Best ways to battle irritable bowel syndrome

When your stomach hurts and your digestion is all over the place but all test results are negative, irritable bowel syndrome is often to blame. Gastroenterologist Peter Musselmann explains how those affected can still live a normal life.

Text: Nicole Krättli; photo: iStock

“There’s nothing wrong with you!” That’s the message those affected often hear – even though they’re suffering frequently from stomach cramps, digestion problems or bloating. That’s because irritable bowel syndrome (IBS) is an invisible illness.

This puzzling disease is seen in a range of symptoms such as cramping, abdominal pain, bloating, gas as well as diarrhoea or constipation, or both. It is estimated that 10% to 15% of the Swiss population suffer from IBS. However, as diagnosis is very difficult, the number of unreported cases is probably much higher. 

Causes of IBS unclear, women more often affected 

Studies show that those affected often suffer from disrupted bowel movements and the intestinal mucosa reacts more sensitively to mechanical or chemical stimuli. Psychological factors such as nervousness, anxiety or grief can also affect digestion and exacerbate irritable bowel syndrome.

It’s interesting that there’s no clear evidence that an unhealthy lifestyle can contribute to the development of IBS. “In fact, in all the years I’ve been practising medicine, I’ve seen that many patients with IBS often avoid stimulants and unhealthy foods,” says Dr Peter Musselmann, gastroenterologist and telemedicine doctor with Medgate.

And there’s still no clear scientific support for the theory that intestinal fungal infections could be a trigger for IBS. Fungi are part of the natural flora of our intestines, and their quantity varies from person to person, depending on factors such as dietary habits.

So the exact causes of IBS still remain a mystery for medical science. However, it’s undisputed that women suffer from IBS more than men. One reason for this may be the female sexual hormone oestrogen. For example, high oestrogen levels reduce intestinal activity, so digestion takes longer. This could mean that women with irritable bowel syndrome suffer from constipation. Oestrogen can also influence how much pain you feel and therefore exacerbate the symptoms of IBS.

How is IBS diagnosed?

Medical examinations of patients often show no pathological changes, which makes diagnosing IBS a real challenge. Peter Musselmann is familiar with this problem: “Before doctors can diagnose irritable bowel syndrome, they have to rule out a long list of other potential conditions,

ranging from recurring infections and food intolerances to allergies and bowel disorders caused by bacteria, viruses or fungi.” Chronic inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis as well as potential tumours in the bowel or ovaries also have to be excluded.

The exclusion process involves several tests and examinations. These may include gastroscopy, colonoscopy, abdominal ultrasound, blood tests with complete blood count, liver enzyme, salt, thyroid and kidney values, and stool tests to rule out parasites. If all these examinations don’t reveal any organic findings, but the patient suffers from cramping abdominal pain, severe flatulence, diarrhoea or constipation over a longer period of time, the diagnosis is usually irritable bowel syndrome.

Wide ranging symptoms of IBS patients 

While irritable bowel syndrome may be difficult to pin down diagnostically, the distress it causes is very real. IBS is a master of disguise and can show itself in a wide variety of symptoms.

Patients most commonly report abdominal pain and generally feeling unwell. Other common symptoms also include irregular bowel movements, be it constipation or diarrhoea and bloating.

And the complaints are not limited to the abdomen, with many people also suffering from back pain, joint pain and headaches. Anxiety and depressive moods are also typical.

Given the variety of symptoms, IBS can easily be confused with other medical conditions. Musselmann also warns that there are also some indications that speak against irritable bowel syndrome and could point to another disease. “If symptoms come on very suddenly, you lose a lot of weight or discover blood in your stool, it’s important to see a doctor right away.”

Another sign that it’s not irritable bowel syndrome is when stress doesn’t aggravate the symptoms and relaxation doesn’t improve them. “Irritable bowel usually doesn’t interfere with a good night’s sleep either. So if the complaints interrupt sleep, then further investigations are urgently needed,” says Musselmann.

