Alexandra Falconer | 11 Jun 2020 | Dysbiosis

Irritable Bowel Syndrome (IBS): How Can The NHS Help?

One in five of us in the UK has IBS. If your bowel habits have changed, or you have pain anywhere in your abdomen, you must tell your GP right away. But what kind of help can you expect from the NHS if you have IBS?

Contents

What is IBS?
What Causes IBS According to the NHS?
How is IBS Treated in the UK?
Getting a diagnosis of IBS on the NHS
What are the Symptoms of IBS According to the NHS?
NHS recommended Lifestyle Changes for IBS
NHS Medication for IBS
Conclusion

What is IBS?

IBS is a long-term condition where pain in your abdomen is accompanied by a change in bowel movements: diarrhoea, constipation or both.
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What causes IBS according to the NHS?

The NHS state that the exact cause of IBS is unknown, but say that it’s “linked to things like food passing through your gut too quickly or too slowly, oversensitive nerves in your gut, stress and a family history of IBS.” They add that it’s usually a lifelong problem, but diet changes and medicines can help control the symptoms.

Healthpath’s view on the causes of IBS

We agree that the exact cause of IBS is unknown. However, while it’s clear there’s no single cause, research on the possible causes of IBS has exploded since the turn of the millennium. We still don’t have any conclusions, but we know a lot more about the many reasons why so many of us could be suffering from IBS symptoms.

Here are some of the most researched possible causes of IBS:

SIBO

Many studies have looked at the relationship between SIBO and IBS symptoms. In them, up to 78% percent of IBS patients have been found to have small intestinal bacterial overgrowth (SIBO), compared to up to 40% of people without IBS symptoms (Source: NCBI). This suggests that SIBO is a cause of IBS in some—but by no means all—IBS sufferers.

Dysbiosis

Dysbiosis is a fancy word we use to describe an imbalance in the populations of microbes in our guts. We know that the trillions of bacteria and other microbes that live there—known as our microbiome—play at least some kind of role in IBS (Source: NCBI). The big question is how much.

One group of researchers conducted a ‘meta-analysis’—a review of the current research—to determine whether the dysbiosis found in patients with IBS symptoms was significantly more serious than that found in ‘healthy’ controls without IBS symptoms (Source: NCBI).

They concluded that IBS is ‘characterised’ by dysbiosis. In other words, if you have dysbiosis, you’re extremely likely to show symptoms of IBS. They found that people with decreased populations of two types of bacteria in particular—Lactobacillus and Bifidobacteria—were especially likely to suffer bowel problems.

Food sensitivities

Sensitivities to foods like wheat, milk and certain fruits and vegetables are very common in people with IBS symptoms. However, there’s a big difference between being allergic to a food and being ‘intolerant’ to it. Food intolerance happens when your gut reacts to food, triggering spasms, gas and diarrhoea.

Food allergies are much less common than food intolerances, and involve an immune reaction. This research showed that food intolerances are much more common in people with IBS symptoms, but food allergies are not (Source: NCBI). However, this study showed that allergic reactions to food are more common in people with IBS symptoms (Source: NCBI), so we clearly need more research into this before we can conclude anything.

There’s a lot of evidence to suggest that rather than food sensitivities being responsible for IBS symptoms, it’s the other way round: the food sensitivities happen because a disordered gut with an imbalanced microbiome can’t digest and absorb food properly, resulting in an immune system reaction (allergies) (Source: NCBI).

The same goes for food intolerances, which usually result in gas, bloating, and diarrhoea or constipation after eating certain foods. Gluten intolerance (a protein found in wheat) for instance, can often happen after food poisoning disrupts the bacterial balance in your gut (Source: NCBI)

Chronic stress

There’s a lot of evidence that shows that psychological stress impacts the sensitivity, motility (movement), secretions (digestive juices) and permeability (leakiness) of your gut (Source: NCBI). What’s more, researchers have found that the same processes in your body that cause these changes in your digestive system as a result of stress, also cause changes in your immune system and the make-up of your microbiome.

Leaky gut

Several studies have shown that leaky gut is more common in IBS patients (Source: PUBMED), (Source: NCBI), and that if you have leaky gut, you’re more likely to have IBS symptoms (Source: NCBI). Some experts still deny that leaky gut exists as a health condition at all, but as time goes on and evidence of the connection between leaky gut (also known as intestinal permeability) and a wide range of diseases builds up, they are finding it increasingly difficult to defend their position.

Childhood trauma

In 2016, a study on childhood trauma and IBS provided evidence for something many mental health professionals, Functional Medicine practitioners and people from traumatic backgrounds have suspected for a long time: childhood trauma leaves people more susceptible to developing IBS symptoms (Source: NCBI).

