IBS and Asthma

Just wondered if anyone who posts on here has IBS (irritable bowel syndrome). After 5 yrs of ongoing problems I've recently been diagnosed with IBS and the doc told me that my steroid medication and anti-biotics that I end up having for chest infections is one of the main factors which causes me problems. Just wondered if anyone else has been told anything similar. I'm wondering if it would be worth discussing with asthma nurse about reducing steroid dose.


27 Replies

  • Hi Danni,

    Sorry to hear that you've just been diagnosed with IBS - hope it doesn't cause you too many problems!

    I have had brittle asthma for about 12 years and IBS for around 10 years - in fact, the IBS symptoms started quite suddenly just after my second ventilation for the brittle asthma, which was obviously a very stressful time and also a time when I received a lot of IV antibiotics, so two potential triggers there.

    IBS is really an umbrella term which describes a number of different clinical syndromes, with different symptoms, that are linked by the fact that there is little underlying pathology to be seen under the microscope - ie, the bowel is not behaving normally, but tests reveal that there is not actually a lot of abnormality of the bowel tissue that can actually be seen. This is why IBS is described as a 'functional' bowel disease - the bowel does not function as it should, but no real hard and fast reason for this can be found. There is still a great deal that we don't know about IBS; some doctors may be dismissive of it because of it's status as a functional bowel disease, but whatever is causing it, it is a real illness that can cause a great deal of pain and distress.

    I have the type of IBS that is predominantly diarrhoea, with colicky abdo pain; I don't get the alternating constipation and diarrhoea that some people get. Sometimes it is more troublesome than other times, occasionally it can be quite incapacitating and dehabilitating. I have to say, though, that I tend not to place too much importance on it - I know that some people find it to be a very dehabilitating and emotionally taxing condition, but I think I approached it from a point of relief that it wasn't something more serious, as I have a strong family history of the quite different set of conditions, inflammatory bowel disease (ulcerative colitis and Crohn's disease) which can be very severe, occasionally life-threatening, and can require people to have extensive surgery. In comparison with these conditions, and indeed in comparison with my asthma, the IBS is really nothing more than an inconvenience most of the time. There is plenty of reassurance to be had from the fact that this condition can't actually kill me or make me severely unwell. However, I do recognise that this approach to it is not necessarily helpful for everyone, and that some people find that their lives are pretty severely affected by it.

    As I say, there is a lot we don't know about IBS, including why it happens. I've certainly been told in the past, and have read, that antibiotics can contribute to the development of IBS, and there is some evidence that probiotic drinks and so on can help with the symptoms. I've never been told that steroids have contributed, and as far as I am aware there is no real evidence for a higher incidence of IBS in steroid users. Reducing your steroid dose is always a good idea if you can without the asthma deteriorating, for all sorts of reasons, but I would not expect it would vastly improve your IBS symptoms. Theophylline, however, can certainly cause IBS-like symptoms, and I suspect it probably contributes to my IBS. As with a lot of conditions (including asthma) stress also can be a big issue, and IBS can obviously both cause stress and be made worse by stress. As with most of these issues, the relationship is not simple, and I've certainly had times in my life when I've been very stressed and have not suffered with my IBS or my asthma, and times when the converse has applied.

    There is a documented association between IBS and asthma - people who suffer from one are more likely to suffer from the other. It is not known whether this is because one causes the other, or because the two have a common cause, or because the medications for one cause the other, or any of the other likely cause-effect permeatations. I have plenty of papers showing this association, though - I can let you have copies if you are interested, although I'm on my hols so don't have them to hand right now!

    I suffer from irritable bladder as well (basically characterised by urinary frequency and urgency, a bit like having a urine infection all the time) and also from severe menstrual cramps (although this is not currently an issue as I take the Pill continuously to control severe hormonally related exacerbations of my asthma). My sisters also suffer from severe menstrual cramps, and experience symptoms similar to my IBS and irritable bladder symptoms when they are just about to start their periods, which is the point in my cycle when I tend to get exacerbations of my asthma, and indeed of my IBS/bladder problems.

