I have had IBS C for over 20 years. I am aware that stress plays a big part in my condition. I have tried hypnotherapy and CBT gut related therapy (NHS) None have helped. At night I take a single Amitriptylene. I'm wondering if one to one therapy with some kind of stress manager might be the way forward. They would give me a simple and straightforward practical programme. This would be reinforced by follow up visits to keep me focussed. I appreciate this may not available via the NHS. What suggestions do you have to aid my search ?

Answer: As you will know with IBS, what works for one person, isn't going to necessarily work for another.  I would advise against dismissing hypnotherapy and CBT approaches altogether, as of key importance is finding a therapist with whom you can feel comfortable.  To help your research have a look at our Counselling and Psychotherapy; Hypnotherapy and Stress, Trauma and IBS factsheets. Included in those factsheets are details of all the professional bodies and associations through which you will be able to find someone suitably qualified in your geographical area and in an approach which aligns with your thinking. I would also reacquaint yourself with the self care programme as you will find lots of useful advice.

Is there a test for IBS? 

Answer: No. IBS is diagnosed by a combination of long term bowel disturbance and abdominal discomfort for which there is no other cause. Doctors should rule out other diseases of the bowel by conducting screening tests for Cancer, Inflammatory Bowel Disease and Coeliac Disease. 

Why does IBS come and go?

Answer: It may tend to be due to fluctuations in your diet but is more often caused by changes in your life. Every change is a stress and may be perceived in the context of previous life events as a threat or loss which may stimulate the areas in the brain stem that control bowel function.Keep a wellness diary or fill in your symptom tracker. Try to identify the changes. If you know what they are, you can more easily avoid them or deal with them. 

Is there a cure for IBS? 

Answer: No but it can be managed and it may disappear with a change in life.   

Do people ever get over IBS?

Answer: Yes they do. IBS does seem to mellow with age, but when people have been able to change their life and leave a stressful situation or work through what has happened, they symptoms can go.       

Does IBS run in the family?  

Answer: It can but that does not necessarily mean that there is a genetic link.  It could just be that members of the same family share the same colonic bacteria, eat the same diet, have the same stresses and identify with each other’s symptoms. 

Could I have a food allergy?  Are allergy tests useful?

Answer: Food allergy is generally thought to be rare in adults with IBS, though it is more common in children. Therefore allergy testing is generally not useful and may be misleading. Antibodies to common foods may suggest a normal response to a somewhat leaky gut. On the other hand, food intolerance is present in most people with IBS and may come and go according to fluctuations in the sensitivity of the gut. Foods that are implicated are fats, hot spices, coffee, alcohol, insoluble fibre and poorly absorbed fermentable sugars (FODMAPs) that either retain fluid in the gut and cause diarrhoea or are fermented by colonic bacteria releasing gas. 

Why did it all start?

Answer: The person with IBS is the best place to answer that. They may have been abroad and had an attack of gastroenteritis, the gut might have been upset by a course of antibiotics, they might have changed the diet, but the most common cause is a life change, which may have upset their system. This may be due to leaving home, going to university, the start or the break up of a relationship, a severe disappointment, the death of a close relative.  Life events tend to feel more devastating when we are young and trauma can often ‘go to the gut’.

How can stress cause IBS? 

Answer: IBS fluctuates according to the stresses and changes in life. Stress can excite the brain stem centres that control bowel function. Finding time and space to think damps down the activity and reduces symptoms.       

What causes my bloating? 

Answer: Bloating may be caused by an increase in gas production due to eating foods that contain FODMAPs, but most people with bloating do not have an increase in intestinal gas. What they do have is an increase in intestinal sensitivity (a sensitive gut) and a change in abdominal posture,descent of the diaphragm and relaxation of the muscles of the abdominal wall that causes the abdomen to protrude, both of which may be related to tiredness and an increase in emotional tension.    

What can I do to calm my symptoms?

Answer: Keep a symptom diary on which you can identify the flare ups of your IBS and any changes in diet or events that that occur before those. Once recognised, these may then be avoided or dealt with.Try to find time and space in your life to do something for you. This might be going to yoga classes, sunning, swimming, learning to draw or paint, cooking. Exercise and creative activity are all forms of mindfulness that can allow respite from IBS and what causes it and may allow you to consider life changes.           

Why do my symptoms alternate between diarrhoea and constipation?

Answer: In about 20-30% of people, symptoms switch between diarrhoea and constipation. The reason for this is not clear, but some people demonstrate fluctuations in eating behaviour and emotional expression/behaviour.      

What can I take for diarrhoea?  

