin cancer. 

Taking a supplement may be helpful for some people. However, at Erbology, we always advise you to obtain your nutrients from healthy whole foods rather than tablets or capsules. This is because you receive greater clarity over what you are consuming. You’re also likely to benefit from gaining a range of other healthy nutrients at the same time if you source your vitamin D from food.

For example, our Organic Hemp Seed Oil is a fantastic source. Furthermore, hemp is a low-FODMAP food. Try adding a spoonful to your daily routine to increase your intake. Its versatility means you could take it by the spoonful, use it in salad dressings, or even drizzle it over your favourite dishes.

Alternatively, our Organic Hemp Seed Powder also offers vitamin D, plus a dose of healthy plant-based protein and fibre. It’s ideal for adding into a post-workout smoothie or mixing into breads and cakes.

Despite biological plausibility, more trials need to be conducted to confirm the role of vitamin D in the prevention of sleep disorders.

Cognitive behavioural therapy 

Cognitive behavioural therapy (CBT) works by identifying and addressing how a person’s thoughts and behaviours interact. Therapists work with individuals to recognise how negative thought patterns can influence how a person feels. CBT aims to stop negative cycles such as these by breaking down things that make a person feel stressed or anxious. 

IBS is not a psychological disorder however it has come to be closely linked with both stress and anxiety. There’s a fine line between stress and anxiety. External triggers cause stress. The trigger can be short-term, such as a work deadline or long-term, such as being unable to work. Meanwhile, worries that don’t go away even in the absence of a stressor cause anxiety

Chronic stress or anxiety can cause an imbalance of the gut’s bacteria and trigger chemicals in the brain that turn on pain signals in the gut. Therefore the colon might react. Many people experience spikes in their stress levels just before they start reporting symptoms. 

Furthermore, research has shown promising results on the effectiveness of CBT, in improving symptoms and an individual’s quality of life with IBS. CBT for IBS usually involves teaching the individual specific strategies for calming the body, coping with unpleasant symptoms, and learning to face difficult situations. Although promising, longer-term follow-up and research are needed to translate these findings into usual clinical practice.(19) 

Living with irritable bowel syndrome (IBS)

Unfortunately there’s no cure for IBS. In addition, the goal of treatment is to control and manage symptoms. Managing symptoms of IBS can be frustrating, moreover it’s not uncommon for treatment to be trial and error. Fortunately, the majority of people can find a treatment that helps. 

In general, dietary and lifestyle changes improve symptoms over time. However, patience is key in identifying triggers, which you want to avoid. As a result, after a few weeks or months, significant improvement in how you feel should be noticeable.

Related readings

• What are the benefits of exercise on mental health?
• Anti-inflammatory diet: what foods to eat?