More flare-ups than ever before

[PelucaPastora83]

Afternoon all.

I have had IBS for about 9 years now and take mebeverine for it. I’m wondering if it’s time to speak to GP about changing my medication as my flare-ups are more frequent of late. I am keeping a food diary to try and identify the culprit but my diet hasn’t really changed and I’m wondering why the sudden change in number of flare-ups. I am more stressed than usual with work but stress has never affected me in this way. I wake up around 3/4am every day with cramps and either can’t go at all or I have frequent trips to loo but no diarrhoea. I’m so baffled and considering trying a low FODMAP diet. I’m really grasping at straws to try and help improve things. Any ideas/advice/suggestions? Thank you.

[Annabelle90]

Hi

I know how you feel this condition is horrible and ruining our lives. Low FODMAP diet works I can testify but you need get the Monash App to know exactly the portions and follow it strictly don’t bother searching on it Google it’s never accurate. There are vast options of food to eat am just lazy and love eating problematic foods like dairy and gluten which makes me go back to square one. I would also say sleep at least 7-8 hours a day it keeps my gut calm and relaxed.

[PelucaPastora83 in reply to Annabelle90]

Thanks for this advice. I struggle to even get 6 hours so I need to work on that! Will look at the app you’ve recommended

[xjrs]

Stress can certainly make IBS worse. If your symptoms have changed it is worth mentioning it to your GP in case they want to re-run some tests.

Here is some information about IBS that I have shared with others in this group in case any of these tips are of interest to you. Please ignore the ones that you have tried already. In regards to FODMAP, note that total elimination of all FODMAPs is required for 2 weeks prior to reintroduction:

IBS can be due to a number or combination of factors - these can be stress (including stress from early life experiences) which impacts the communication between the brain and the digestive system. There are lots of free webinars online at the moment regarding mindfulness meditation which might help. Plus you can ask to be referred for CBT or something similar to reduce anxiety - I would have thought online appointments are available. Exercise can play a major role in IBS in terms of reducing stress, helping your gut microbiome and regulating bowel movements.

There is also not absorbing certain types of carbohydrates called FODMAPs very well, the residue ending up in the colon and bacteria feeding off them causing symptoms. Ordinarily feeding gut bacteria is a really good thing - when you feed good gut bacteria these produce by-products that have great health effects in the gut and throughout the body. However, in some people with IBS bad bugs might have the upper hand over good - these bad bugs may cause symptoms such as excess gas, pain or disordered bowel movements. There is an interesting infographic on this here:

gutmicrobiotaforhealth.com/....

This is why it’s worth trying probiotics such as Alflorex (which has been scientifically studied for IBS) or Symprove to crowd out the bad bugs and make their numbers die down. If that doesn't work you can try the FODMAP elimination and reintroduction diet. This is normally under the guidance of a nutritionist via GP referral - this may not be possible at the moment so you can read about it online. If you download the Monash University FODMAP app and Kings College fodmap apps, they will tell you which foods contain FODMAPs and in what quantities. You can eliminate all FODMAPs for 2 weeks and then introduce each type of FODMAP one at a time starting in small quantities, increasing over a 3 day period and wait up to 4 days for symptoms. I go much slower than this - only introducing a small amount (1/4 to 1/3 of a normal portion size) of the same food for 3 days and then increase if tolerable or no symptoms and cut back to the previous amount if symptoms for longer and then try to increment again . I've read your microbiome can adapt to handling a new food if introduced very slowly and your bad bugs are under control with a good probiotic. Ideally you want to eat as many FODMAPs as you can since they are good for your health. Many people with IBS don't have diverse gut bacteria - it has been found that people who lack a diverse microbiome are more prone to diseases in general. In the long run, if you can get your symptoms under control, the ideal situation is to have a very varied diet - lots of different coloured fruits and vegetables, a variety of protein and carbohydrate sources including cereal fibres. This may seem a long way off, but with the right treatment all of this is possible. Last year all I could consume to control my IBS was white rice, protein and limited low fodmap veg. Using the approach above (particularly introducing Alflorex) I am now able to consume far more foods - more than I've ever dreamed of including wholewheat bread which is unheard of for me.

If you are also suffering from pain, you may be suffering from visceral hypersensitivity (functional abdominal pain) - there is info about it here:

iffgd.org/lower-gi-disorder...

It is where the brain interprets the normal activity of the bowel as pain - this is due to a wearing down of neurons in pain control centres of the brain which can be caused by PTSD, neglect or abuse in childhood, extreme stressful events etc. The first line treatment is nerve pain agents such as low dose amitriptyline. There is a theory that being on something like amitriptyline for 6-12 months can help the pain control centre neurons to regenerate. Note that amitriptyline can cause constipation, but this can be helpful in people who are diarrhea dominant. Unfortunately I couldn't tolerate these. Linaclotide (for IBS-C only) & Alflorex have helped me with this intestinal pain.

You may also find assistance with enteric coated peppermint.

You can find some info on self management here:

theibsnetwork.org/the-self-...

If all of the usual IBS remedies fail and you are experiencing diarrhea, it is worth getting tested for BAM (Bile Acid Malabsorption), which can cause constant diarrhea - there is a separate test and treatment for that. Good luck.

[PelucaPastora83 in reply to xjrs]

Thank you SO much! You really

Know your stuff! It’s so odd because I have gone months without symptoms and then suddenly I have been suffering all week. It’s making me a little nervous to eat which isn’t like me. No diarrhoea since yesterday morning but waking up at 3/4am daily in pain.

[xjrs in reply to PelucaPastora83]

IBS can be very much like that and stress can certainly be a trigger, though may be best to get checked out again. I tended to get re-tested whenever I've had flares in the past.

[Andann in reply to xjrs]

Thankyou. Sounds VERY helpful. And back to the morning bowel management. Yes, eat first, have 2 movements or even 3 and you will probably be fine till an hour after lunch. Be near a toilet then. Definitely try low FODMAP and keep a diary. It does seem to help a lot. My worst reactions are with onions, garlic and fats (olive oil usually fine). The worst thing I can possibly eat is avocado , causes extreme nausea, even a tiny piece in a sushi roll.. just saying in case someone else got this and wondered why as it is supposed to be so good for us.