IBS, you motherfucker.
One in five people suffer from this not-so-subtle lifestyle-ruiner, which affects twice as many women as men and usually begins in your 20s or 30s.
My own elusive IBS – a combination of high-intensity stomach cramps, severe bloating, constipation, diarrhoea, and all the details in between – started around 25, just as my career took off, so I’ve always assumed it’s linked to stress. In the last five years, it’s come and gone with no identifiable dietary pattern, causing me all kinds of embarrassment, not to mention the pain, which has meant leaving nights out early, cancelling plans and frequently wincing at my desk.
Apart from grinning and bearing it, I’ve never really tried cutting out food groups as I’ve never identified any consistent culprits apart from stress, which, given the demands of my job, is not something I can eliminate. Given that a third of IBS sufferers will experience symptoms for the rest of their life, I realise I need a management plan that’s not ‘just deal with it’ when it comes and ‘forget about it’ until it returns. So I spoke to Dr. Naila Arebi, consultant gastroenterologist at St. Mark’s Institute for Bowel Disease, who specialises in IBS to find out why women are more susceptible than men, if there are certain foods or drinks that universally irritate the bowel, and how to manage symptoms brought on by stress.
Who suffers from IBS?
Mostly young women. It’s curious… There are lots of theories and hypotheses about it and one of those is that women internalise!
How do you define IBS?
IBS is a final destination diagnosis based on a series of symptoms. It’s a constellation of symptoms of which there must be pain, a change in bowel habits and some other manifestation of abnormal sensation such as bloating, urgency, feeling the need to open your bowels. The diagnosis is as easy as ABC: abdominal pain, bloating, change in bowel habits. There are other conditions that can give you this manifestation; if it’s diarrhoea then Coeliac disease is quite common. If it’s constipation, I’d want to asses if the muscles of the pelvic floor are working correctly. I wouldn’t do a colonoscopy in someone who is young but if someone is older – over 50 – then I might begin to check for ovarian cancer.
What’s the difference between bloating and IBS?
Bloating is a symptom – you feel your tummy is swollen but actually it might be flat. And it gets worse before your period.
Any foods universally known to irritate the bowel that I should avoid?
You want to identify whether there’s any specific intolerance, like Coeliac disease which is entirely treatable if you omit gluten. Or lactose intolerance – I’ve just diagnosed myself with that so I’ve stopped lactose and now I’m fine. Then fructose intolerance: sugars and some preservatives.
What about alcohol, fizzy drinks, and coffee?
There is nothing specifically related to alcohol. Beer is fermented barley so the fermentation in beer might make it worse [if you are intolerant to gluten] but I haven’t seen any conclusive studies. Possibly the sugar in the wine can irritate the bowel, but not necessarily the alcohol. Coffee and fizzy drinks have additives and sorbitol the sweetener, which can cause IBS symptoms. Coffee stimulates the gut.
How does IBS relate to stress?
I don’t think stress causes it but when you’re stressed, you feel the symptoms more or when you’re anxious, you might get an attack. For example, before I give a lecture, I might get an attack and there are people who are chronically stressed, which enhances the symptoms and makes you feel it much more. Constant, repetitive exposure to something that you feel threatened by – like constant deadlines at work, bereavement, conflicts in life, divorce – can exacerbate symptoms. Unfortunately, it’s often the things we have no control over.
How do you advise people manage it? It can be really painful and antisocial. Is there any quick-fix pain relief?
There’s anti spasmodic drugs – things like Buscopan or tablets that relax the muscles of the gut, like peppermint oil. Peppermint tea sometimes works, too.
When should you see your doctor?
There are red flag symptoms which you should always report: weight loss, blood in your stools, family history of bowel cancer.
Why do you think people are embarrassed to admit they have IBS? And how do you advise people to talk about it?
People are embarrassed not just because of the diarrhoea and constipation, but because everything ‘looks normal', they 'look normal', despite being in pain and often having severe symptoms – and a lot of patients who come with IBS symptoms say to me, "I’m anxious, I’m mad". I tell them that a lot of people have this problem, in fact it’s becoming more and more common. Some papers indicate that about a third of the population have some form of IBS, which is based on coding from GP surgeries.
Does IBS last forever?
For a third of people, it gets better and is resolved. For a third, it comes and goes. And for the remaining third, it’s chronic – these are people with anxiety disorders, depression, chronic stress. With education and addressing concerns and not dismissing people’s symptoms, I would say that the majority of people do get better or find a way of coping with it and getting on with life as normal.