Q&A on irritable bowel syndrome (IBS) with Buscopan
Experts from Buscopan IBS Relief answer your questions about coping with IBS, including practical tips and advice to help you take back control of your health.
IBS affects around one in three people and can have a big impact on the life of people affected. But there are a range of tips and techniques that can help people with IBS manage their symptoms. By getting to know your triggers, and with the right treatment, it's definitely possible to get your IBS under control.
Panel of experts
Helen Bond, consultant state registered dietitian
Helen is one of the UK's leading dietitians, with over 17 years experience in food, diet and health. She has a degree in dietetics from Queen Margaret University. Helen is passionate about food, home cooking and the positive impact it can have on people's health, but she is also a realist. Her philosophy is to provide nutrition advice based on sound science, yet is practical, simple and realistic for today's busy
Dr Anton Emmanuel, consultant gastroenterologist at University College Hospital
Anton is a senior lecturer in neuro-gastroenterology at University College London and consultant gastroenterologist at University College Hospital and the National Hospital for Neurology and Neurosurgery (Queen Square).
Nicola is a 30-year-old office manager from Brighton. She was first diagnosed with IBS 16 years ago. She has compiled a range of strategies to help her stay in control of the condition.
Q. Openerofjars: I've been told by my GP that my symptoms (diarrhoea, constipation, one-sided abdominal pain) are probably IBS, but what do I do next? I have been advised to try Fybogel and peppermint oil capsules, but was given no other information.
A. Anton: It is important to first have a positive diagnosis - whether this needs investigation or not depends on your GP's assessment of your case.
Your symptoms are compatible with IBS, among other diagnoses, and your GP who has seen you at first hand is in a better position to assess whether this is IBS or not.
If your symptoms are of infrequent emptying, then fibre supplementation can help. If peppermint oil capsules do not work for you, there are other antispasmodics medicines available, so ask your GP or pharmacist for further advice. You can also find out more by visiting www.ibs-relief.co.uk.
A diet, stress management and lifestyle approach can also be very helpful for many patients. Having a better understanding of one's gut and the triggers to symptoms, is critical to improving symptom burden.
The pain of IBS is caused by muscle spasms in the bowel. Buscopan IBS Relief is an antispasmodic treatment, which helps relax these spasms to quickly and effectively help relieve the pain and discomfort of IBS.
Buscopan IBS Relief works differently to regular painkillers as it targets the spasms, the root cause of abdominal pain in IBS, and its fast action quickly helps calm the spasm and allows the digestive process to return to normal.*
For further information and advice on IBS, to try our free IBS diary app and to download a Managing IBS Better Together booklet, visit www.ibs-relief.co.uk.
Q. Sparkle9: I've felt fairly certain that I have IBS due to an urgency to go to the toilet, terrible stomach cramps, awful flatulence etc. I seem to be badly affected when I eat too much dairy - especially ice-cream or creamy pasta dishes and when I drink alcohol. Are these common triggers?
Is there any point in seeing my GP? Other posters seem to suggest this is a pointless exercise. Can IBS worsen over time? Does IBS after TTC/conception or pregnancy? Could IBS be a symptom of another problem? I ask as someone who is now being referred to an infertility clinic due to a short luteal phase and I'm just curious.
A. Anton: The dietary triggers you describe are typical - dairy, yeast and wheat are the commonest things. The effect of pregnancy and breastfeeding is described by some individuals, but there is no medical consensus on how this may arise. It is probably not just a hormonal effect but may relate to environmental and dietary changes that occur during pregnancy and breastfeeding.
It is important to get an assessment of the gut, at least once. IBS can be difficult to treat, as symptoms and triggers can vary but it is important to be assessed to make sure there is no other condition present, since the symptoms of gut illnesses often closely overlap.
Q. Reastie: I have IBS and gluten intolerance, diagnosed by a gastrointerologist. I find that I have to eat meals/snacks regularly or the hunger somehow can cause an IBS attack. If I'm too busy to eat, I get an awful painful, bloated tummy. Is there anything I can do to stop this happening - other than eating, obviously. I tend to find starchy foods like oats/muesli work the best when I get this type of pain and bloating but I have no idea why.
