A guide to understanding your IBS: From diagnosis to treatment

If you have stumbled across this article, then it is highly likely you have been experiencing some uncomfortable (if not downright embarrassing!) tummy troubles. For some of you, it may feel like these issues have appeared out of the blue, although in my experience people often suffer for many years before getting any sort of professional help. Whatever the case, navigating the endless suggestions and opinions online can be a minefield.

The goal of this article is to simplify the process, providing no-strings advice on how to navigate your IBS journey. Knowledge is power after all! So, without further ado…

What is IBS and how is it diagnosed?

IBS stands for irritable bowel syndrome and is medically defined as chronic and recurrent abdominal pain and/or altered bowel habits for a period of at least six months.

IBS can express itself as a variety of symptoms, however, these symptoms can vary wildly from one individual to the next. Common symptoms include constipation, diarrhoea, abdominal pain, bloating, wind, nausea, and reflux. Symptoms may remain constant, or you may find that they vary day to day.

Beyond the myriad of symptoms, one of the reasons IBS can be particularly infuriating is that it is a diagnosis of elimination – i.e. to get a diagnosis, you will need to rule out several other conditions. This means that a trip to your doctors is a sensible first step.

When you have managed to get hold of your doctor. There are two main things to get checked:

1. Do you have coeliac disease? 

Coeliac disease is an autoimmune condition where the body attacks its own tissues when gluten is consumed. Symptoms often replicate that of IBS, and it can develop at any age. Symptoms resolve when a gluten-free diet is followed. This involves a blood test called: TTG IgA (you can just ask for a coeliac screen).

2. Do you have inflammatory bowel disease (IBD)?

IBD includes conditions such as Crohn's and ulcerative colitis, both of which involve chronic inflammation of the tissues in your digestive tract. Again, symptoms can be akin to those of IBS, however treatment can be very different, so it is important to distinguish between the two. This involves a stool test called faecal calprotectin.

Furthermore, if you are over the age of 60 and have a sudden change in bowel habits, or if you are any age and have bleeding from the back passage, it is important to mention this to your doctor. This can, in very rare cases, be indicative of bowel cancer, so important to flag!

I now have an IBS diagnosis – what next?

Option 1: Dietary therapies

Following an IBS diagnosis, the most sensible thing you can do is to book an appointment with a dietitian.

A dietitian is an HCPC-registered professional, and their title is legally protected by law. This means that in order for a person to call themselves a dietitian they must have a relevant degree, they are clinically trained, and they must adhere to a strict code of conduct in order to maintain their registration within the UK. This means no rogue suggestions, just clinically proven, research-backed advice.

During your first IBS consultation with a dietitian, your nutrition, lifestyle, and medical history will be comprehensively analysed to determine the best course of action. This may be eliminating certain foods from the diet, fibre modifications, identification of trigger foods, or implementation of behavioural techniques. Every person is unique in their symptoms and history, so a personalised approach is always required.

One of the most well-researched diets for IBS is the low FODMAP diet, so it would be amiss to not touch upon this here. It is suitable for those who experience bloating, pain, and/or frequent loose stools, however, it is unfortunately not suitable for those who primarily suffer from constipation.

FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are types of carbohydrates that can trigger IBS symptoms by fermenting in the gut, producing gas, and drawing excess water into the bowel. The low FODMAP diet involves three phases:

• Elimination: Avoiding high FODMAP foods for 4–6 weeks.
• Reintroduction: Gradual reintroduction of FODMAPs to identify personal triggers.
• Personalisation: Maintaining a long-term plan based on tolerated foods.

There is a lot of misinformation regarding the FODMAP diet online, so I urge you to do this alongside a trained professional. The diet itself requires strict adhesion so small mistakes can cost its success.

Regardless of whether the FODMAP diet is chosen as a course of action, or you and your dietitian feel another route is more appropriate, you are likely to need a minimum of three sessions.

Option 2: Psychological therapies

To understand the rationale for how psychological therapies can help your IBS, we first need to explore a little bit of the science (I’ll try to keep interesting I promise).

The brain and the gut are linked via the gut-brain axis which connects the nervous system within the gut (the enteric nervous system) to the nervous system within the brain (central nervous system). These are connected physically via the vagus nerve, and chemically by neurotransmitters. Neurotransmitters are chemical substances, which allow the nerve networks to communicate. Common examples include norepinephrine, epinephrine, dopamine, and serotonin. These are made in both the brain and gut.

As the communication network between the gut and the brain is bi-directional (i.e. it works both ways), it is now possible to see why our mood affects our gut and why our gut affects our mood.

Two common psychological therapies used to treat IBS are gut-directed hypnotherapy and cognitive behavioural therapy (CBT).

Gut-directed hypnotherapy is a psychological treatment that is designed to help you gain better control of your symptoms. There has been extensive research into this treatment and studies have shown that up to 76% of people with IBS experience a reduction in symptoms (by at least a half) when treated with GDH.

Hypnotherapy can help to:

• Decrease sensitivity within the gastrointestinal system.
• Decrease the frequency and severity of symptoms such as bloating, urgency, and pain.
• Decrease anxiety and stress regarding your symptoms.
• Build confidence in managing your IBS.

CBT is a method of psychotherapy originally used to treat anxiety and depression and is founded on the premise that our thoughts (cognitions), behaviours, and feelings are all interconnected. It is now widely used (and scientifically proven to be effective) in a range of conditions including IBS. It is a short-term therapy with a direct plan of action developed between yourself and your therapist.

Option 3: Medication

Some symptoms can be alleviated with medications. If this is something you are interested in, then it is worth a conversation with your doctor. Note – whilst lots of medications for IBS may provide mild symptomatic relief, they also do not tend to address the root cause of the problem. If you and your doctor do decide that a certain medication is suitable, my recommendation would be to also implement dietary and/or psychological therapies as well.

Now that you've reached the end of this article (thank you for sticking with me!), I hope it has provided you with a clearer understanding of how to pursue a diagnosis for IBS and explore the diverse therapies available for its management. Whether you decide to collaborate with a dietitian, explore psychological treatments, or take a combined approach, you can now move forward with greater confidence in evaluating the best options for your personal needs. Remember, managing IBS is a journey, and finding the right path can empower you to take control of your well-being.