Irritable Bowel Syndrome (Diarrhoea/Constipation/ Wind/Bloating)
Written by Aoife McDonald, Consultant Dietitian and Founder, The Digestive Clinic
Introduction
Irritable Bowel Syndrome (IBS) is a prevalent functional gastrointestinal disorder affecting up to 20% of the Irish population. It manifests with a range of symptoms, including diarrhoea, constipation, wind, and bloating, and is diagnosed using the Rome IV criteria, which are outlined below:
Recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of the following criteria:
• Related to defecation
• Associated with a change in the frequency of stool
• Associated with a change in form (appearance) of stool
IBS symptoms can vary in severity and can be triggered by a number of factors, which I will touch on below.
What causes IBS?
The exact cause of IBS is unknown, and may be linked to genetics, imbalances in the gut microbiota, stress, or it may be caused by an infection, as is the case in post-infectious IBS.
IBS tends to affect more men than women, and factors that exacerbate symptoms can vary from person to person, ranging to hormonal changes related to the menstrual cycle for many women, to the foods we eat, as well as stress.
Challenges at Christmas Time
Diet
For many individuals with IBS, dietary factors are a common trigger for worsening of symptoms. During the Christmas period, a number of challenges may arise for those who are sensitive to certain foods due to changes in diet and routine. During the few weeks we are celebrating Christmas and New Year, we often eat out a lot more frequently, consume more alcohol, and indulge in more rich and creamy foods than we normally would. In addition to this, we also tend to visit other people’s homes more, where control over food choices can be limited. These factors can make it challenging for those with IBS to avoid known trigger foods, which can lead to more IBS flare-ups over the festive season.
Irrespective of the particular foods we eat, the volume of the foods consumed over Christmas can be problematic for some. The physical stretching of the stomach and intestines alongside the gut hypersensitivity associated with IBS, can lead to people feeling bloated and uncomfortable, and even in pain.
As a result of the above, more people with IBS are likely to be dealing with uncomfortable gut symptoms during the Christmas and New Year celebrations.
Stress
As well as diet potentially worsening IBS symptoms in some individuals, stress is also a well-established trigger for gut symptoms. This is primarily due to the bidirectional communication that occurs between the gut and brain, often referred to as the gut-brain axis.
While Christmas is a joyful time, the associated stress of planning, social obligations, and spending time with friends and family can intensify symptoms for some. For those with food sensitivities, even the worry of trying to avoid a trigger food can itself cause gut symptoms, regardless of whether a trigger food is eaten or not.
Increased stress and anxiety may also be experienced by individuals with IBS who may be dealing with more urgent or loose stools, and who may feel anxious about whether they will have access to a toilet if they are out, or they may have anxiety surrounding using the toilet at the home of a friend or family member due to a lack of privacy. Again, even the anxiety around the potential ‘what-ifs’ can be enough can induce gut symptoms in certain individuals.
Changes in routine
Alterations in meal timing and routines can also provoke symptoms in some individuals. Those with IBS-C (constipationpredominant IBS) may be particularly sensitive to factors such as changes in their usual meal pattern, reductions in movement and changes in their sleep schedule, leaving them at greater risk of less frequent and more difficult to pass bowel movements during the Christmas period. Due to constipation, many people are also coping with the increased wind and bloating that often accompanies it.
Alcohol intake
Certain beverages, notably alcohol and carbonated drinks, can be a common cause of heightened gut symptoms.
Alcohol acts as a gut irritant, which can affect gut motility, while carbonated drinks (with or without alcohol) can introduce excess air into the digestive system, leading to increased wind and bloating. Excess alcohol intake is also associated with dehydration, which of course can hinder optimal gut function. Alcohol consumption can also influence our food choices, leading us to choose more highfat and high-sugar options more frequently and in larger quantities. Common problems presented at the pharmacy Over-the-counter (OTC) products can assist individuals in managing their symptoms as effectively as possible during the Christmas period.
For those with constipation, fibre supplements or osmotic laxatives may be helpful for promoting more regular and comfortable bowel movements.
On the other hand, for individuals experiencing increased loose stools, having anti-diarrhoeal medication readily available can provide a sense of control and comfort, especially when away from home.
Indigestion and heartburn presentations are also frequent during this period, often due to increased alcohol intake, eating more fatty foods & larger portions. The pharmacist may recommend an antacid medication to help the individual get fast relief from their symptoms.
Due to a higher intake of particular trigger foods (e.g. high FODMAP foods) or more carbonated drinks, increased wind or trapped wind can be a common issue, and simethicone-based products may help alleviate this discomfort.
Taking all this into consideration, it is fair to say that pharmacists play an extremely important role in helping IBS sufferers to manage their gut symptoms, especially at this time of year.
Quick tips to minimise gut symptoms over Christmas
Fibre: maintaining a certain level of fibre intake may be particularly beneficial for those who are more sensitive to the effect of fibre. Incorporating more fruits and festive vegetables into meals, adding seeds to cereal and yoghurts or snacking on nuts are all simple strategies to help maintain a good fibre intake when out of our normal routine. In some cases, temporarily enlisting the help of a fibre supplement can be helpful if access to high fibre foods is an issue.
Minimise triggers: every person with IBS will have different triggers for their symptoms, whether that be FODMAPs, fatty foods, caffeine, alcohol, stress, lack of exercise, and so on. In order to reduce the risk of a severe flare-up, it is advisable to avoid or minimize known triggers as much as possible, and make a realistic plan of how to do so over the Christmas period.
Hydration: staying adequately hydrated, especially if alcohol is being consumed, is an important aspect of IBS management. Aiming for a daily intake of about 2 litres of water daily can help to support digestion.
Movement: planning regular movement into the day can help to keep digestive symptoms at bay. It does not have to be anything strenuous, even just a gentle walk or some yoga can help to support digestion and calm the gut-brain axis.
Chew food well: savour food and chew it thoroughly, to a puree consistency if possible. This can help slow down eating, prevent overeating, and reduce the risk of feeling overly full.
Self-care: taking some time each day for self-care is important to prioritise. Embracing moments of relaxation and recovery where possible to help ensure we are starting the New Year feeling refreshed and recharged.
Conclusion
Irritable Bowel Syndrome is a common condition that can be exacerbated during the holiday season due to dietary changes, increased stress, and disrupted routines. Pharmacists have a vital role to play in helping individuals with IBS manage their symptoms effectively during Christmas time. By providing education, guidance, and support, pharmacists can help patients enjoy the festive season with greater comfort and peace of mind.