A. Helen: You are absolutely spot on - one of the key treatments for managing IBS symptoms is to ensure that you are eating regularly, taking time to eat without rushing, not skipping meals or leaving long gaps between eating. Establishing a regular eating pattern and making sure you have lots of healthy snacks when you are in the office or out and about, can help keep your hunger and IBS symptoms at bay.
Lactose can sometimes cause wind and bloating and IBS-type symptoms. It may be useful having a trial using lactose-free cows' milk, yogurts, cream and cheeses instead of ordinary versions for two to four weeks. Using these products will help maintain your calcium intake.
If it makes no difference, then return to using ordinary milk and dairy products.
Q. Tillyo: I've had IBS for just over five years now. I want to diet as I need to lose a lot of weight but find anything high in fibre sets off my IBS badly. Too much fruit and veg can leave me in bed for days. What's the best way to get round this?
A. Helen: The only way to shed the pounds is to take in fewer calories than you use up, so that your body draws on its fat stores to supply it with enough energy. Cutting your calorie intake by just 500kcal a day should help you lose 1lb (0.5kg) a week.
For example, women should lose weight each week on 1,500kcal and men on 2,000kcal. If you're also more active (which also helps relieve stress and stimulate healthy contractions in your intestines) you can expect it to be a little more.
IBS can be an extremely frustrating condition, as the types of low-energy density foods are the very foods that seem to trigger off IBS symptoms. Low-energy density foods are things like fruits and vegetables and high-fibre foods that provide less energy per gram of food, so you can eat more of them without consuming too many calories.
I would recommend asking your GP for a referral to a dietitian, who will be familiar with your medical and diet history, weight and body composition measurements. He/she could work with you to look at your portion control, advise on fruits and vegetables and a fibre tolerance level to ensure your insides work well. A dietitian would also ensure your energy levels remain topped up throughout the day and that you have a balance of foods, including low-fat and protein-rich foods that will help keep your hunger at bay.
A. Helen: I am afraid I am not able to give you definitive answers to your questions. What I can tell you is that certain people with IBS do find that one or more individual foods can trigger IBS symptoms, such as cramps and nausea or make symptoms worse (a food intolerance or food sensitivity).
If you believe a food is causing your symptoms, it may be worth discussing this with your doctor who may refer you to a state-registered dietitian. A dietitian may be able to advise on an elimination diet, then guide you on reintroducing different foods gradually to your diet to see if any cause the symptoms. It may be possible to identify one or more foods that cause symptoms.
This can be a tedious process, and often no problem food is found. However, some people say that they have identified one or more foods that cause symptoms. Then they can control symptoms by not eating them.
It may help for you to keep a food and lifestyle diary to monitor your symptoms and activities. Note down everything that you eat and drink, times that you were stressed, and when you took any formal exercise.
This may identify triggers, such as a food or ingredients like garlic and onion, alcohol, or emotional stresses, and will show if exercise helps to ease or to prevent symptoms. You can download a free IBS Food Diary App from www.ibs-relief.co.uk. Good luck.
Q. Dolallytats: I have had IBS for several years now. It is a huge contributor to me getting panic attacks and becoming agoraphobic. I have always wondered why I can eat a food sometimes but get an IBS attack from it at other times. It makes things very confusing. Also, there are things I can eat separately but not together, eg I can eat mince beef with separate potatoes and veg, but can't eat a cottage pie. Do you know why that might be?
A. Helen: I am sorry to hear of your troubles but I do hope that you can take some comfort in the fact that you are not alone. One in three people are affected by IBS and, as illustrated by this Mumsnet Q&A, many of those affected are puzzled by their condition - the very nature of IBS is confusing.
IBS is a journey of discovery: understanding your condition and learning how your lifestyle and diet can affect your symptoms is key. Look upon your gut as your alarm signal. If it goes off, ask yourself why? This will help you work with your gut, not against it.
Certain people with IBS do find that one or more individual foods can trigger IBS symptoms or make their symptoms worse (a food intolerance or food sensitivity).