    My personal theory (somewhat endorsed by Prof Ayres when I used to see him, if he wasn't just humouring me!) is that all my smooth (non-skeletal) muscle is irritable. I have twitchy airways, twitchy guts, twitchy bladder and a twitchy womb. These all manifest themselves in different ways, but the underlying disorder is the same - the tendency of these muscular tubes to clamp down and close up/spasm for no apparent reason. I have to stress, though, that this is largely my personal theory as to why I have brittle asthma and the other conditions, and is not particularly something that many of my doctors would subscrible too! Certainly, though, the asthma attacks that I have, which are very sudden onset and severe and often go as quickly as they come, have been attributed to airway spasm, rather than airway inflammation (the consultants at RBH wondered about this). I do also suffer from atopy (allergy) and have a component of allergic asthma, but I believe this is a separate issue (lucky me, eh, to have two types of asthma!).

    There are many many different treatments for IBS, and there are several different types of IBS, so I am not going to delve into the realm of what is likely to help you. I will say that it can take quite a long period of experimentation to determine what will work for you, so don't despair if things don't seem to be improving a great deal at first. Also, don't be surprised or worried if your doctor suggests trying you on certain types of antidepressants for your IBS - there is some evidence that both the SSRI group and the tricyclic group of antidepressants can be useful in different types of IBS. If your doctor suggests this, they are not necessarily trying to imply that you are depressed or that your problems are 'all in your head' - it is not known how antidepressants work to help with IBS, but it is almost certainly at least partly due to a direct effect on the bowel rather than due to any antidepressant action.

    Personally, the thing that helps me most with my IBS is the drug amitriptyline, which is a tricyclic antidepressant, but given at a much lower dose than would normally be used in depression. This drug acts as a smooth muscle stabiliser, making the muscle less twitchy. It acts on the same branch of the nervous system (which controls the twitchiness of the muscles) as the asthma drug ipratropium (Atrovent) (and the drug tiotropium (Spiriva), which is really licensed for COPD but is sometimes used in difficult asthma, and which I am also on). Not only does amitriptyline help with my IBS symptoms, it also helps with the bladder symptoms, and I believe that it helps with my twitchy airways too. Coincidentally, it also helps me to sleep better at night, and also helps with nerve pain that I have in my feet from ICU-admission related nerve damage. A useful little drug overall! When we are on so many different medications, it is always useful to find one that will work for several different problems at once.

    I am not about to suggest that you rush to your doctor and ask for amitriptyline, because it is certainly not the answer to everyone's IBS. In fact, if you have IBS which is characterised by predominant constipation, amitriptyline might reasonably be expected to make it worse. As I have said, it is essential to have an understanding of how IBS presents itself in you, and tailor treatment appropriately.

    Some people believe firmly that food intolerance is a strong factor in causing IBS - dairy and wheat are often implicated. Personally, I have tried changes in diet and eliminating certain things, and I don't find it helpful. The only dietary manipulation that I have found to help a little, perhaps, is taking probiotic yoghurt drinks. If you are going to alter your diet or start eliminating things, it is wise to discuss it with your doctor, and perhaps a dietician, prior to changing things, to make sure that you are doing it appropriately and are getting all the necessary nutrients. If you are on oral steroids, it is particularly important to think about your calcium intake, which could be a factor if you were to eliminate dairy.

    IBS is an important condition, which can cause a lot of misery. As I have said, it can take some time to find the correct treatment for you, so do be patient if you can in the first few months! However, if you are not having any joy with your GP, there are specialists (usually gastro consultants) who have a special interest in the classification and treatment of IBS (we are lucky enough, in Nottingham, to have one of the leading specialists, who has published some very interesting work). If you are not happy that your current doctors are sorting out your symptoms, you can ask to be referred to one of these specialists.

    I hope this helps a little; if you want further info or references, let me know. I have a great many papers on this subject, although many of them are interesting only from an academic point of view rather than because they suggest particular treatments. I do hope that you manage to find something that does help your symptoms.

    Take care,

    Em H

  • Curious this,although I dont have IBS,I have noticed that quite often when my asthma is playing up and I feel like throwing up, I have also had to ""launch"" a number 2-it sounds a bit ""comical"" but it has happened a few times as if my system is trying to expunge whatever is irritating it out of both sides-needless to say it is also quite awkward from a ""practical"" point of view!

