Irritable bowel syndrome fact from fiction
Irritable bowel syndrome: Separating fact from fiction
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In the days before her wedding, the last thing a bride needs is diarrhoea so extreme she almost faints on the toilet.
In early 2011, Sofia* was planning a wedding and starting a business in the wake of the Christchurch earthquakes. The then 23-year-old hairdresser had suffered tummy troubles for years, thinking it normal to feel ill after meals.
But with unprecedented stress levels, she was rushing to the bathroom within minutes of eating.
“It would come through so quick that my body couldn’t keep up with it,” she recalls.
“I would break into a hot sweat, and my consciousness would waver.”
The bride-to-be lost 12 kilograms in five months.
“I was getting really scared at how much I was losing.
“At the time I was like oh, I might look nice in my dress, but this is horrible.”
She was tested for bowel cancer, Coeliac’s and Crohn’s diseases. When the tests returned clear, Sofia was diagnosed with irritable bowel syndrome.
The condition, known as IBS, affects one in six women and one in nine men in New Zealand.
Professor Richard Gearry, a consultant gastroenterologist at Christchurch Hospital, says IBS differs from the less common inflammatory bowel disease (IBD). The two types of IBD – ulcerative colitis and Crohn’s disease – affects about one in 500 Kiwis.
While people with IBD have inflamed gastrointestinal tracts, IBS is diagnosed in people whose bowels look normal but suffer ongoing pain, gas and a change in bowel habits, including diarrhoea and constipation.
“The two get mixed up all the time”, Gearry says.
“The way I describe IBS to patients is, it’s like their bowel is hypersensitive.”
“Anything that stirs the bowel up will be much more profound in people with the condition.”
For Sofia, stress combined with dairy – especially butter – other fatty foods, gluten and coffee, triggered the worst reactions, as did some fructan-rich foods, such as garlic and onions.
Gearry says while IBS isn’t fatal, “the unpleasant symptoms can really affect a sufferer’s quality of life”.
Those with the condition miss work and visit their GPs three times more often that the general population.
Sofia would often limit her food intake to avoid discomfort, which she describes as “sharp, knife-like pains… like you’ve been punched in the stomach”.
“You knew if you got the knife jab, you didn’t have long – you needed to run,” she says.
“I knew where bathrooms were at all times.”
Gearry says the gut’s intimate relationship with the brain, known as the “gut-brain axis”, is a primary source of gut problems.
“We know that when people get stressed or worried they get symptoms through their whole body.
“It might might be a slight tremor, or feeling sweaty. In the same regard, the gut can be a major target for stress.”
Unsurprisingly, diet can also have a major effect on gut symptoms.
Research has shown eliminating the group of carbohydrates known as FODMAPs – including fructose, lactose, fructans, and carbohydrates found in legumes, artificial sweeteners, and stone fruits – helps about 75 per cent of IBS sufferers.
Gearry says it is the only diet he is aware of, among thousands that purport to control gut symptoms, that has high quality data to support its use.
“We suggest seeing a dietician who’s an expert at the diet – it’s quite a difficult one to teach,” Gearry says.
“They generally implement the diet quite strictly at the start and after six weeks, begin to reintroduce some foods.”
Gearry says ongoing dietary manipulation is usually required to keep IBS symptoms at bay, but there’s no long-term health risks in straying from a low FODMAPs diet.
Medications can be used to treat constipation, diarrhoea, and stomach cramps, and occasionally anti-depressants are prescribed to modulate the gut-brain interaction.
However, Gearry says, “most people with IBS don’t want to take drugs”.
“And to be honest, most of the drugs we have for IBS aren’t as successful as we would like.”
Gearry says many IBS sufferers self-diagnose.
“That’s probably ok, except if they’re missing something that’s more serious.”
Weight loss, bleeding and stomach pain at night would require further investigation.
“My bottom line would be if you have symptoms discuss them with your GP.
“They’re very, very good at working out who needs to be referred on, and who doesn’t.”
There is no cure for IBS. Medications can be used to treat constipation, diarrhoea, and stomach cramps, and occasionally anti-depressants are prescribed to modulate the gut-brain interaction.
Patients can better manage their symptoms with diet, relaxation techniques, and by avoiding gut infections.
Gearry says usually, people readily identify their IBS triggers.
“They go, oh it’s all about stress or, it’s all about diet, I’ve got no stress problems.”
Gearry advises patients to manage stressors using “whatever works”.
“Every individual will relax in a different way – some people exercise, some people do meditation – I don’t think it really matters … But if people find that there’s a link between stress and their gut, then they need to have methods of dealing with that.”
Sofia managed her IBS by eliminating triggering foods from her diet. And when her business was up and running, and her wedding was over, she found her symptoms eased.
“I still kept most of the diet similar, but it wasn’t as extreme,” Sofia says.
It’s five years since Sofia’s IBS first flared up. Now pregnant with her second child, the symptoms have returned. Once again, she’s foregoing her favourite chocolate milk.
Sofia knows it’s not forever, though.
“If I’m really relaxed and not pregnant then I’m actually fine,” she says.
“But when I’m stressed, or really busy, or something’s going on with my body in other ways, then I tend to have to pull back.”
“I wouldn’t say my IBS dictates my entire life, just certain seasons of it.”
*Not her real name