Occasional diarrhoea, bloating. IBS?

[cassiex]

Hi.

About this time last year I started getting diarrhoea about twice a week. Had this for a couple of months then spoke to my doctor who suggested dietary changes and trying mebeverine which I tried but found no change. Eventually it changed to diarrhoea every weekend, and I thought maybe I was eating differently at a weekend (more likely to have takeaway/eat out) so started being very careful with what I ate (tried low FODMAP, no dairy, no garlic,onions etc) but this didn't help at all.

The last few months its been a lot better, I was able to go 6 weeks without any diarrhoea and then 4 weeks which is so much better! But happened again now only a week after the last bout Does this sound like it could be ibs? I'm hesitant to contact the Dr again because I think they'll say because it can be so intermittent that it's not ibs? I do get bloated occasionally, maybe like a weeks worth out of a month, but not visible bloating. And occasionally I can feel a little constipated, will still go everyday but sometimes may strain more and be small amount (sorry for tmi!) 9 times out of 10 it'll make me have diarrhoea just the once so I just don't know that that sounds like the flare ups etc that I see when I read about ibs.

Sorry for waffling, any help would be appreciated.

Thanks

[Leconfield]

Symptoms can be really random, mine are. I’m now making a note, when it’s been really bad, what I ate the night before and breakfast. Mine gets me after breakfast. I’m back to using Mebeverine before meals hoping I won’t get the sudden need to visit the loo.

[Maureen1958]

Basically IBS is a name (if you can call it that) for any thing that isn't crohn's, colitis or cancer with a few others thrown in for good measure, like celiac disease. It sounds pretty much like IBS to me. Not everyone has flares ups, and some people can go a long time between them and others less time. Then you get people like me that just have it everyday! We are all different or should I say unique!

[xjrs]

I'm wondering if you can link these bouts to stress rather than food?

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. Apologies if this crosses over with things that you have tried already:

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) 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. The year before last 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 anti-spasmodic medication such as 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.