There are a number of reasons as to why one might suffer bloating and abdominal pain. It can be down to the food that we eat, how often we eat and even factors like stress have a role to play. Sometimes there are no obvious causes. IBS, or irritable bowel syndrome, is a leading cause of abdominal cramps and bloating. It affects twice as many women as men. Diarrhoea and constipation are also symptoms related to irritable bowels.
We asked one of the UK’s leading laparoscopic abdominal surgeons Mr Michael Stellakis about how we can relieve the symptoms of irritable bowel syndrome.
Our approach to relieving symptoms depends on a number of factors, including the actual symptoms present. There are medicines designed to relieve pain and reduce bloating. There are also drugs that can reduce diarrhoea and also drugs that prevent constipation. That said the first area to look at would be diet. We can look at a patient’s diet and omit certain food groups to which some patients may be intolerant:
- Lactose; the sugar found in dairy products like milk, soft cheese, ice-cream and yoghurt
- Gluten; this is a protein found in all wheat-based products including bread, pastries and cereals
- Yeast; found in bread, biscuits, beer and stock cubes
There are also a number of so-called trigger foods, but these are very patient-specific. These could include spicy foods, caffeinated drinks, sweeteners (in particular sorbitol), onions, chillies, chocolate, alcohol and wine and eggs. These foods can, in some patients, lead to bloating, pain and erratic bowel actions.
Resistant starches can be an issue for some patients. Resistant starches are harmless but form when you re-heat or re-cook pasta and potato dishes. This would include things such as lasagne, pasta bakes, pies etc. It is also worth remembering that a lot of cook-chill foods will contain resistant starches.
It may be worth reducing the amount of FODMAPs one eats. FODMAPs are essentially sugars that commonly occur in certain foodstuffs, predominantly fruits and vegetables that ferment in the gut and cause bloating and pain and sometimes diarrhoea.
Fibre is also an important constituent of any diet. There are two types, soluble and insoluble. Soluble fibre is in foods such as oats, barley, brassicas and greens, whereas insoluble fibre (roughage) is in wholemeal, wheat germ, bran, nuts, pips and skins. Both are very healthy for the gut, but soluble fibre tends to bloat less, but possibly causes more flatulence. It is not necessarily all about eating as much fibre as possible, but eating the right amount, as we shall see later.
How can I test if a specific food is causing me problems?
If you believe that something you’re eating is causing bowel problems, it’s recommended to cut out that specific food or food group for three to four weeks to see if symptoms subside. This is the only true way to detect if a specific food is causing your symptoms. Keeping a food diary can be a useful exercise to note what foods trigger symptoms. This is easier to do particularly if your symptoms are intermittent and not constant. If you are going to eliminate certain parts of your diet to see if symptoms improve, this is best done initially at least, under the guidance of a specialist or dietician with an interest in IBS.
It is important not to go for long periods without eating and then eat a big meal. Contrary to popular belief, grazing is not a good way to eat either. This can often lead to patients putting on weight. Drink plenty of fluids throughout the day (water is best) and take regular exercise.
Don’t forget, if your symptoms are new or change significantly you must make your doctor or specialist aware – particularly if you are over 45 years of age.
What advice have you to relieve diarrhoea?
- Decreasing fibre intake
- Reducing FODMAP foods in your diet. There is plenty of information and even certain apps now that inform you about FODMAPs
- Food elimination diets (best done with a specialist)
- Using probiotics in tablet form, such as acidophilus and lactobacillus (not the bioactive yoghurt drinks found in the supermarket)
- Medications (over-the-counter or prescribed)
What advice have you to relieve constipation?
- Increase fibre in the diet
- Use osmotic (not stimulatory) laxatives to help you empty your bowels
- Increase daily amount of fluid /water
What drugs might a doctor recommend?
There’s a large area of research now looking for new IBS treatments. Recommended drugs largely depend on the patient’s individual symptoms.
There are specific drugs for:
1. Treating chronic pain; these include:
- Drugs that reduce bowel spasms and gut hypersensitivity. These include Spasmonol, Colofac and Colpermin
- Neuropathic pain relievers. These must be prescribed under careful observation. Such drugs include amitriptyline, Pregabalin and Gabapentin
2. Treating constipation. There are different categories of drugs for constipation, such as:
- Drugs that draw more moisture into the bowel to help prevent constipation like osmotic laxatives (Movicol, Cosmocol, Laxido) or milk of magnesia
- Drugs that stimulate the bowel to encourage it to work harder to make bowel movements happen more frequently (Senna, Sennakot, Dulculox etc). These are best avoided for long-term use
- New drugs that target different receptors in the bowel to make it work harder or keep more fluid within the bowel and restore a more natural rhythm (e.g. Prucalopride and Lubiprostone
3. Treating diarrhoea associated with IBS. These drugs can also fall into different categories, such as:
- Loperamide or Imodium
- Drugs that absorb bile acids (Colestyramine)
- New generation drugs such as Alosetron that slow the bowel down
- Drugs that help absorb irritant constituents of bowel contents (so-called adsorbents)
What advice do you have for anyone suffering from irritable bowels?
Sometimes natural supplements can help, like aloe vera for constipation or diarrhoea, or silicol gel which can relieve symptoms of IBS, from nausea to tummy aches and discomfort. Chinese herbal medicine can also be of benefit, such as Iberogast which can be bought over-the-counter. Simethicone preparations like ‘Deflatine’ and ‘Windeze’ can also be helpful.
Psychological therapy can help like cognitive behavioural therapy, which can relieve pain with relaxation techniques. Stress management may help to reduce symptoms. Although this might sound surprising to some, in fact, of all the research into IBS, CBT comes out clearly on top compared with all other treatments, including dietary restriction and drugs.
It is extremely important to note that if your symptoms are new or if you have had a sudden change or deterioration in your symptoms, or you have blood in your poo, you must consult either with your GP or specialist who may want to request an endoscopic (camera) test or some other investigation, such as a scan. Sometimes it is important to exclude more serious causes of your symptoms.
Working out what the exact cause of bloating and abdominal pain is can be difficult and may be a long, drawn-out process, but it is well worth it, advises Mr Stellakis.
If you’d like to book a consultation with Mr Stellakis to talk about irritable bowels, please visit his Top Doctors profile to book an appointment.