Written by Juhi Bhambhaney APD
An insight into IBS-constipation
Irritable bowel syndrome, commonly known as ‘IBS’, is not a condition we should shy away from talking about, given that 7-21% of the general population struggles with it.
Having IBS can be frustrating because firstly there is no blood test to make a definite diagnosis and secondly there is no one magic medicine to cure it. Although not life threatening, the symptoms are debilitating and can affect a person’s quality of life in many ways.
IBS is most diagnosed in young people below the age of 50 and it is more common in women than men.
IBS is a functional bowel disorder
It is commonly associated with constipation (IBS-C), diarrhoea (IBS-D) or sometimes people have a mix of symptoms (IBS-M).
The easiest way for me to explain what tends to happen in IBS is for you to imagine the gastrointestinal tract (GI tract) as a tube and the water in the tube is flowing in an abnormal fashion, either too slow or too fast. When it moves too slow it causes constipation.
One of the major causes can be stress due to the strong connection between the GI tract and the mind. The reason why general constipation is much more troublesome in people with IBS is due to the fact that people with IBS suffer from ‘visceral hypersensitivity’ which means that that nerve endings in the GI tract are very sensitive and when there is havoc in the GI tract for e.g., constipation, it can lead to other uncomfortable symptoms such as excess bloating and abdominal pain.
The definition of constipation is unclear in the general public, it is important to understand that it is not just defined by irregular bowel motions but also incomplete bowel motions. So, if you are evacuating completely, chances are you could be constipated.
IBS is diagnosed when a person complains of abdominal pain on average of 1 day per week for 3 months associated with a changed in stool form, frequency of stool form or in the ability to have comfortable stools.
If you relate to this, it’s time you see your GP for a formal diagnosis. The GP will usually diagnose this by a process of elimination. Conditions which have similar symptoms such as coeliac disease are usually ruled out before a diagnosis of IBS is made.
Once a diagnosis is made, the doctor will usually recommend seeing a dietitian. The dietitian will formulate an individualised treatment plan. The most common approach is trialling the Monash university certified low FODMAP diet.
FODMAPS (fermentable oligosaccharide disaccharide monosaccharide and polyols) refer to certain types of carbohydrates which can be poorly digested in the small intestine after which they go into the large intestine in that form and get fermented by the bacteria creating excess gas.
The FODMAPs may draw water into the large intestine and all this water and gas starts to tug onto the nerve endings of the GI tract causing pain, excess wind and bloating. Once symptom control is achieved, each fodmap subgroup is systematically reintroduced to figure out your personal triggers.
The bloating may be significantly reduced on the low Fodmap diet. Specifically, for constipation, fibre and fluid intake will have to be optimised which your dietitian can discuss with you.
Juhi is an accredited practising dietitian and Monash university certified FODMAP dietitian.She is extremely passionate about helping people with irritable bowel syndrome as she herself is an IBS sufferer and understands the impact it can have on quality of life.She specialises in gut health and weight management.You can find her and message her on instagram at @soulfulldietitian.