What you May Not Know About IBS
Written by Colleen MacKay, RD
Edited by Brooke Bulloch, RD
Irritable Bowel Syndrome, or IBS, is a very common diagnosis that can affect people of all ages. It is estimated that 13-20% of Canadians live with IBS. Despite this massive prevalence, there is a lot that people don’t know about the condition nor how to manage symptoms. Some of the most common questions I get are: “what is causing my symptoms?” and “how can I improve my quality of life?”. In this blog post, I’m going to answer some common questions related to IBS.
What exactly is IBS?
IBS is a functional gut disorder, meaning that the gut (stomach, small intestine and/or large intestine) is not functioning properly. So even though a gastroscopy won’t show inflammation, ulcers, or structural issues (that would be seen in people with celiac disease, Crohn’s or colitis), people with IBS experience real symptoms including pain, cramping, bloating and distension, gas, and diarrhea and/or constipation on a regular basis.
Does IBS increase my risk for other health issues?
An important distinction between IBS and other bowel diseases is that IBS is not inflammatory and does not come with increased risk of colorectal cancer or surgery, nor does it decrease life expectancy. While IBS does not cause inflammation or come with these increased risks, it most certainly affects an individual’s quality of life. People with IBS may experience absences from work/school, and often struggle with self-blame, guilt, anger, and social isolation.
What causes IBS symptoms?
Let’s start out with a simplified overview of “normal” digestion in a body that is functioning properly. After a food is eaten, it will move through all parts of the digestive system - mouth, esophagus, stomach, small intestine, and large intestine – being broken down along the way. This is done through motion (chewing, squeezing and mixing) and the action of digestive juices (enzymes, stomach acid and bile). Bacteria in the large intestine also help with digestion. As food is broken down, nutrients that the body needs are extracted and absorbed into the bloodstream, and the waste left behind will result in a bowel movement. This whole process is controlled by hormones and nerves that communicate not only within the gut but also back and forth along the gut-brain-axis.
In the body of someone with IBS, something about this process is not working correctly. Two of the more common disruptions relate to issues breaking down certain types of foods (FODMAP-containing foods), and/or an oversensitive, overreactive gut (called visceral hypersensitivity).
I have heard about FODMAPs. But what are they and how do they trigger my symptoms?
Research investigating the relationship between diet and IBS has focused on FODMAPs - fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are specific types of carbohydrates and sugar alcohols that, in people with IBS, are poorly absorbed in the small intestine, and are fermented by bacteria in the large intestine. FODMAPs can be an issue because they can pull extra water into the small intestine (leading to diarrhea and cramping), and are fermented in the large intestine (leading to excess gas production, distention, and pain). Decreasing the intake of high FODMAP foods may decrease IBS symptoms.
People are often surprised to hear that many high FODMAP foods are nourishing foods that people include in their everyday diet. This does not mean that these foods are “bad” for you, it just means that your body is having trouble breaking them down, triggering some pretty awful symptoms as a side effect.
The low FODMAP diet is a therapeutic diet and should be trialed under the supervision of an experienced dietitian. (Read more about the low FODMAP diet HERE).
Okay, so what is visceral hypersensitivity and how do I know if I have it?
Visceral hypersensitivity (VH) is a complex interaction between the nerves of the gut and the nerves in the brain (often referred to as the gut-brain-axis). It is defined as experiencing pain in the inner organs (viscera) at a higher level than what would be considered normal. In other words, people with visceral hypersensitivity have a more sensitive digestive system that reacts more strongly to the extra pressure put on the bowel by the gas produced during digestion.
While the stimulation of digestion should not be painful, in IBS, the oversensitive nerves of the gut overreact and send signals to the brain that something is wrong. This can result in the brain producing the sensation of pain, cramping and even bloating. The brain may then tell the bowel to change the speed of contraction, resulting in either diarrhea or constipation (or both!). It is unknown why exactly some people have a more sensitive gut, but one theory is that hypersensitivity can start after the gut is irritated by a virus, illness or injury.
VH is a new diagnosis and we don’t know how common it is. There is no set diagnostic criteria for VH, but it is often diagnosed by observing symptoms and then ruling out structural causes for them.
I‘ve heard that my IBS is “in my head” and caused by stress. Is this true?
Because of the link between the gut and the brain, it is a common misconception that mental health conditions such as stress, anxiety and depression are causes of IBS. If unmanaged, these conditions may trigger or worsen IBS symptoms. Therefore, it is important to consider whether mental health may be impacting symptoms and treat as needed.
What can I do next?
There are many factors that may cause IBS symptoms, and because of this there are many different treatment options available. These may include:
- Diet and lifestyle options such as the low FODMAP diet phases
- Nutritional supplements
- Herbal remedies
- Psychological therapies (cognitive behavioural therapy or hypnotherapy)
No single plan is going to be perfect for everyone, and typically a combination of treatment options will help with symptom relief. If you are interested in navigating your IBS symptoms, your triggers, dietary treatment options, and long-term management of IBS, connect with me here to learn more or to book an initial consultation.