  • I haven't been diagnosed with IBS but get iritations in my lower bowel when I reduce my steroids! Stress doesn't help it either. I am lactose intollerant too so that contributes to certain issues if I misbehave and have any quantity of milk!

    Mine gets worse when I have had a stomach bug - obviously clears out the good bacteria. Anti Bs don't help either but the steroids seem to calm it down -so whatever I have must be some form of inflamation.

    I am reducing wheat (& gluten) at the mo to see if that makes my guts feel less bloated etc.


  • I haven't had any problems with my stomach cramps etc since being on my wheat free diet. I do feel really daft that i took the spasmonal type pills thrown at me for stomach cramps and mucus type diarrhoea and didn't associate it with my dodgy lungs and eczema and that it was all caused by allergy how daft am I! I wish everyones IBS could be cured so simply.

  • Hi Danni

    I have brittle asthma and I too have IBS and my doc told me that it was the combination of the drugs i take for my asthma and i was only diagnosed quite recently too. I am taking peppermint oil capsules for it although i dont think it is really making that much of a difference. My GP has just said that it will be a long term thing and i should include more fibre in my diet!!

  • Big belly

    Sounds like we are all the same with the bowel problems. I suffer so much that it affects my breathing so bad that i can hardly walk from the pain. Been to hospital today, again i get told ""oh its the steroids."" Well after twenty years of them there aint much chance of coming off them for a while or if at all. get down to twenty mg. then usually back up again The IBS covers a lot of things, so i get told just to live with it. glad your all helping each other.

  • Hi - I started taking asthma medication a couple of years ago and since then have suffered IBS symptoms - this has made me wonder....

  • Thanx for sharing your experiences. like I said Ive had it for just about 5 yrs but have only just had it confirmed and have tried numerous different meds for it. I tend to be more constipated or feel like I need to go to the loo all the time as opposed to having the runs but itis the constant tummy ache that really gets me down and unfortunately I am a big stresser which undoubtidly plays a big part. My doc said that my asthma meds and the antiBs when I'm on them assist to the pain but I'm not on antiBs that often I don't think. Anyway Im now on the peppermint oil and although its only been a week I do think they are making a bit of a difference but I'm sure I still have a long way to go until I get it under control if thats at all possible. I didn't realise IBS is so common until you mention it to people and then they tell you they suffer from it!


  • Hi Danni,

    Yup, the old stress does play a bit of a part, doesn't it? I know I can sometimes feel my bowel (and my lungs!) clamping down when I get stressed. Is there anything you can do to relax - have a massage, get a pedicure, any little treat like that? Have you tried relaxation exercises - I swear by them - I am not going to re-post my whole relaxation exercise regimen here cos I'm always banging on about it (and I'm getting teased!) but I have posted it before in a previous thread and I'll bring it to the top if I can find it.

    If you are tending to be constipated, have you tried a very gentle - well, I hesitate even to call them laxatives, they are so gentle - stool softener of some kind? Sodium docusate tablets and Fybogel natural fibre drink (fairly disgusting) can both be helpful. I would probably avoid bowel stimulating laxatives like senna - in my experience they can make the tummy pains worse.

    Hope you find something that helps, anyway; as I said, it's often just a process of elimination finding what works for you.

    Em H

  • Nice play on words Em ""it's often just a process of elimination

  • Heh, Cathy, not quite what I intended but I'm glad you approve the motion...

    I have found some info about a certain fern that can be quite effective in relieving constipation... and with fronds like those, who needs enemas?

    I'll get my coat.

  • I have senna every now & again, usually when I have taken lots of codeine etc and have noticed lower gut pain for 12-24 hrs before the senna actually works - fybogel works better. Though I prefer prunes!

    Stress definately affects my guts - have lost a few pounds this week - who needs senna or prunes - get stressed instead! (Only Joking!!!!)

    I think the drugs we take have a lot to answer for gut wise.

    Em - what fern are you talking about?



  • Kate, I can't remember the name of the fern and I'm pretty sure it doesn't actually work - I was just using the opportunity to make a very bad pun!

  • I suffer from ibs, my mum thinks it is caused by too much medication. I am sure it is not.

  • One question. Terrible bloat after bowel movement everytime leaves me breathless. Could it be IBS from medication. Am i alone with this issue or is there somebody in same boat as me. Beginning to think its time stop eating.

