IBS in the coronavirus (COVID-19) era

In the UK, irritable bowel syndrome (IBS) is a common condition that affects approximately 35% of the working population. The condition is more likely to occur in young working adults especially women and is often associated with work-related stress.

The impact of COVID-19 early in 2020 had a dramatic effect, on global health and finances. People in high-risk categories include those over the age of 65, the obese, hypertensive, diabetic, patients with heart disease and those that are immunocompromised, in particular cancer sufferers. Ethnicity, in particular those of Afro Caribbean and Asian descent, is an independent risk factor.

The impact on the young and healthy with no risk factors was less pronounced. However, COVID-19 can affect any individual, irrespective of age and sex. The impact on individuals with IBS is difficult to define. Here one of our expert colorectal and laparoscopic surgeons Mr Romi Navaratnam shares his advice and lifestyle tips for those living with IBS during the pandemic.
 

What are the symptoms of IBS?

The common symptoms of IBS include:
 

• Abdominal pain
• Bloating
• Alteration in bowel habit (constipation, diarrhoea, or both)
• Mucus discharge
• Excess flatulence
• Incomplete evacuation

The gastrointestinal (GI) manifestations of COVID-19 include a loss of taste and smell, diarrhoea and nausea. GI symptoms in COVID-19 are not as common as previously estimated when the pandemic first broke. At that time it was presumed that the prevalence of diarrhoea and nausea was approximately 50 %, but now it is assumed to be in the region of 7 – 8 % and abdominal pain less than 5 %. GI symptoms are often associated with other chest symptoms.
 

What are the types of IBS?

The condition can be sub-divided into a diarrhoea-predominant or constipation-predominant IBS, or the most common variant, which is a combination of both.

Intermittent symptoms of diarrhoea may be related to IBS, food intolerance or medical conditions such as an overactive thyroid or Coeliac disease.

Constipation may also be a variant of IBS or slow transit constipation. It may arise from a medical condition, such as underactive thyroid and should respond to the routine use of a natural laxative or herbal tea.

In the presence of rectal bleeding or a persisting altered bowel habit (either diarrhoea or deteriorating constipation), you should seek advice from your GP and then arrange a consultation with a GI (bowel) specialist.
 

How is IBS investigated?

IBS can be investigated using any of the following options:
 

• Blood tests - to exclude thyroid and Coeliac disease
• Stool tests – faecal calprotectin to investigate inflammatory bowel disease (IBD), faecal elastase to exclude bile acid malabsorption or a FIT test to exclude more sinister pathology.
• Breath testing - excludes lactose intolerance and small intestinal bacterial overgrowth (SIBO)
• Colonoscopy or CT pneumococci - to address rectal bleeding or an altered bowel habit

COVID-19 testing can be undertaken using a nasal or oral swab to establish the presence of a current infection. Antibody testing can determine the presence of previous exposure. A positive antibody status should reduce the risk of future severe deterioration in symptoms.
 

What is your dietary advice for those living with IBS?

I recommend the following:
 

• Drink more water
• Reduce caffeine-based products - such as tea and coffee
• Limit dairy product in patients who are lactose intolerant - including milk, margarine, ice cream, yoghurt, soft cheese.
   

In patients with diarrhoea predominant IBS

Symptoms can be improved with a reduced intake of high fibre wholegrain products, such as brown bread, nuts, seeds and avoid sweeteners that contain Sorbitol. Taking Imodium on an intermittent basis can also help.

I recommend patients follow a low FODMAP diet. Foods that are high in FODMAP content include garlic, onions, certain artificial sweeteners, some vegetables such as asparagus and cauliflower, lentils and pasta.

Fruits high in FODMAP include apples, pears, peaches and plums.

Foods low in FODMAP include vegetables such as aubergine, carrots, cucumber, green beans and green or red peppers. Low FODMAP fruits include blueberries, grapes, melon, kiwis, oranges, papaya and strawberries.

The majority of meats and seafood are of low FODMAP content. Alcohol intake should be limited.
 

In patients with a constipation-predominant IBS

In cases where patients are predominantly constipated, I recommend that they drink plenty of water and eat a lot of soluble fibre, which is found in foods such as oats, carrots and peeled potatoes. The regular use of a laxative will also help.
 

What about prebiotics and probiotics?

There is increasing evidence supporting the role of prebiotics and probiotics in the establishment of good gut flora. Common probiotics incorporate Lactobacillus, Bifidobacteria and Saccharomyces. Probiotics have beneficial effects in abdominal bloating, IBS and potentially inflammatory bowel disease (IBD).

Probiotics are naturally identified in Kimchi (common in Asian diet), some natural yoghurts and sauerkraut. Caution is strongly advised in pregnancy and immunocompromised individuals.
 

What lifestyle changes should someone make to manage their IBS?

The following can help in managing IBS:
 

• Regular exercise
• Sufficient sleep
• Relaxation techniques - including yoga, meditation and listening to music
• Try to reduce workplace and domestic stress
• Work on adopting a positive mindset
• Reduction in smoking
• Journal your moods and symptoms - to look for any patterns
• Eat a balanced diet - with appropriate supplements, such as probiotics.

COVID-19 can present atypically with diarrhoea as an initial symptom but is often associated with other chest symptoms. Adopting the measures discussed, in the presence of normal investigations, can bring about significant reassurance, even during the current pandemic, resulting in excellent gut-related health and overall improved quality of life in people with IBS.


If you would like to further discuss your IBS symptoms with Mr Navaratnam, you can book an appointment to see him via his Top Doctor’s profile here.