Dr Sachi De Silva from Clifton Beach Medical and Surgical discusses Irritable Bowel Syndrome.
Video Transcription Below.
Dr Sachi De Silva, MBBS, FRACGP
Hi my name is Sachi De Silva. I’m a GP at Clifton Beach Medical and Surgical. I’m originally from, born in Sri Lanka actually and then moved to New Zealand. Grew up there and then did my medical, training at JCU and then come back up to sort of, enjoy lovely Cairns and so today.
I want to talk about irritable bowel syndrome or IBS, which is a common gastrointestinal gut disorder, which is currently affecting about one in five Australians.
What is the cause of IBS?
We don’t know the exact cause of IBS, but we do believe it is triggered by a gut infection or a serious life event or stressful event and there’s a few sort of contributing factors to it as well. So, things such as food tolerances, imbalance in gut bacteria and we also believe that a gut pain hypersensitivity plays a part.
What are the common symptoms of IBS?
So, the most common symptoms are abdominal pain or discomfort which is usually associated with diarrhoea, constipation and or bloating and then based on those symptoms we can sort of classify it further into four main groups really one where the diarrhoea is more common, one where constipation is more common, one where both are more common and one where neither are common.
IBS affects women more often than men
So it is known to affect women more often than men and it’s usually diagnosed under the age of 45.
Conditions or diseases commonly associated with IBS
And people with IBS are also known to more commonly have mental health conditions such as anxiety or depression and other medical conditions such as reflux disease, chronic fatigue syndrome and fibromyalgia.
How is IBS diagnosed?
So, doctors usually diagnose IBS when they can prove that the symptoms are not due to an underlying physical gut disease or another medical condition which may have similar symptoms to IBS. So, this is usually done through a thorough history examination, blood tests and poo tests. So, in a small group of individuals, your doctor may feel like you may need a colonoscopy, just to exclude any significant gut disease.
Signs that call for special attention
Worrisome features that your GP may recognise are things such as symptoms after the age of 50, blood in your poo, unexplained weight loss, iron deficiency anemia or any family history of bowel cancer, celiac disease or inflammatory bowel disease.
What are the treatment options for IBS?
The good thing is there are many treatment options available for irritable bowel syndrome. The one with the most amount of research is following a low-FODMAP diet. FODMAPs is an acronym that encompasses a group of carbohydrates and it stands for fermentable oligo-saccharides, di-saccharides, mono-saccharides and polyols. So, what does this all mean? Well it means that there is a bunch of food groups which are high in these carbohydrates that cause problems for people with irritable bowel syndrome. So, while this list is not exhaustive, I mean, you can find exhaustive lists and charts online or through your dietitian, so, I mean, generally, food groups such as milk products, wheat products, artificial sweeteners, certain beverages, certain fruits and vegetables, legumes and certain nuts cause these symptoms in people.
Is there a cure for IBS?
So, while there is no cure for IBS unfortunately, you can reduce symptoms by up to fifty to eighty percent by just following the low-FODMAP diet.
What is involved in following a low-FODmap diet?
So, what does that involve? So, usually it is a bit of hard work on your behalf. So, there is a period of elimination of all the high-FODMAP foods for about two to four weeks to allow the gut to rest. And then generally your most favourite things from the high FODMAPs list you introduce back into your diet every two to three days and then just see if it flares up your symptoms. And then you do this for a period of, sort of, six to eight weeks finding out what your triggers are. And then you sort of follow a maintenance diet. So, rest assured that you will still be able to have your triggers, such as, ice cream or something like that, you know, in a small amount and occasionally without causing sort of significant symptoms if you’ve been following a sort of a maintenance low-FODMAP diet.
Are the other IBS treatment options available?
So, there are other treatments available. So, these include things like probiotics, medications to reduce gut spasms which can help with the pain and then also a sort of a vast array of treatment for, sort of, other associated conditions such as sort of mental health conditions so, whether that is sort of some relaxation therapy or sort of a referral to a psychologist and some stress relaxation techniques.
Does IBS cause a reduction of life expectancy or other serious disease?
While the symptoms are obviously bothersome for people with IBS, it is also reassuring to know that there is no reduction in life expectancy or it does not lead to any other serious disease.
How do I start the diagnostic process?
So, most GPS will be able to start the diagnostic process of IBS and refer you as needed to a dietician to sort of further discuss and to help you with the FODMAPs diet and if your case is particularly complicated I mean they may need to refer you to a specialist gastroenterologist for sort of further investigations and a colonoscopy if needed.
What is the difference between irritable bowel syndrome and inflammatory bowel disease?
So, some patients ask, “what’s the difference between irritable bowel syndrome and another sort of common term, inflammatory bowel disease?” So, inflammatory bowel disease is a more sort of serious condition where there is actually physical gut damage due to a certain sort of trigger and where then the body starts to sort of attack the gut. Common conditions are Crohn’s disease or ulcerative colitis. So, that’s usually where people have sort of significant blood or mucus in their bowel, they’re losing a lot of weight and they generally feel quite unwell. In comparison, irritable bowel syndrome is usually diagnosed when you have excluded inflammatory bowel disease and there is no sort of significant physical gut disease.
So, in summary, IBS is a really common disorder and if you have any sort of bloating or abdominal pain or sort of change in bowel habit it’s probably a good idea to see your GP and so that they can start the process of figuring out what’s going on.