The IBS Compass: Irritable Bowel Syndrome Tips, Information, Fiber Charts, and Recipes

Preface

I am not a doctor, naturopath, faith healer, acupuncturist, or health-food fanatic.

I’m someone just like you: someone whose life has been turned upside down by IBS.

Before I was formally diagnosed, there was little help from my medical doctor other than being told to avoid roughage. I had no idea of what roughage is.

Over time, I developed personal coping strategies to help manage stress and to improve my mood. It’s hard to relax when you feel extreme cramps and waves of nausea. However, I learned to do it. I share these techniques with you in the Coping Strategies chapter.

I spent hundreds of hours doing research, poring through books, and visiting internet sites. There were mountains of information, much of it confusing and contradictory. I weeded through all the data, and here’s an overview of what I found. Be sure to read the entire book. Some things mentioned in passing are explained in more detail elsewhere.

Remember: This is a COMPASS, not a comprehensive encyclopedia of irritable bowel syndrome. A compass must be calibrated before it works correctly. It allows you to take any path you want. If you use it properly, it can steer you in the right direction. Once you have explored the various paths, you control your final destination.

This book is a compilation of information that’s intended to make you think. It guides you toward therapies you might not have tried yet. It mentions many popular (and a few rather unconventional) theories, but doesn’t cover every treatment option available.

Fiber Charts:

Online information and books about IBS made me realize that not all fiber is created equal. Roughage is insoluble fiber, often scratchy in texture. I needed to increase my intake of soluble fiber, the soothing substance that turns into a gel and helps calm an irritated digestive system.

It was impossible to find a book with complete fiber data.

Spreadsheet to the rescue.

I compiled data from multiple sources, including food labels, government publications, and manufacturers’ websites. At times, I e-mailed manufacturers directly. If there were multiple entries for a single food item, I scrutinized the value ranges and discarded anything that looked excessively high or low when compared to the list. At that point, I ended up with several mid-range entries, and picked one based on common sense and previous research.

I created several fiber charts and published my first book about irritable bowel syndrome, IBS-IBD Fiber Charts: Soluble & Insoluble Fibre Data for over 450 Items, Including Links to Internet Resources. Those charts are also included in this book.

Whenever I had a decent day, I prepared food that I could freeze and warm up for those all-too-frequent occasions when the bathroom and I were constant companions.

To improve the quality of my nutrition, I developed a few simple survival recipes, some of which I share with you in this book.

One of the most important lessons I’ve learned on this journey is that I can’t be a superhero. I can’t do everything myself. I have family and friends I can rely on, and when they offer help, I’ve learned to accept it.

In this book, I don’t discuss prescription medications for IBS. It’s beyond my expertise or desire to cover the constantly changing pharmaceuticals that might be prescribed. Medications are a matter to be discussed with your doctor.

You MUST receive a formal diagnosis before you assume you have IBS.

References

If you’re reading this book on a digital device with a touch screen, be careful whenever you reach the References portion of each section. It’s easy to activate a link by accident.

I contemplated including all references in a separate chapter, but decided they would be more useful when placed close to the applicable content.

Disclaimer

The material provided in this book is for informational purposes only. It is not meant to replace proper medical diagnosis, treatment, or advice. Always consult your physician and other appropriate health-care providers before taking any medications, natural remedies, or supplements; or before changing your diet. Discuss all plans, symptoms, and medical conditions with your doctor.

Any use of the ideas contained herein is at your own discretion, risk, and responsibility. The author assumes no liability for any of the information presented. There are no representations or warranties, either express or implied.

You should not begin or discontinue medical treatment based on information contained in this, or any other, book.

What Is IBS and What Causes It?

Here’s some information about IBS symptoms, the criteria for diagnosis, and a list of other conditions that may coexist with it.

Irritable bowel syndrome is a functional disorder of the gastrointestinal tract. It’s not a disease like Crohn’s or inflammatory bowel disease.