They are not necessarily specific to one particular food group. Most people have a flare-up of symptoms that lasts two to four days.
Stress can also play a bit part in triggering IBS, which may be one of the reasons that you can eat a particular food one day but not the next.
It may help for you to keep a food and lifestyle diary, to monitor your symptoms and activities. Note down everything that you eat and drink, times that you were stressed and when you took any formal exercise. This may identify triggers, such as a food or ingredients like garlic and onion, alcohol, or emotional stresses, and may show if exercise helps to ease or to prevent symptoms.
You can download a free IBS Food Diary App from www.ibs-relief.co.uk.
Triggers and changes to IBS
Q. Turkeyboots: How do I learn what sets off my IBS? How long from eating does it take for the pain to start? Is it two minutes, two hours or 20 hours? As I don't know this, I can't figure out what is causing the problems.
A. Helen: True food allergies, which cause an immediate reaction to a small amount of food, are rare and are unlikely to cause IBS symptoms. However, they could be caused by food intolerances. The onset of food intolerance symptoms is usually slower and may be delayed by many hours after eating the offending food. The symptoms may also last for several hours, even into the next day and sometimes longer.
To complicate matters further, an intolerance to several foods or a group of foods is not uncommon. More so, some people can tolerate a reasonable amount of the food but if they eat too much (or too often) they get symptoms because their body cannot tolerate unlimited amounts.
The gold standard method for identifying food intolerance is still the elimination and challenge diet. This is where the suspected food or foods are cut out from your diet for a given period of time and replaced with suitable alternatives. If you are going to follow this method, make sure you do it under medical supervision.
If your symptoms improve, you gradually reintroduce the food back into your diet (one by one) to try to unmask the food trigger(s). Another way to discover which foods might be causing your IBS symptoms is to keep a detailed food and symptom diary (see previous answer). You can download a free IBS food diary app from www.ibs-relief.co.uk
Q. Toffi: I'm wondering if stress/anxiety levels can set off bouts of IBS? I can't seem to figure out any particular foods that trigger it and attacks seem random. Although I know to avoid red wine because on the rare occasions I get to have a glass or two, that does seems to be a trigger. Also, I'm wondering if cooking oils/fats etc can possibly be a trigger to a bout of IBS?
A. Helen: Work, relationships, finances, traffic jams and supermarket queues - there is no end to the list of scenarios that cause stress in our lives. These feeling are normally shortlived. In some instances they can even be useful - a degree of pressure keeps us interested in life and helps get things done.
When stress becomes a more regular feature in our daily lives, it can start to take its toll on our digestive and overall health. According to NHS Choices, intense emotional states such as stress and anxiety can trigger chemical changes that interfere with the normal workings of the digestive system. This does not just happen in people with IBS. Many people who have never had IBS before can have a sudden change in bowel habits when faced with a stressful situation, such as an important exam, driving test or job interview.
Finding ways to manage stressful situations is an important part of treating your IBS. Some ways to help relieve stress include:
- Relaxation techniques, ie meditation
- Physical activities ie yoga, pilates or tai chi (where deep breathing and relaxation is combined with slow and gentle movements)
- Regular exercise is also a good way to help reduce daily stress.
If you are particularly stressed and dietary and medical treatments have not helped your symptoms after a year of treatment, your GP may advise on hypnotherapy, psychological therapy or cognitive behavioural therapy (CBT).
With regards to trigger foods, the best way to discover which foods might be causing your IBS symptoms is to keep a detailed food and symptom diary (see previous answers). Alcohol, together with rich, fatty foods, including cooking oils and spreads, are all common triggers for IBS symptoms.
Q. Suddengeekgirl: Why has my IBS-diarrhoea changed to IBS-constipation after 12+ years? I knew how to handle IBS-d, now I'm back to square one.
A. Anton: It may be of little consolation to you, but this switching between types of IBS is relatively unusual. The first question is, why has it changed? And the second is, what to do about it?
As to why it has changed, it seems as if some individuals have a system which is more volatile in terms of nerve and muscle function in the gut. This is just the way your gut behaves and means you may be vulnerable to it changing back.
