An expert’s guide to living with IBS

“During a flare-up of IBS, I can suffer hours of uncontrollable diarrhoea, often through the night. The pain is terrible and all I can do is lie on my front with a hot water bottle,” says Sophie Taylor, 25, who was diagnosed with Irritable Bowel Syndrome (IBS) two years ago. 

“I also get severe flatulence and that is the worst… People laugh when I tell them, but it’s humiliating, and all I can think about is trying to stop it and the pain in my stomach. I’ve spent hours locked in the loo not knowing what to do.” 

Sophie has tried multiple IBS treatments including medications and supplements, but although dietary changes have eased some of her symptoms, she still suffers from regular and severe flare-ups. 

“The physical symptoms are bad, but the emotional side is the hardest to cope with – knowing that there isn’t a cure for IBS and having to find a way to manage this condition for the rest of my life,” she explains. 

Sophie’s story is far from rare: IBS is common and increasing, with The IBS Network* estimating that between 10-20 per cent of the UK population is currently living with the condition, equating to around 12 million people. Some believe numbers could be even higher as many either don’t seek treatment or find it hard to get a diagnosis. 

The often debilitating symptoms lead to the average IBS sufferer taking nine sick days a year; and sick days related to gut health are estimated to cost Britain’s businesses almost £3 billion annually, according to the IBS network. In a US survey, people with IBS reported missing an average of 13 days of work or school a year. 

Women are twice as likely to be affected and it can take up to three years to be diagnosed. It’s also a significant burden on the NHS as people with IBS visit their GPs six times more frequently a year than those who don’t have the condition. Unfortunately, there is currently no cure, but there are treatments to help manage the condition. 

Here’s everything you need to know.

What exactly is IBS?

IBS is a disorder of the digestive system or gut, with a cluster of symptoms including stomach pain, bloating, flatulence, diarrhoea and constipation. While for some people it’s mild, for others it’s life-changing, affecting their ability to hold down a job, often leading to insecurity about their body, isolation and issues around food. 

Even though there is no known cure, understanding of the condition has progressed rapidly in recent years. IBS used to be thought of as a purely functional disorder of the intestines. However, since the 1970s years of research by the Rome Foundation and others has led to the recent breakthrough that indicates IBS is a problem linked to how the brain and the gut talk to each other. 

“In the past five years our understanding of IBS has really progressed,” says Dr Megan Rossi, a dietitian, the founder of the Gut Health Clinic and a research fellow at King’s College London. “We now know it’s a disorder of gut-brain communication. The brain and the gut are constantly talking to each other and in people with IBS, that connection becomes dysfunctional. This is expressed by an overly sensitive intestine, and as a result, there is an exaggerated response to various things, including hormones and food. This also explains why most people find their symptoms get worse with poor sleep and stress.” 

What are the causes of IBS?

One of the complexities of IBS is that there can be many causes, with multiple factors at play. Dr Will Bulsiewicz is a gastroenterologist, gut-health expert, bestselling author and medical director of the health app, Zoe.

“There are multiple triggers for IBS, and many different paths can lead you to the same place,” he says. “The classic one is an infection or food poisoning. It can also be triggered by stress, a history of trauma and abuse, or it could be lifestyle-related, where a certain pattern catches up with you eventually. That’s often connected to the Western lifestyle – an ultra-processed diet, not enough fibre, being sedentary and disruption to sleep and circadian rhymes from our devices.” 

The main symptoms of IBS

The most common include stomach pain, constipation, diarrhoea, hard stools, bloating and flatulence. Less common symptoms include acid reflux, a gurgling tummy, nausea, headaches, fatigue and immune system issues.

Often the pain doesn’t respond to normal treatments. Claire Irvin, who has struggled with IBS, says: “I felt constantly cowed by the pain – if I could have spent all day doubled up, I would have. I’d spend work meetings trying not to be distracted by stomach cramps and have to take ‘a moment’ away from my desk several times a day.”

Dr Bulsiewicz explains: “It’s a condition that exists on a spectrum. Some people have mild symptoms and aren’t even diagnosed; at the extreme end it destroys your quality of life. It’s not life-threatening, but people have erratic bowel habits, incontinence and urgency, and they can isolate themselves or start to fear food.” 

Women and men are affected differently

Experts think that the reason IBS affects more women than men may be due to their changing hormones, which impact the gut and make it more sensitive. However, Dr Rossi believes that men may be less likely to visit their doctors for IBS, so there may be more male sufferers than the present figures suggest.

“I see predominantly women in my clinic with this issue,” notes Dr Bulsiewicz. “Generally, women are more prone to constipation as a manifestation of their IBS and men are more likely to have diarrhoea. The fluctuations of hormones during women’s monthly cycles are certainly a factor.”

Health app Zoe did a study called the Big Poo Review, and found that out of a random sample of 142,000 people, 23 per cent of women were likely to have constipation versus 13 per cent of men, whereas 18 per cent of men have diarrhoea, compared to 15 per cent of women. 