Symptoms vary widely from person to person, but they may include some of the following:

• Abdominal pain, sometimes localized to lower left quadrant

• Bloating

• Diarrhea

• Constipation

• Alternating diarrhea/constipation

• Change in stool consistency or appearance

• Mucous in stool

• Feeling of incomplete evacuation after bowel movements

• Sunset onset of uncontrollable urges to have bowel movements

• Excess gas

• Pain when sitting down

• Excess gurgling/rumbling/growling in stomach and abdomen

• Nausea and vomiting

• Burping

• Loss of appetite

• Unpleasant taste in mouth

• Heartburn

• Backache

• Lethargy

• Anxiety and/or depression

• Insomnia

• Heart palpitations

• Irritable bladder or incontinence

• Gynecological problems

As you can see, it’s a long list. Many of the symptoms can be caused by other illnesses or conditions. Please don’t self-diagnose. See your doctor, or several if necessary, until you have a specific diagnosis.

If you experience any of the following, get to the hospital or see a doctor immediately. They’re NOT symptoms of IBS:

• High temperature

• Blood in stool, or fresh bleeding with bowel movements

• Constant, unrelenting pain

Most experts agree that IBS doesn’t produce permanent damage, and it doesn’t cause conditions such as cancer or inflammatory bowel disease.

What Causes IBS?

Discussions with several doctors, nurses, and a dietician provided no answers to this question. The internet offered nothing definitive either. However, I discovered guidelines that help physicians diagnose irritable bowel syndrome. Called the Rome III Criteria, you can get more information at TheRomeFoundation.org.

The average patient sees three doctors over three years before finally receiving a proper diagnosis.

The criteria for irritable bowel syndrome include recurrent abdominal pain or discomfort at least three days per month in the last six months, associated with two or more of the following:

- Improvement with defecation

- Onset associated with a change in frequency of stool

- Onset associated with a change in form or appearance of stool

It’s important to obtain a specific diagnosis before you assume you have IBS. Other diseases may cause similar symptoms, and they must be ruled out before making any assumptions. There’s no diagnostic test available yet that can prove you have irritable bowel syndrome. However, extensive examinations can rule out other more serious conditions such as celiac disease, bowel cancer, and Crohn’s.

My most extended, severe attack was preceded by:

• Several months of extreme stress and worry about my ill husband

• A hectic, changing schedule

• Lots of coffee to stay alert while driving to the hospital, three hours away

• Chewing several sticks of sugar-free gum daily

• Not enough sleep

• Not enough fluids

• Very little exercise

• Poor diet, mostly consisting of hospital cafeteria food

• Consoling myself with ice cream, which contains fat and carrageenan

• A course of antibiotics

• Medications for thrush, yeast infection, and GERD

I visited several doctors and had multiple tests before a final diagnosis was provided. A locum in the ER said I had diverticulitis, and he prescribed antibiotics. Another doctor seemed indifferent and told me to avoid roughage. One doctor even suggested I should have a CAT scan of my brain. Did she think it was all in my head?

After several attempts, I finally found a physician who truly listened to me, sent me for basic food-allergy screening, referred me to a dietician, and provided emotional support when I needed it.

I have her telephone number memorized.

Other Conditions that May Affect People with IBS

According to recent research, those with IBS may also suffer from one or more of the conditions on the following list.

• Fibromyalgia syndrome (FMS)

• Chronic fatigue syndrome (CFS)

• Myofascial pain syndrome (MPS)

• Temporomandibular joint disorder (TMJ)

• Restless leg syndrome (RLS)

• Reflex sympathetic dystrophy (RSD)

• Complex regional pain syndrome (CRPS)

• Periodic limb movement (PLMS)

• Multiple chemical sensitivity syndrome (MCSS)

• Tension headaches

• Irritable bladder

• Primary dysmenorrhea

• Migraine headaches

• Vulvodynia

There may also be an overlap of conditions such as

• Globus

• Functional chest pain

• Functional heartburn

• Functional dysphagia

• Functional dyspepsia

• Aerophagia

• Functional vomiting

• Rumination syndrome

• Functional abdominal bloating

• Functional constipation

• Functional diarrhea

• Functional abdominal pain

• Gall bladder dysfunction

• Sphincter of Oddi dysfunction

• Functional fecal incontinence

• Functional anorectal pain

• Functional defecation disorders

Functional disorders don’t produce abnormal test results, and nothing unusual is seen on endoscopy or x-ray. These disorders are generally diagnosed by deciding what they aren’t and then categorizing them by symptoms.