What can you do about it: diet is the first thing to try, perhaps try to optimise intake of soluble (non-cereal) fibre to help relieve constipation. Then you should identify any environmental triggers that make your symptoms worse (especially if pain is a feature). Speak to your GP about an appropriate laxative to use to help with your constipation symtoms if diet does not work for you.
Pelvic floor retraining and hypnotherapy also have a distinct role in IBS-c for some people.
Q. Girliefriend: I had terrible IBS when I was 18 and it had a huge detrimental affect on my mental health to the point that I became very anxious all the time and more or less agrophobic. It was an awful time, but somehow I managed to get myself better, was fine for about 10 years and then it started again. Why?
I keep off milk, as that does help, but I would struggle to find enough to eat if I cut out wheat. I find too much fruit or veg sets me off as well.
Also, even small amounts of stress are not good. I have to rein in obsessive thoughts about 'will there be toilets' as I don't want this to take over my life. I have lost track of how many times I have had to grab my daughter's hand and shouted 'run' as we pegged it to the nearest loo - poor kid.
A. Anton: An increase and decrease in the severity and frequency of IBS symptoms does happen as part of the natural history of the condition in some patients. On the positive side, it is likely that lifestyle modification and self-help, which helped you last time round, will do so again.
As for diet, it is important to not exclude too many items. It is sometimes very helpful to get formal help from a dietitian, especially if there is a risk of becoming too avoidant of whole categories of nutrients.
Toilet phobia and agoraphobia are important co-factors, and can be very amenable to simple psychological help such as counselling, alongside the self-help measures you are undertaking. I am sorry to hear of the intensity of your symptoms, and hope things improve for you soon.
A. Helen: There is no clear-cut cause of IBS, which is simply a set of symptoms that indicate that your colon is irritated and is not functioning properly. As you have sadly experienced, IBS symptoms can affect your overall quality of life, both physically and mentally and they can come and go without explanation for weeks, months and even years on end.
In the UK, about one in 10 people with IBS have lactose intolerance (the main sugar in milk) which can cause wind and bloating and diarrhoea but lactose avoidance rarely cures IBS. As a health professional, it worries me when a major food group, like milk and dairy foods, is potentially removed from the diet, without guidance from a health professional. You may be missing out on vital nutrients like bone-strengthening calcium and putting yourself at risk of other nutritional deficiencies, if you are not replacing them with suitable replacements like calcium-enriched rice milk.
Wheat is one of the most common food intolerances in the UK, but before removing this valuable food from your diet and limiting your food choices, I would strongly recommend asking your GP for a referral to a dietitian.
He or she could work with you closely to try and identify if wheat is actually triggering your IBS symptoms. If it is, they are in the best position to advise you on suitable alternatives to ensure that your diet is nutritionally complete.
Effect of pregnancy, caesareans and breastfeeding on IBS
Q. TerrorTremor: Can IBS be worsened by pregnancy or a c-section? Pre-pregnancy, my IBS wasn't too bad, but it has been playing up a lot post-pregnancy. I gave birth six months ago.
A. Anton: The onset of IBS symptoms may follow the trauma of operations, such as a c-sections, and onset after pregnancy is also described. In addition, the lifestyle changes that occur after the birth of a child may influence the stresses on the gut.
A. Helen: Firstly, many congratulations on your new baby.
IBS is very unpredictable. You may go for many months without any symptoms and then have a sudden flare-up. It can also take many months for symptoms to settle down. Some people do find that being pregnant makes their IBS symptoms disappear but, for others, their symptoms may become worse during pregnancy or after a caesarean or other invasive abdominal surgery. At present, it is not understood exactly why.
What we do know is that intense emotional states, such as stress, can trigger chemical changes that interfere with the normal workings of the digestive system. It can become a bit of a vicious cycle - if you're more stressed you will get more IBS symptoms and if you get more symptoms, you will get more stressed.
Having a baby is so exciting, but equally bringing a new life into the world involves huge changes to both your body and mind, which can be immensely stressful and could unsettle your insides.
Just as life's daily stresses can change from moment to moment according to what is happening or what you are thinking, so can your sensitive gut. Being aware that you are stressed is one of the first steps towards dealing with it and in turn may help lower the frequency and severity of your IBS symptoms.
