"I have swelling and pain in my belly but the doctors tell me everything is fine. What now?"
If you have searched for phrases like "I have a tummy ache after eating, is this normal? or "I have gas all day, what can I do?"you may have heard of the Irritable Bowel Syndrome (IBS).
But what exactly is it? And more importantly, can it be cured or improved?
What is IBS?
IBS is a functional digestive disorderThis means that there is no visible lesion in the digestive tract, but there is an alteration in its functioning. It is characterised by the presence of abdominal pain or discomfort associated with changes in the frequency or consistency of bowel movements.
It is a diagnosis of exclusionIn order for a doctor to diagnose it, other digestive diseases such as coeliac disease, inflammatory bowel disease or SIBO must first be ruled out.
What are the symptoms?
Everyone experiences it differently, but the most common symptoms include:
- Abdominal bloating (feeling of an "exploding" belly after eating).
- Pain or cramps in the abdomen that improve or worsen with bowel movements.
- Alternate periods of constipation with periods of diarrhoea.
- Feeling of incomplete emptying after going to the toilet.
- Excessive flatulence and/or belching.
- Fatigue, anxiety and even mental fog.
What are the causes?
There is no single cause of IBS, but the most common triggers are:
- FeedingA diet high in ultra-processed food (pastries, biscuits, cereals, salty snacks, etc.) and/or saturated fats (very fatty meats such as bacon, chops, black pudding, sobrassada, pâté, sausages, etc.) can alter the composition of our microbiota, increasing our predisposition to develop this digestive pathology.
- High stress in our daily livesOur gut and brain are connected via the gut-brain axis, so anything that affects our brain can have an impact on our gut and vice versa. This can include altered microbiota and altered gut motility and sensitivity. For this reason, psychological disturbances such as anxiety disorders are often a predisposing factor.
- Menstrual cycleHormones also influence our intestinal transit, for example shortly before menstruation when progesterone levels drop (it stimulates intestinal muscle contractions) can increase the symptoms of diarrhoea or facilitate evacuation if we are constipated.
- Altered gut microbiota: scientific evidence shows that IBS patients have a higher proportion of pro-inflammatory bacteria (such as Firmicutes) and a reduction in anti-inflammatory bacteria (such as Lactobacillus and Bifidobacterium). This may explain the digestive sensitivity and low-grade inflammation associated with IBS.
How is Irritable Bowel Syndrome diagnosed?
The diagnosis of IBS is based on the Rome Criteria IVwhich indicate that you must have had recurrent abdominal pain at least once a week for the past 3 months, along with altered bowel movements (diarrhoea, constipation or both).
Before reaching this diagnosis, it is essential to rule out other digestive pathologies, with which it can be confused, by means of tests such as:
- Coeliac disease test (anti-transglutaminase antibodies in blood)
- Breath test (to rule out food intolerances: lactose and fructose)
- SIBO (Small Intestinal Bacterial Overgrowth) Test
- Blood tests to rule out endocrine diseases.
- Stool analysis to rule out intestinal hyperpermeability and Inflammatory Bowel Disease.
- Colonoscopy if there are warning signs such as blood in stool or others.
Do I really have to take all the tests?
Some tests can be expensive and are not always covered by public health or insurance. However, it is often not necessary to do all of them. With proper assessment and a well-planned nutritional strategy, other diagnoses can be effectively ruled out without the need to spend on unnecessary tests, and the most appropriate tests, such as SIBO, blood and stool tests, can be performed.
Irritable Bowel Syndrome Treatment: How to improve symptoms?
There is no "miracle cure", but the good news is that IBS can be managed with the right strategy. In fact, many patients return to normal and regain their digestive function.
1. Personalised food
It's not about eliminating senseless foods, but identifying what is affecting you. Some key changes are:
- Low FODMAP dietA strategy based on temporarily withdrawing certain fermentable carbohydrates and gradually reintroducing them. Some people do not need so many restrictions, beware of this.
- Improving gut microbiota composition once digestive function has improved. Natural or supplemented prebiotics, probiotics and postbiotics can be used for this purpose on a case-by-case basis,
- Controlling fibreToo much can make bloating and gas worse.
- Drinking enough waterDehydration worsens constipation.
- Chew well and eat slowlyThe key to prevent air intake, reduce bloating, reduce stress and avoid a disturbance of the gut-brain axis.
Stress reduction
As mentioned above, stress can trigger symptoms, which is why strategies such as the exercise, yoga or diaphragmatic breathing can make a difference. Scientific evidence supports that short-duration high-intensity interval training (HIIT) can help improve symptomatology.
3. Professional support
Trying to manage IBS without guidance can be frustrating. Working with a specialist nutritionist will help you find what works for you without over-restricting, structure your meals, improve your nutritional status and improve your quality of life.
If you have been feeling for some time that your digestive system is not working properly and you are unable to solve it, the first step is to seek professional help.
Irritable Bowel Syndrome can be greatly improved with a strategy tailored to you. If you don't know where to start and need help with your diet, write to me or visit my website! Together we can find the best solution for you.
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