The foods to avoid 

The first step in tackling IBS is trying some tweaks to your diet. “I would start by reducing caffeine as it can increase diarrhoea, being careful around spicy and fatty food, which can trigger symptoms, as well as not eating too much fruit in one sitting as the fructose can also worsen symptoms,” says Dr Rossi. “Then I would recommend distributing your fibre more evenly across the day to avoid increasing diarrhoea and constipation. Try chickpeas and lentils, but also oats, and even selenium husk, a supplement that is a rich source in fibre, which I use for people with constipation.”

Some people find that they get relief from cutting out gluten, but, if this is the case, it’s important to get a test for coeliac disease, which is an immune disorder where gluten can’t be digested. 

If coeliac is ruled out, then it is unlikely to be the gluten irritating your gut, but the fructans in the gluten, which is a FODMAP – a type of carbohydrate also found in wheat, garlic, onion, chickpeas and butterbeans, milk, some fruits and low-calorie sweeteners, which can exacerbate IBS symptoms. 

These foods are restricted in the FODMAP Diet which was first developed in Australia and is backed by extensive research, with success seen in around 70 per cent of people.

“For people with severe IBS, we suggest trying the FODMAP Diet for four to six weeks where you cut out all the FODMAP foods, then slowly reintroduce them back into your diet as otherwise it could do damage to your gut bacteria,” explains Dr Rossi. 

The goal of the diet is to work out which FODMAPs are triggering your IBS. It is very important not to cut out all the FODMAPs long term as many of these are very beneficial for gut bacteria. The goal of the diet is to discover your triggers, remove them and then ideally gradually re-introduce if you can or if not, at least keep some of the others as they provide beneficial bacteria for your gut.

Managing IBS effectively

Making changes to your diet is usually the first step in managing IBS whether that be small tweaks or trying the FODMAP elimination diet. 

If dietary changes aren’t effective, there are a number of different treatments to try. 

“Firstly we need to look at what kind of IBS it is because there are slightly different approaches to constipation and diarrhoea,” says Dr Bulsiewicz. “I try introducing more fibre because fibre is the only thing that exists that can improve both diarrhoea and constipation, but sometimes fibre is not enough. For constipation, I’ve had amazing success with magnesium supplementation, but do this with your doctor as you need the right type of magnesium.” 

He also recommends peppermint oil, taken in a delayed-release capsule. “It’s fantastic for IBS. It helps soothe the intestines in the same way that menthol cools your mouth, and there’s overwhelming evidence that this works.” 

Antidepressants given in very low doses have also proved effective at managing the gut-brain connection, explains Dr Bulsiewicz. “One of the things that happens when people have IBS is that the brain misinterprets the nerves in your gut, they think that something is causing pain when it is not, something which a person without IBS wouldn’t experience as pain.” 

SSRI (selective serotonin reuptake inhibitors) antidepressants such as Prozac and Sertraline can help to calm the nerves in your gut by boosting the feel-good hormone serotonin (around 95 per cent of serotonin is produced in the gut), and also help to stimulate movement in your gut if constipation is the issue. For diarrhoea-based IBS, older-style tricyclic antidepressants (TCAs) are more commonly used.

Early-stage research has shown that faecal transplants can be effective. This is where stool samples from healthy donors are transplanted directly into the colon of an individual with IBS, the idea being that the healthy gut bacteria will begin fighting off bugs causing distress or infection. The treatment is now available at some private clinics. However, Dr Rossi advises against it for now. “Animal studies are suggesting that you could also transfer depression and anxiety via the gut bacteria, so it’s too risky to recommend at the moment; in the future it could help,” she says. 

Mitigating stress can really help 

Stress is intimately linked to IBS and is often a trigger for a flare-up. “Mitigating stress can really help; of course, it sounds simple, but it’s hard to do. We live stressful lives, and often there is stress in the subconscious and we don’t realise it’s there. We suppress it and it shows up in our guts,” says Dr Rossi. 

She suggests daily “gut-brain axis work” such as 10 minutes of mindfulness every day, and not just doing it when you get a flare-up. Research shows that deep belly breathing is also effective, particularly when done five minutes before a meal, for desensitising gut nerves. 

Hypnotherapy is also a recognised treatment for stress and anxiety, as is cognitive behavioural therapy (CBT). “Some people may have had an occasion where they soiled themselves and they’re scared to leave the house and they’re fixated on those thoughts, CBT can really help with managing those thoughts,” says Dr Rossi. 

It’s also worth talking about and being open about your condition. Sophie Taylor says: “I know people with IBS who have had to quit jobs because of the nature of the role. I couldn’t work in a restaurant for example, where I’d be on my feet all day.” 

Dr Bulsiewicz is most proud of his success with patients who have IBS and a history of trauma. “The issue for these people is that they can do everything right, but they are still not better,” he says. “But if they bring their attention to the gut-brain axis and the thing that happened 20 or 30 years ago, they can get better so much faster. They may think their trauma is not relevant, but their subconscious has not forgotten.”

In the meantime, Sophie is still searching for effective treatments and is planning to focus more on mindfulness and stress reduction. “I would say to anyone suffering, please go to your GP and seek support from The IBS Network. You are not alone in suffering from this debilitating condition.”

* The IBS Network supports people living with IBS as they learn to self-manage this long-term condition. Call: 0114 272 3253, Mon-Fri 9am-4.30pm. Email: info@theibsnetwork.org