Irritable Bowel Syndrome (IBS) and Constipation

If you have any unexplained pain, change in bowel habit or have black/tarry stools you need to consult your medical practitioner immediately.

Is IBS making your life a misery?

A diagnosis of IBS often means that the medical tests have failed to find any cause for the diarrhoea, constipation, bloating, abdominal pain or excessive flatulence that a patient is suffering.

If you have a diagnosis of IBS here are some possible factors to consider:

Are you stressed?
Tiredness, low mood, anxiety and insomnia are found in almost all IBS sufferers1. With IBS, relaxation is crucially important. Did you know that if your diet is short of relaxing nutrients (eg. B vitamins, magnesium) then you will tend to be more frazzled.

Are you dehydrated?
Sugary/salty foods and stimulants increase the body’s need for water. Adults need to be getting around 2 litres of non-sugar non-caffeine fluids daily to keep up with demand. Water softens the stool and makes it easy to pass.

Do you have enough micronutrients?
Certain nutrient deficiencies can cause digestive problems. For example, deficiency in vitamin B3, B complex or vitamin A can cause diarrhoea whereas low B12 or magnesium can contribute to constipation. Magnesium is needed in order to relax the bowel so a stool can be passed. It is also needed for mental relaxation. If you are stressed or have insomnia it could be a sign you are short of magnesium. Vitamin B5, B6, folic acid and antioxidants are needed for everyday repair and maintenance of your bowel. Low levels can contribute to the development of digestive symptoms.

Overconsumption of stimulants and refined foods (including alcohol), or smoking, depletes you of nutrients needed for a healthy digestion.

Is your body making enough digestive juices?
Did you know that in order for you to break down the food you eat your stomach needs to produce hydrochloric acid. You need adequate supplies of vitamins and minerals (especially zinc) to make this vital acid. When the food empties from the stomach into the small intestine (usually an hour or so after a meal) the mixture needs to be very acidic in order to trigger the release of digestive enzymes and bile salts to complete digestion. If this does not happen (because the mix is not acidic enough) then the food sits undigested and fermenting in the gut. This inadequate digestion can cause bloating, flatulence, constipation or diarrhoea.

Do you have food intolerances?
Food intolerances are where the immune system reacts inappropriately to certain foods. Symptoms can occur up to 48 hours later, making it difficult to pinpoint the problem food. The most common food intolerances are to wheat and dairy products, which contain proteins that are difficult to digest. Soya and eggs are also common triggers. Certain people also lose the ability to make the enzyme for digesting milk sugar (lactose) after infancy which makes them “lactose intolerant”.

You can find out if food intolerances/allergies are affecting you by doing a 2-3 week elimination diet. This takes out all the most likely problem foods, including anything you eat often. After this you gradually re-introduce foods and monitor any reaction in order to identify “problem” foods. You can also do blood testing for food allergies (IgE antibodies) and intolerances (IgG antibodies) and some people prefer the convenience of these blood tests.

Do you have the right balance of bacteria?
Overgrowths of “bad” bacteria, parasites or inadequate levels of beneficial bacteria can all contribute to IBS. Parasite infection is quite common, even in Ireland, and many patients obtain significant relief when they address this (after stool testing). Pathogenic bacteria/parasites in the gut can damage the lining of the gut wall and this can also lead to food sensitivities. If you have had to take antibiotics or were not breast-fed you will not have a healthy balance of bacteria in the gut and will be at higher risk of digestive disorders. “Bad” bacteria feed on refined foods and alcohol. Taking steroid medication or oral contraception will also upset the balance of bacteria in your gut.

Did you know that bifidobacteria (a beneficial bacteria) are essential for the formation of soft but solid stools. That is they help prevent both constipation and diarrhoea. Lactobacillus, another “good bacteria” produce lactic acid. Lactic acid inhibits the growth of pathogenic (“bad”) microorganisms in the gut. There are more bacteria living in your digestive system then there are cells in your body. They need to be in the right balance for a healthy bowel.

Do you eat enough soluble fibre?
A type of fibre called “soluble” fibre is found in certain fruits (plums, berries, apples, pears), vegetables (leeks, onions), and grains (oats) as well as beans and pulses. Soluble fibre feeds beneficial bacteria in your gut to promote bowel health. Insoluble fibre, found in wholewheat, can be irritating to the gut and many people find that it makes their condition worse.

Could you be intolerant to disaccharides?
Some IBS sufferers cannot break down certain sugars (fructose and sucrose) properly. If eating more fruit (high in fructose) makes your condition worse then this might be a factor. This is a slightly rarer factor in IBS.

Do you have low thyroid function (hypothyroidism)?
Constipation is a common symptom of underactive thyroid. Blood tests do not always give the full picture – thyroid function may low enough to give symptoms but not enough for a doctor to recommend medication. This is a less common cause of constipation than most of the factors mentioned above.

 



[1] Svedlund J et al (1985). Upper gasterointestinal and mental symptoms in the IBS. Scand J Gastroenterol, 20, 595-601.