  • My GP does not think that the asthma medication's i am on affects my ibs, I have also got to the point where sometimes i am scared to eat.

  • I can get bloated often but there doesn't seem to be much of a pattern but now I'm on peppermint oil it has made a massive differnce. I'm on seretide 250 for my asthma and ventolin and my doc has said that the steroids do play a part of the 'flare ups' in my IBS also anti-biotics if I end up with an infection


  • IBS and asthma

    I ave had IBS for some ten years which coinsides with the onset of problem asthma again, to date my GP has never mentioned that there could be alink between my meds and the IBS. I do suffer slightly more when having course of steriods and antibiotoics, but the usual warning of probable increased bowl action when the antibiotics start to work.

    Would be interesting to get a medics or Asthma nurse thoughts on the matter.

  • The first reply in this thread is a (very comprehensive) response from Dr Emily!

  • Hi I saw a nutritionist recently and she said that there is a definate link between asthma and IBS especially when you have anti-Bs and pred and I found it really interesting how those affect both conditions and contribute to flare ups in both. Emily H you said you had several papers relating to the link between the two and i would be quite interested in reading more about it to see if I can help improve either condition?



  • Danni, I don't have web links to most of the articles, but if you PM me your postal address I'd be glad to send you copies. It might take me a while because they are in a place which is not very accessible to me at the moment.


  • im begining to wonder if igot ibsihave bouts cramp sore tum, diarhoea,i feel so sick,

    i find if attempt to eat fruit or veg more than once a week then i suffer,have had to reduce milky things too.

    no one seems to care anymore,my gp saidwhat do you me to do aboutit yourlots medication already.

    if only somebody would listen to me

    pants line keeps sticking

  • IBs

    I have asthma and IBS too, didnt realise how common it was which makes me feel better!

    I have been on colofac for my IBs for two months now, and it has really helped, it is in theory meant to stop the gut contracting/cramping and although it obviously wont work for everyone I think its great.... I also take peppermint oil and buy calcium carbonate tablets like Rennie or Tums and found they have helped loads too.... but too much calcium carbonate causes constipation so be warned!

    I was advised to try herbal calming remedies by a friend who has IBs although I dont tend to get that stressed so hav't tried it, but thought I would pass on the idea.


  • I had Asthmas as a kid and beat it. But in adulthood have IBS.

    What has helped with the IBS :-

    - don't drink tea / coffee

    - don't drink coca-cola

    - avoid high sugar foods e.g. cakes, fizzy drinks

    - avoid food with hydrogenated vegetable oil

    - avoid too much wheat. Analyze how much wheat you eat. e..g you could start you day with cerial, when a sandwich (more wheat) and then have pasta (again more wheat!)

    - try rice based cerials instead of wheat


    - have fruits for breakcasts

    - avoid fried foods

    - If you take pepermint (try it before a meal) - though I never found pepermint to be a wonder cure

    - try alternative teas such as Camomile Tea

  • IBS and Asthma

    I have IBS and I also have asthma affected mostly by colds sore throats etc. I was diagnosed with IBS 3 years ago. I have only took steriods on about 7-10 occasions in my whole life but have regularly had to have Antibiotics during my whole life.

    I have found cutting nearly all the fat out of my diet and eating healthy had controlled my IBS for the past 2 years.

    Hope this helps Chris

  • I was diagnosed with IBS in the seventies, long before I started suffering from asthma. As you can proably imagine, I have managed to get a bit of control on it in that time and so much is automatic that I don't know if I could list all the changes I have made. A few highlights, most of which have already been listed:-

    Cut down drastically on coffee

    Reduced fat - a by-product of a weight-loss diet anyway, so dual purpose

    I do not understand the next one, but have noticed the difference since making my own bread rather than buying from supermarket.

    Finally, but not to be recommended - have some bowel removed - that's less to get irritated (really, really do not recommend that, but it certainly helped my IBS!!!!)



  • NICE have recently issued some guidance about managing IBS, and I was delighted when they acknowledged that some people with IBS cannot tolerate certain types of fibre. When I have told people that eating certain fruit or veg Iworsened my constipation and pain, they looked at me as if I had lost the plot. Now I know it is true and feel validated.

    By the way Movicol helps me without causing bloating or pain.


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