IBS

05 Oct IBS

My daughter was 2 years old when she walked into our lounge one evening crying, “Daddy, I have a tummy ache…”  

Any irritation to the gut – whether it be from bacterial overgrowth, other microbiome imbalance (dysbiosis), or just the low-grade inflammation associated with IBS, leads to abdominal bloating due to a sharing of the nerve supply between the digestive system and the abdominal muscles.  Image borrowed from “How to Eat, Move & Be Healthy” by Paul Chek

Of course, as any parent would, I went straight to rubbing her tummy and grabbed the thermometer as, in kids, a tummy ache may be a sign of an infection elsewhere. Little kids often get tummy aches when there’s an infection, as somewhere around 70-80% of our immune system lines the digestive tract.  Consequently, when the immune system is stimulated – whether that be through a “tummy bug” or a bug elsewhere in the body, the immune system ramps up, the temperature usually does the same (to facilitate immune function) and the tummy often aches as a result.

The interesting thing in adults is that many of us may suffer from similar bloating or inflammation to my 2 year-old, but we seem to “get by” with it, or ignore it – what Paul Chek terms enteric amnesia – in other words, we’ve forgotten what our guts are trying to tell us.  The enteric nervous system, which informs the brain of what’s going on in the organs seems to misfire (or to not fire)… and so many adults walk around with bloated stomachs – a sure sign of digestive inflammation, sometimes with little or no obvious pain.

Might you have irritable bowel syndrome?

Bloating is a classic feature of irritable bowel syndrome (IBS) which affects about 10-20% of the population.  IBS is categorised into 3 sub-types:

• IBS-D (diarrhoea)
• IBS-C (constipation)
• IBS-A (alternating)

IBS-D, tends to be associated with frequent bowel movements, loose stools and feelings of urgency for 3 or more days per month. IBS-C refers to those who experience constipation, defined as infrequent bowel movements, lumpy or hard stools, a sensation of blockage in the anus and/or rectum area, straining when attempting to pass a stool, and even sometimes the requirement to remove the stool using the fingers. These symptoms also must occur for 3 or more days per month over the last 3 months to meet the criteria of IBS-C. Finally, IBS-A is the same as the former two categories, but alternating between the two – sometimes across weeks or months or, for some, even within a single day.

Regardless of the subtype, most people who have IBS will almost always experience gas and bloating, a feeling of incomplete clearance of the bowel, mucus in the stool and, often, abdominal pain.

This bloating is not only frustrating and aesthetically challenging, but can also impact on function

One of the reasons that IBS is so commonly linked to low back pain is that the bloating found in IBS is an indication that the abdominal wall (core) muscles are not functioning optimally. In this instance, it doesn’t matter how much exercise one does to tone or condition these muscles; they will remain neurologically inhibited or “switched off” until the irritable bowel syndrome is addressed.

When the inflammation, dysbiosis and food sensitivities are addressed, the abdominal wall is able to function optionally again. Image borrowed from “How to Eat, Move & Be Healthy” by Paul Chek

Is your IBS part of a bigger picture of events?

However, there is more to it than this, as IBS has been classified into a group of diagnoses known as “central sensitivity syndromes”. A syndrome is where several conditions tend to come wrapped up in the same bundle – so, with IBS, it is commonly associated with other health challenges, such as interstitial cystitis (recurrent bladder issues), TMJ (jaw joint) dysfunction, dysmenorrhoea (premenstrual and/or menstrual symptoms), post-traumatic stress disorder, fibromyalgia, chronic fatigue or musculoskeletal aches and pains.  Having one of these conditions increases the likelihood of you experiencing one of the others.

When working with people experiencing IBS, our approach is to work both locally with the digestion, and systemically to work with the whole person and their surrounding environment.  A part of how we do this is to assess for overall physiological load and to screen for (and address) the associated central sensitivity conditions to ensure we are not just working with symptoms, but actually addressing all contributing factors.

It turned out, as I rubbed my daughter’s stomach, that I wasn’t helping. “It’s not there daddy, the tummy ache is here”, she said, pointing to her knee!