Answer: Loperamide is the most common drug taken for diarrhoea but it can cause abdominal pain and constipation in some people. Bile acid sequestrants such as Questran can mop up irritant bile acids that are not well re-absorbed in people with IBS-D and can be very useful when Loperamide is not tolerated, but they have to be taken before meals and balance the dose with the size of the meal as well as the response of the symptoms.  A diet low in fructose (fruit sugar) or lactose (milk sugar) can be very effective in people who do not absorb these sugars well.       

How can my headache and backache all be due to IBS? 

Answer: Although is defined by typical bowel symptoms, people often have many other unexplained symptoms affecting other regions of the body. These include backache, headache, fatigue, muscle pains, bladder irregularity and many other symptoms.  All of these symptoms might be triggered by stress since stressful events can excite the centres in the brain stem that control body function. This would explain why symptoms come and go according to the changes in a person, and may seem to represent the memory and the meaning of previous traumatic episodes.      

My gut upset started with an attack of gastroenteritis, but has never gone away? 

Answer: About 10% of people who suffer an attack of food poisoning or gastroenteritis develop persistent symptoms of IBS. The reason for this is not clear and may be related to changes in colonic bacteria, the gut immune system and the leakiness of the gut wall as well as changes in the brain stem centres controlling the gut.  Post infectious IBS is more common in people who have suffered a more severe attack and who were also depressed, anxious and experience difficult life events at the time.           

Does a low FODMAP diet  work? 

Answer: Excluding foods that contain FODMAPs (some fruits, onions, pulses, broccoli, sprouts, artichoke, wheat, milk and dairy) has been shown to reduce symptoms in about 70% of people with IBS, but unless these are reintroduced piecemeal to find out which foods are particularly implicated, they might leave the bowel vulnerable and the person with a nutritionally depleted diet.  A more pragmatic solution for most people might be the restriction of FODMAP foods during times when your IBS flares up due to life changes or stresses.

What can I do if my low FODMAP diet does not work?   

Answer: FODMAPs are not the only foods that may stimulate a sensitive gut. A lot of people are sensitive to fats, so reducing the intake of dairy, fried foods and red meat can help. Similarly avoiding hot spices, insoluble fibre and coffee may help.  Stress can make the bowel sensitive to FODMAPs so another approach would be to identify any stresses in your life that are causing flare ups and either avoid or deal with them. Your symptom tracker should help you do this.  

Should I go on a gluten free diet?

Answer: Many people have found that going on a wheat free diet reduces symptoms of IBS, but this may not be so much due to exclusion of gluten as reduction in FODMAPs.

Which probiotics work best?  

Answer: Some probiotics may help to reduce symptoms of IBS in some people some of the time, though the differences in bacterial strains, preparation and delivery (freeze dried or in a liquid medium) means there is no clear advantage of one product over any other. Intuitively those with multiple strains are delivered in a nutrient medium that survive passage through the stomach should work better, but the evidence is uncertain as to whether that is the case.    

Do complementary therapies work? 

Answer: Yes, they can. Complementary therapists are healers. They spend time finding out about you and what brings on your symptoms and then customise their treatments to suit your requirements. Complementary therapies are subjective treatments and as such cannot be assessed by blinded controlled trials, but the attention, active listing, time and understanding can be therapeutic. Chose a therapist you get on with.      

Should I see a counsellor? 

Answer: If you know that your IBS is brought on or associated with stressful episodes, a counsellor or therapist may help you bring them out of your gut and into your mind where they might be dealt with. Counsellors are also conversant with mindfulness techniques that may relax your system and help you think and focus.   

Does IBS ever lead to cancer? 

Answer: There is no evidence that IBS leads to cancer, but people developing IBS for the first time in later life (after the age of 50) should be investigated by colonoscopy.   

Could I have Cancer or Crohn’s Disease?  

Answer: The symptoms of IBS can resemble those of Bowel Cancer, Coeliac Disease or Inflammatory Bowel Disease (Crohn’s and Colitis) but these can be screened by specific tests. The recent NICE Quality Standards (National Institute for Health and Care Excellence) for IBS recommends that everybody with ongoing symptoms of IBS should be screened for these diseases by blood or stool tests. 

My doctor has done lots of tests and can find nothing wrong?  What else should be done?

Answer: IBS is defined as a combination of bowel disturbance (constipation or diarrhoea) and abdominal discomfort (bloating or pain), for which there is no obvious cause.  There is no diagnostic test for IBS, but there are tests for colitis, Crohn’s Disease, coeliac disease or bowel cancer, which might cause the same symptoms. So IBS is for most doctors a diagnosis of exclusion.  If all tests are negative and you have no worrying symptoms like blood in the stool or weight loss, there is little to be gained except worry by doing more investigations.

To Read More join today to access Member Exclusive Content

To Read More join today to access Member Exclusive Content