April is IBS Awareness Month, and it is designed to spread the message about the condition that affects 10% – 20 % of the world population. (1) Here we take a look at some of the treatment challenges and the reasons why women are more likely to experience IBS symptoms.
Treatment Challenges
Since IBS is a symptom-based disorder, treatment goals are aimed at resolving symptoms. (2) This has limitations and disadvantages but while IBS is complex and incompletely understood, (3) Naturopaths are adept at exploring the root cause of the problem for each individual and can offer sophisticated testing options such as stool testing using DNA sequencing, SIBO breath tests and blood testing to identify Post-infectious IBS (IBS-PI).
Pain relief remains a significant challenge in the management of IBS, with current interventions including diet, probiotics or antibiotics, antidepressants, antispasmodics, and drugs targeting specific gastrointestinal receptors such as opioid or histamine receptors. (4) There are limitations with each of these options, for example, antibiotics may only improve symptoms short term and antidepressants may come with unwanted side effects.
While diet interventions like gluten elimination and low FODMAP (fructose, oligo-, di-, monosaccharides and polyols) have acquired recognition as valid therapeutic alternatives, (5) there are limitations to remaining on a restricted diet for extended periods of time. For example, the low FODMAP diet consistently demonstrates clinical effectiveness but markedly reduces Bifidobacteria concentration. (6)
Patient education and confidence to slowly reintroduce restricted foods (which will vary for the individual) is an important part of the long term management of IBS. Patients often believe certain food intake is associated with their symptoms and nutritionists are vital to providing dietary recommendations for IBS.
The IBS patient population has a wide variety of symptoms (7) with chronic pain disorders frequently overlapping with IBS, namely fibromyalgia, migraine headache, chronic pelvic pain, interstitial cystitis, and chronic fatigue syndrome. (8) Many of these conditions are more common in women who present to the clinic with a chronic pain disorder only to reveal that they also experience IBS symptoms during a consultation.
IBS Awareness and Women
- It is estimated that 2 out of 3 IBS sufferers are female. IBS female patients are more likely to report: (8)(9)
- dysmenorrhea and premenstrual distress
- constipation and feeling of incomplete evacuation, infrequent stools and hard stools
- bloating, abdominal distension and severe abdominal pain
One of the reasons for this is the dynamic changes in ovarian hormones during the menstrual cycle, which can modulate gastrointestinal contractility, transit, secretion, motility and visceral hypersensitivity. (8) Oestrogen, in particular, can modulate various clinical manifestations of IBS, (10) with significant connections between IBS and endometriosis and polycystic ovary syndrome (PCOS) being reported. (8)
The take-home message for IBS Awareness
Whether you:
- experience gut symptoms and have considered you may have IBS and need further guidance
- already have a diagnosis and need help to better manage your IBS, including a less restricted diet
- are female and noticing your gut is worsening alongside hormonal fluctuations
When it comes to monitoring and managing gut symptoms, seeking professional advice can help to improve the quality of life. Let’s make April the month to have that conversation here at Brisbane Livewell.
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