What is IBS?

Many clients come to me because they are confused and upset by their “stomach issues.” It’s usually some combination of bloating, gas, intestinal pain, reflux and of course all manner of poop problems. Pooping too often or not often enough; poop is too runny, too hard, or somehow both. And it’s always too consuming. In a few words, this is:

IBS: Irritable Bowel Syndrome.

IBS is categorized as a “functional disorder,” which means that while everything may feel wrong inside, nothing looks especially wrong on colonoscopies or in blood tests. This can make people feel crazy—and especially women, who IBS disproportionately impacts, and who are routinely made to feel that they’re crazy anyway.

So, if this feels familiar…

You’re not alone!

Of course, in reality something is going wrong physiologically, but our diagnostic tools are not yet sophisticated enough to pick it up. Part of my motivation for becoming a Nurse Practitioner is to join a community of researchers who are working to understand the physiological mechanisms of IBS. In the meantime….

Where do I start if I have IBS?

What do you do with a mysterious condition that has no medical fix and no timeline for resolution? I find it helpful to break IBS treatment into two parts.

1. Short-term Strategies: Get relief from pain and discomfort. This part takes some dedication on your part. But it’s well worth it because you can feel better. 

2.  Long-term Strategies: Find and grow the strategies that will improve your condition and be sustainable in your life. Once the short term strategies help you regain comfort and ease, this maintenance phase is much easier! So, no, your life is not permanently tied to a long list of restricted foods and proximity to a toilet.

 Each person is unique and complex. That’s why therapies need to be personalized. But, in my own work with clients, I always make sure the plan has at least these three prongs:

1. Herbs

I use herbs judiciously, primarily to help people feel relief, especially from three symptoms that respond well: pain from gas, acid reflux and nausea. Herbs can also support good sleep and promote relaxation (see below on why that’s important). I have a grab-bag of 10-15 favorite herbs here. Catnip and lemon balm are two of them. Some of my other favorites are marshmallow root, licorice and peppermint.

II. Diet

The quickest and surest way to get relief from IBS symptoms is to reduce or eliminate foods that cause pain, bloating, and other symptoms. But the mistake I see a lot of people make is to cut out lots of foods, and to do so without any plan for bringing them back in. Over time, this reduces the diversity of your microbiome, and is not supportive of overall wellness. Never mind how much it impacts your flexibility and quality of life!

Recently, I’ve been guiding people through the low FODMAPS diet, whose efficacy is backed by significant research. More about that in my next post. Long story short: it has a weird name, and it’s a bit of work, but it often works, so hallelujah! And, when done correctly, it provides a clear plan for re-introducing foods so you only cut out those that are actually not working for you.

III. Stress-reduction Techniques

This is an essential component of treating IBS. IBS shouldn’t be thought of as just a GI disorder, but one that takes place at the intersection of the GI and nervous systems—i.e., a gastro-neuro disorder. In fact, research shows that IBS is often precipitated by a stressful event or time.

Strategies that reduce stress are many and it’s important to choose those that work for you. Some strategies, like Mindfulness-Based Stress Reduction and yoga, are backed by research that supports their efficacy in reducing IBS. But you don’t have to wait for placebo-controlled studies to find the things that are relaxing to you: take a warm bath, a leisurely walk around a park, or read a book you enjoy. For the record, I do my own research on the belly-soothing ability of baths every night—and I’m here to declare that aqua-therapy for IBS should be get some funding to be studied!

For the purposes of this post, I’m lumping physical activity and sleep into the stress reduction category, which is of course unfair. They are important enough to deserve their own categories. But I do so because moving your body and getting enough sleep are essential parts of stress reduction and building overall resilience.

IBS Bottom line

IBS can be really debilitating, but it does NOT have to run—or ruin—your life. There are absolutely ways to feel better! As always, if you just want someone to talk to about your condition and options, please reach out.

Naliboff, B. D., Smith, S. R., Serpa, J. G., Laird, K. T., Stains, J., Connolly, L. S., Labus, J. S., & Tillisch, K. (2020). Mindfulness‐based stress reduction improves irritable bowel syndrome (IBS) symptoms via specific aspects of mindfulness. Neurogastroenterology & Motility, 32(9). https://doi.org/10.1111/nmo.13828

Rej, A., Aziz, I., Tornblom, H., Sanders, D. S., & Simrén, M. (2019). The role of diet in irritable bowel syndrome: Implications for dietary advice. Journal of Internal Medicine, 286(5), 490–502. https://doi.org/10.1111/joim.12966

Shahabi, L., Naliboff, B. D., & Shapiro, D. (2016). Self-regulation evaluation of therapeutic yoga and walking for patients with irritable bowel syndrome: A pilot study. Psychology, Health & Medicine, 21(2), 176–188. https://doi.org/10.1080/13548506.2015.1051557