References:

You can find the following links online at:

http://kathysteinemann.com/Musings/compass

http://www.webmd.com/ibs/guide/irritable-bowel-syndrome-ibs-symptoms

http://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/basics/symptoms/con-20024578

http://www.emedicinehealth.com/irritable_bowel_syndrome/page2_em.htm

http://www.romecriteria.org/assets/pdf/19_RomeIII_apA_885-898.pdf

http://www.iffgd.org/research-awards/2003-award-recipients/report-from-klaus-bielefeldt-md-phd-understanding-pain-and-discomfort-in-functional-gi-disorders.html

http://en.wikipedia.org/wiki/Rome_process

http://gut.bmj.com/content/45/suppl_2/II43/T1.expansion

http://www.webmd.com/fibromyalgia/guide/fibromyalgia-symptoms?page=3

http://www.mayoclinic.org/diseases-conditions/fibromyalgia/basics/symptoms/con-20019243

http://www.ncbi.nlm.nih.gov/pubmed/21570907

http://www.mdjunction.com/dealing-with-rsd-ibs

http://www.rsdhope.org/crps-or-fibromyalgia.html

http://patient.info/doctor/vulvodynia-pro

Other Conditions that May Be Confused with IBS

Since there’s no specific test that can pinpoint irritable bowel syndrome, other conditions with similar symptoms may be confused with it.

Pelvic Floor Dysfunction

A study conducted by the Mayo Clinic indicates that many people diagnosed with IBS may actually have pelvic floor dysfunction. There is considerable overlap in the symptoms of these conditions.

Pelvic floor dysfunction may include:

• The urge for frequent bowel movements

• A sensation of incomplete evacuation after a bowel movement

• Constipation or straining

• Frequent urination

• A need to stop/start multiple times during urination

• Painful urination

• Recurrent bladder infections

• Unexplained lower back pain

• Recurring pain in rectum, genitals, or pelvic area

• Feeling like you’re sitting on a ball

• Urinary or fecal incontinence

• Discomfort for women during intercourse

• Increased vaginal discharge in women

Did you notice how many of the above symptoms are similar to IBS? Please discuss all your symptoms with your doctor, even if they seem unrelated. Don’t label yourself a hypochondriac just because you have so many things happening in your body. A physician must know your complete history before making a diagnosis.

Kegel exercises are a first-line approach to dealing with pelvic floor dysfunction. In serious cases, surgery may be required.

Some internet sites advise you to do Kegels by stopping and restarting the flow of urine several times during urination. According to the Mayo Clinic, this isn’t recommended. If you try to do the stop/start routine with a full bladder or while emptying it, Kegels can actually weaken the muscles, lead to incomplete evacuation, and thereby increase the risk of urinary tract infections.

Directions for Kegel Exercises:

- First, you must determine where the pelvic floor muscles are. (See the next step.)

- While urinating, stop the flow of urine and remember how you did it.

- After you’ve finished urinating, contract the muscles again.

- You shouldn’t feel your stomach or buttocks contracting.

- Practice until you’re able to do it properly.

Now that you know how it feels, do the following.

- Contract for three seconds; release for three seconds.

- Do ten to fifteen repetitions per session, three to four times daily.

You can perform Kegel contractions anywhere, and nobody will know.

According to websites like WebMD, Kegel exercises can also help women who have persistent difficulty reaching orgasm.

Go to the websites of the Mayo Clinic or WebMD for more information.

The Yoga pose known as the stomach lift or abdominal lift might be helpful. It’s a sequence of two poses that are purported to

- Massage and tone organs in the abdominal area

- Massage the heart and improve circulation

- Relieve constipation, gas, indigestion, and liver trouble

- Tone nerves in the solar plexus

- Strengthen abdominal muscles and reduce abdominal fat

Directions for the Abdominal Lift:

First Part

- Empty your bladder and bowel.

- Stand with feet about shoulder-width apart, knees slightly bent.

- Lean forward from the waist and place hands just above your knees.

- Inhale deeply as you push out your abdomen.

- Exhale completely as you pull in your abdomen.

- Without taking another breath, pull abdomen in even more.

- Hold your breath for about ten seconds.

Second Part

- Perform the same sequence as above, except for the last step.

- Quickly push out and pull in your abdomen ten times without breathing.

It should be easy to fit this Yoga pose into your routine by performing it when you use the washroom. It’s so simple that you can even do it in public toilet facilities.

Small Intestinal Bacterial Overgrowth (SIBO)

Another disorder that’s sometimes mistaken for irritable bowel syndrome is SIBO. This condition results in abnormally large numbers of bacteria in the small intestine. These bacteria are more representative of