If you went through physical, emotional or sexual abuse as a child, or someone in your household was in prison, mentally ill, or being abused themselves, you’re around twice as likely to suffer from IBS symptoms as an adult.

A sensitive nervous system

We’ve all had the feeling of ‘butterflies in our stomach’ when we’re nervous, or a sinking feeling in our guts when we get bad news. The effect is immediate: it’s our brain/gut connection at play. Because we’re all different, some people are more prone than others to feeling the effects of stress in their guts.

Those effects don’t always show up right away. Over time, if we’re stressed a lot, the classic IBS symptoms like diarrhoea, constipation, pain and bloating can become our constant companions. Some researchers believe that certain people have an ‘IBS personality’—either by birth, life experience or a blend of the two—that makes them more susceptible to IBS (Source: NCBI).

In this study, researchers used balloons to stretch participants’ gut walls from the inside and asked them to rate their pain and pressure levels. (Source: NCBI). The sensation threshold, defecation threshold and pain threshold in the people with IBS symptoms are always much lower on average than in the controls. This basically means that people with IBS are much more likely to feel worse pain in their guts from a ‘normal’ amount of gas or stool than people without IBS (Source: PUBMED).
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How is IBS treated in the UK?

If a doctor diagnoses you with IBS, initially they are likely to offer lifestyle advice like cutting down on fast food, keeping a food diary, finding ways to relax, and exercising. Recently the NHS started recommending that IBS patients try probiotics for a month.

If none of this helps, your GP might suggest an over-the-counter medicine like Loperamide for diarrhoea or Fybogel for constipation. Every doctor will have a slightly different approach. If you’re still having trouble, a GP might refer you to a gastroenterologist (a doctor that specialises in diseases of the digestive tract). Gastroenterologists are able to prescribe specialist medication for IBS symptoms.

Infographic of how the NHS can help

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How Healthpath tackles IBS symptoms

You should always report any changes in your bowel habits to your GP right away, especially if you see any blood or mucus in your stools. At Healthpath, we look for the root cause of your gut symptoms. While getting your symptoms under control is important for your quality of life, we want to find out why you developed them in the first place.

That’s why we use Functional Medicine tests: to get a window into what’s going on behind your IBS symptoms. If you have the symptoms of SIBO, we’ll send you a test so you can find out for sure. If it’s positive, our Functional Medicine practitioners will guide you through a protocol to get to the other side.

If your tummy troubles point towards a problem in your large intestine, one of our three stool tests can reveal:

  • your levels of friendly and unfriendly bacteria
  • the presence of yeasts and parasites
  • how your digestion is working
  • markers of leaky gut
  • evidence of worms

We believe that knowledge is most definitely power. Once you know what’s going on with your gut, you’ve taken the first step on your health path.
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Getting a diagnosis of IBS on the NHS

GPs usually use the ‘Rome IV criteria’ when diagnosing IBS:

Recurrent abdominal pain, on average, at least one day a week in the last three months, associated with two or more of the following criteria:

  • related to defecation
  • associated with a change in frequency of stool
  • associated with a change in form (appearance) of stool.

The criteria must be fulfilled for the last three months, with symptom onset at least six months before diagnosis.

The Healthpath approach to diagnosing IBS

It’s important to state that Healthpath can’t diagnose any condition. We’re a team of Functional Medicine Practitioners and Registered Nutritional Therapists, not doctors. We’re bringing Functional Medicine to the masses: we believe that you have the right to find the root causes of your own ill-health. We’re here to help you get the answers.
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What are the symptoms of IBS according to the NHS?

The NHS state that the main symptoms of IBS are:

  • stomach pain or cramps
  • bloating
  • diarrhoea
  • constipation

How Healthpath sees the symptoms of IBS

At Healthpath, we see IBS as a name for a collection of symptoms. It’s not a very useful label, because it doesn’t steer us (or anyone) towards any answers.

Every person with IBS will have a different path back to health.

However, because it’s a term most people understand, we use it in the same way the NHS would use it: to talk about a cluster of symptoms that have a multitude of causes.
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NHS recommended lifestyle changes for IBS

The NHS suggests a number of lifestyle changes to support IBS symptoms. Here are a few examples:

To reduce diarrhoea:

  • cut down on high-fibre foods like wholegrain foods (such as brown bread and brown rice), nuts and seeds
  • avoid products containing a sweetener called sorbitol

To reduce constipation:

  • drink plenty of water to help make your stools softer
  • increase how much soluble fibre you eat – good foods include oats, pulses, carrots, peeled potatoes and linseeds

Healthpath recommended lifestyle changes for IBS

Our website is full of information and articles on what you can do to take control of your IBS symptoms and your overall health. It’s why we’re here!