In any case, it’s worth discussing prolonged complaints with a specialist. 

Treatment: how to get symptoms under control

When IBS strikes, treatment tends to be based on the most pronounced symptoms. With milder cases, nutritional advice is often enough. It’s also worth avoiding certain foods that are particularly stressful, including vegetables that are known to cause bloating such as cabbage, beans and onions, as well as coffee and hot spices.

However, the reality is that little research has been done on the influence of diet on IBS, so those affected often have to find out for themselves which foods they should avoid. It can help to keep a food diary for several weeks. You should not only record what you’ve eaten, but also the symptoms you’ve experienced and whether other factors – such as stress at work – may have had an impact on your well-being. 

An Australian study has also researched a special form of diet that is very effective in soothing the bowel: the FODMAP method. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These fast-fermenting carbohydrates can be found, for example, in sweets, bread (especially wheat), dairy products, stone fruit and cabbage. Polyols (sugar alcohols) are found in many industrially manufactured products as sweeteners or humectants. Avoiding all of these ingredients can help manage intestinal discomfort.

As the FODMAP method is a radical diet, you should only do it under medical supervision. After four to eight weeks of extreme dieting, the various foods are then gradually introduced again.

It is important to record in a food diary which foods you’ve eaten and which symptoms occurred after eating them. This is the only way to find out what your bowels can handle and where symptoms arise.

Before resorting to medication, it is also worthwhile to try natural home remedies. 

Home remedies for stomach ache:

  • Fennel seeds in tea can help ease stomach cramps
  • A hot water bottle, cherry stone cushion or a warm shower can have a relaxing and relieving effect 

Home remedies for bloating

  • Peppermint tea can help reduce bloating and cramps
  • Aniseed also helps reduce bloating and cramps
  • Cumin oil relaxes the bowel muscles
  • Heat stimulates the circulatory system and relaxes the bowels 

Home remedies for diarrhoea

  • Peppermint tea soothes the intestines and can thus curb diarrhoea 
    Home remedies for constipation
  • Dried fruit and sauerkraut stimulate digestion
  • Psyllium taken together with water can loosen the stool and thus facilitate bowel movements
  • Probiotics contain various bacteria that are important for intestinal function

In challenging life phases, Musselmann also recommends talk or behavioural therapies where patients learn various coping strategies. Relaxation techniques such as autogenic training or yoga can provide a way to manage stress and restore inner balance.

However, if these therapeutic approaches don’t provide relief, medication can also help alleviate painful and troublesome symptoms. “Because of the many possible triggers and symptoms of IBS, it’s important to discuss drug treatment with a specialist and to use it only for a limited time,” says Musselmann. 

Four top tips to relieve IBS symptoms

Eat slowly: The way you eat plays a crucial role in keeping your digestive system healthy. Take your time with eating and focus on what you’re doing. And don’t forget to chew your food thoroughly. This way, digestion starts in your mouth and eases the burden on your stomach, small intestine, pancreas and gallbladder.

Eat a balanced diet: What and how much you eat has a significant impact on digestion. A balanced diet rich in fibre, including plenty of natural foods, fresh fruit, vegetables and salad, aids digestion. Although a high-fibre diet is important, the amount of fibre you eat should only be increased slowly to prevent bloating and stomach pain. Fibre can cause digestive problems, especially for people who have limited mobility or are bedridden. Oats, linseeds and psyllium can help with constipation, because they improve the lubrication of the stool.

Drink plenty of fluids: Sufficient fluid intake is essential for good bowel function. A lack of fluids in the bowel can lead to digestive problems such as constipation. Generally, a fluid intake of at least two litres a day is recommended, ideally water, juice or tea.

Exercise regularly: Moderate-intensity activities that strengthen the stomach muscles as well as hiking, swimming, cycling and yoga help keep the bowels moving.