Factors Impacting IBS Beyond Diet
Irritable bowel syndrome (IBS) is a gastrointestinal disorder that holds many captive every day. Symptoms such as abdominal pain, gas, bloating, constipation, and diarrhea can have a huge impact on someone and easily disrupt their daily life. As you might have guessed, diet does play a crucial role in managing IBS symptoms. Certain foods can trigger or worsen these symptoms and those triggers can vary from person to person making it essential to monitor what you eat. However, with that said, are there times you feel like you're eating all the right things but your IBS is still flaring up? Even though diet tends to play the main role in the management of IBS, there are other non-dietary factors impacting the disorder. Factors such as stress, anxiety, menstruation, medications, sleep, and activity are all worth exploring.
Psychological Factors
Stress and anxiety can directly affect the gut and influence IBS symptoms through it’s effects on the timing of digestion, pain tolerance, barrier functions of the gut, etc. The brain-gut axis is the communication between the central and enteric nervous systems, AKA the brain and the gut! This relationship is a two-way street, meaning when stress and anxiety are present it's linked with the gut and can exacerbate your IBS symptoms. The same is said then when the bowel is distressed, this can alter your quality of life and thus cause stress and anxiety, an unfortunate loophole. This relationship is important to realize because it may not be the particular food you ate that caused such a bad reaction in your gut. Maybe you had a recent stressful event in your life and this is negatively impacting your IBS. Keeping track of these stressful events and your IBS symptoms can help find these correlations and give some great insight.
Menstruation
If you’ve noticed your symptoms getting worse around that time of the month, you are not imagining it! The drop in hormones during the start of menstruation has been shown to be connected to the worsening of IBS symptoms. The gut has receptors for these hormones just like the uterus and can therefore change how your gut reacts. It also may be important for your doctor to explore if endometriosis is present. Endometriosis is “defined by the presence of endometrial-like tissue outside the uterus and occurs in 5–10% of women of reproductive age”. It can have similar symptoms to IBS and can also worsen during menstruation. Studies have shown these two conditions often have an association with each other and should always be explored by a health professional.
Medications
There are several medications you may take or have an interest in to help manage IBS symptoms. Usually, these can be helpful, but for some, it may be making IBS symptoms worse. There may also be medications you are taking for other reasons that might have gastrointestinal side effects. Both are key to consider and should be presented to your health provider to establish necessity and alternative options if needed.
Sleep & Activity
Quality sleep and maintaining adequate physical activity seem to be staples in improving your health and for good reason! Studies show the connection between poor sleep and the misalignment of your circadian rhythm to influence poor gastrointestinal symptoms. Poor sleep can also increase anxiety and depression which as previously discussed, have a strong connection to the gut. Since physical activity can also improve anxiety and depression, it is recommended adults exercise at least 150 minutes per week of moderate intensity according to Physical Activity Guidelines for Americans for health benefits. As you can see, everything is connected!
Summary
The management of IBS extends beyond just diet. It’s essential to acknowledge the influence of psychological factors, hormones, medications, sleep, and activity as part of a holistic approach to addressing IBS. IBS can be complex and a comprehensive approach is crucial to navigating the challenges of the condition and achieving good well-being.
References:
Randulff Hillestad, Eline, et al. "Gut Bless You: The Microbiota-Gut-Brain Axis in Irritable Bowel Syndrome." World Journal of Gastroenterology, vol. 28, no. 4, 2022, pp. 412-431, https://doi.org/10.3748/wjg.v28.i4.412. Accessed Jun. 2023.
Bharadwaj, Shishira, et al. "Symptomatology of Irritable Bowel Syndrome and Inflammatory Bowel Disease during the Menstrual Cycle." Gastroenterology Report, vol. 3, no. 3, 2015, pp. 185-193, https://doi.org/10.1093/gastro/gov010. Accessed Jun. 202
Schomacker, Mia, et al. "Is Endometriosis Associated with Irritable Bowel Syndrome? A Cross-Sectional Study." European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 231, 2018, pp. 65-69, https://doi.org/10.1016/j.ejogrb.2018.10.023. Accessed Jun. 2023
Orr, William C et al. “The effect of sleep on gastrointestinal functioning in common digestive diseases.” The lancet. Gastroenterology & hepatology vol. 5,6 (2020): 616-624. doi:10.1016/S2468-1253(19)30412-1