Check out these blog posts for starters:

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NHS medication for IBS

The NHS uses a range of medications for people with IBS. Every region, and every doctor, has their own preferred protocols.

Some of the prescription medicines used for constipation include:

  • Prucalopride (Resolor) acts on serotonin receptors in your gut to stimulate peristalsis (the muscular movements that push stools through your bowel). It is licensed to treat severe laxative-resistant constipation in women.
  • Lubiprostone (Amitiza) works through chloride channel receptors in your bowel, stimulating them to release liquid.
  • Linaclotide (Constella) treats constipation associated with bloating and abdominal pain and reduces intestinal sensitivity.

Many of the medicines used for diarrhoea work by slowing the time it takes for food to travel through the small intestine, or helping the absorption of bile acids, which can cause diarrhoea if they remain in the gut for too long.

Some examples are:

  • Cholestyramine (Questran)
  • Colevesalam (Welchol)
  • Colestipol (Colestid)

How Healthpath supports people with IBS symptoms

In a nutshell, we look for the root cause. There is literally no end to the number of reasons you could have IBS symptoms.

A few of the reasons you might have diarrhoea:

SIBO

Diarrhoea is frequently associated with SIBO—a condition in which bacteria from the large intestine have migrated to the small intestine, where they cause irritation.

Food sensitivities

These are a known contributor to diarrhoea. In simple terms, if your body doesn’t like something, it will try to get rid of it as quickly as possible.

Chronic stress

The stress hormone, cortisol, disturbs the digestive system. It’s a known contributor to symptoms of IBS, including diarrhoea.

Parasites or infections

Parasites can attach themselves to the lining of the small intestine, affecting nutrient absorption and causing diarrhoea.

Low stomach acid

Without enough stomach acid, food cannot be broken down properly. This can lead to diarrhoea.

Inflammatory bowel disease (IBD)

Diarrhoea is frequently associated with Crohn’s disease and ulcerative colitis, which are inflammatory conditions of the intestines.

Too much caffeine

This can act as a prokinetic, meaning it makes food move through the digestive system too quickly.

Too much alcohol

Alcohol irritates the digestive tract, affecting its function and contributing to diarrhoea.

Hyperthyroidism

This is a condition in which you have too much thyroid hormone available. It causes everything to speed up, leading to diarrhoea.

A few of the reasons you might have constipation:

SIBO

Small intestine bacterial overgrowth can produce gas that leads to constipation.

Dysbiosis

An imbalance of the bacteria and other microbes in your large intestine, which can influence constipation.

Chronic stress

Too much of the stress hormone, cortisol, can disturb the digestive system and contribute to constipation.

Low water intake

If your body is dehydrated, it will take water from your large intestine (colon). This can make your stools dry and difficult to pass.

Low fibre intake

Fibre bulks up the stool. Too little fibre can mean your poop is insufficiently formed, resulting in a slow transit time.

Hypothyroidism

This is a condition in which you don’t have enough thyroid hormone available. This slows everything down, contributing to constipation.

Neuromuscular issues

Your intestines move stools through (and out) via a series of signals that involve your nerves and hormones. If your nerves aren’t working properly, constipation can result.

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Key takeaways

Your GP should always be your first port of call if you’re suffering from IBS symptoms. Once they’ve ruled out anything serious, they could offer you:

  • dietary advice
  • lifestyle advice
  • medications
  • a referral to a gastroenterologist who can investigate further

The Healthpath way
At Healthpath, we see IBS symptoms as a prompt to dig deeper. There’s a reason your gut is struggling, and it’s our mission to find out why.

Getting your symptoms under control is important for your quality of life. But finding the underlying cause of your symptoms is crucial for your long-term health.

We do this through an in-depth symptom survey and Functional Medicine tests that dig deep into your body systems and biochemistry.

IBS is a term to describe a cluster of symptoms. Your path back to health is as individual as you are. We’re here to help you find it.
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Author
Alexandra Falconer MA (Dist) DipCNM mBANT is a Registered Nutritional Therapist specialising in IBS and related conditions. A graduate of Brighton’s College of Naturopathic Medicine, she is committed to fighting the root causes of chronic illness and bringing functional medicine to everyone who needs it.

Before her natural health career, Alex was a journalist and copywriter. She continues to write for magazines and media agencies, and now combines her two great passions—writing and health—by creating content that empowers people to claim their right to a healthy body and mind.
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