Some ways to help you relieve stress include:
- Rest when you can. Sleep deprivation will make your day harder to cope with, so try to catch up on sleep during your baby's daytime naps. If you can't nod off, why not make yourself a hot milky drink and curl up on the sofa.
- Relaxation techniques, such as meditation or breathing exercises that you learned at antenatal classes.
- Physical activities, such as yoga, pilates or tai chi (where deep breathing and relaxation is combined with slow and gentle movements)
- Regular exercise, such as short walks, swimming etc are good for your physical and mental wellbeing, and can give you more energy. Exercise triggers the release of endorphins, your body's feel-good chemicals. Over time, you can build up your exercise regime, but wait until you have had the go ahead from your doctor before you start more strenuous exercise. Why not find out if there are any postnatal exercise groups, aqua aerobics sessions or yoga classes in your area? Remember to tell the instructor that you have just had a baby.
- Make time for yourself. Ask a trusted friend or relative to sit with your baby so you get some time off. You could swap babysitting duties with other mums for short spells. Remember, taking care of yourself is an essential part of taking care of your baby and your insides.
Q. Ugglyboots: Why does my IBS go when I'm pregnant or breastfeeding? I've only ever seen a GP once (15 years ago) about my IBS and have never been formally diagnosed. He just suspected IBS and told me to try avoiding certain food groups. I now avoid wheat and diary. Is it important to have tests to diagnose it properly and to put a healthy diet in place?
Furthermore, why does IBS come about as a result of food poisoning (as in my case)? Does it ever wear off/get better?
A. Anton: The effect of pregnancy and breastfeeding is described by some individuals but there is no medical consensus on how this may arise. It is probably not just a hormonal effect but may relate to environmental and dietary changes that occur during pregnancy and breastfeeding.
The testing is important to exclude other diseases that can mimic the symptoms of IBS - this is done by clinical examination, blood tests and, occasionally, specialist investigations (endoscopy and ultrasound).
The onset of IBS symptoms after gut infection is very well recognised - about a quarter of patients date their IBS from such an event. It is thought that this may result from changes in inflammatory cells and chemicals in the gut of some vulnerable individuals.
The prognosis is that the symptoms of IBS persist in the majority of patients, with an important minority in whom the symptoms resolve.
IBS in children
Q. Belo: It has been suggested that my eight-year-old daughter suffers from IBS. Often after eating she needs to disappear to the toilet. She will be in there for about 15 minutes while she has her explosion. It was a bigger problem when she was younger, as it led to a lot of accidents. Now she seems to know how to manage it. She knows that she needs to get to a toilet ASAP as she feels her stomach go hard and starts to hurt.
When she was 4.5, the doctor referred her to the hospital and they found nothing structurally wrong with her. The doctors said that it was probably her age and a lot of children aren't properly potty trained at that age. She had been since the age of two.
Could she have IBS? If so, what could I do to help her?
A. Anton: It is hard to be specific without having a bit more information:
- Are there periods when the gut functions normally?
- Are the stools loose?
- Is the abdomen distended?
- Is the 15 minutes in the toilet because the stools won't come out or because they are too loose to void completely?
Before a diagnosis of IBS is made, it would be important to determine that there is no other abnormality. This can be done through clinical examination and blood tests.
Diagnosing IBS in an under 10 year old is not very common. It is important to look into another diagnosis first and foremost such as: intolerance to gluten, gut inflammation, gut allergy, lactose intolerance. Make sure you visit your daughter's GP to explore this further.
Q. Isitme1: My son is three and currently undergoing tests. He suffers from blood in his stools, mucus poo, aches and pains in arms and legs and cramps. Is IBD and IBS the same?
A. Anton: Inflammatory bowel disease is quite different from IBS and the management needs to be quite different, hence the reason for investigating carefully.
Blood in the stool, at any age, needs investigating and is NOT a feature of IBS. I do hope he and you get an answer and some improvement in symptoms soon.
*For medically confirmed IBS. Contains hyoscine butylbromide. Always read the label.