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Managing an IBS flare-up

Updated: May 10

By Sim Sekhon and Sascha McMeekin


If IBS flare-ups are keeping you up, getting you down or taking over, read on to learn the 3 ways to settle your symptoms and get back to being your best.



Last week we dived into my 5 most common causes of IBS flare-ups to help you get the bottom of why you are experiencing periods of intense IBS symptoms. It is also important to note that not all flare-ups are by accident. Sometimes, life can simply get in the way. You may have eaten a high FODMAP food on purpose because your loved one prepared it for you and you did not want to upset them, or you may have been famished and had no other options, or simply because you felt like it! We have all been there.


Whatever the reason for your IBS flare-up, it’s important to know how to manage both your physical symptoms and your mind to fast track your way to a settled tum.



How to recognise a flare-up

Symptoms of IBS flares include lower abdominal pain, diarrhoea, constipation or a combination of both, bloating, excessive wind, and distension. As well as the physical bowel symptoms, the state of being in a flare-up can strain your brain causing stress, anxiety, feelings of confusion, isolation, frustration and overwhelm, worry about what to eat and what others think of you, brain fog, fatigue, and difficulty explaining your situation to others…



What is actually happening in the gut to cause a ‘flare’?

When FODMAPs are at the heart of your IBS struggles here is what is really going on inside you.

If you're new to IBS and FODMAPs a simple overview can be found here.


Different FODMAP subgroups have different actions in the gut:

  • Polyols and fructose are slowly absorbed or not absorbed at all in the small intestine of everyone.

  • Lactose can be poorly absorbed in the intestines of some people.

  • Fructose intake in doses larger than glucose is poorly absorbed in everyone.

  • Fructans are poorly absorbed by everyone but for with people IBS, lower doses are tolerated.

  • Oligosaccharides are poorly absorbed in everyone’s intestines.

These slowly absorbed or unabsorbed compounds attract water into the intestine, via a process called osmosis, as they move through the gut. In the large intestine, they are readily fermented by colonic bacteria and produce gas. This causes expansion in volume, stretching of the intestinal wall and stimulation of nerves in the gut, which triggers sensations of pain and discomfort. People with IBS have disturbances in gut motility and/or heightened gut sensitivity such that these sensations of pain and discomfort are intensified.


What is NOT an IBS flare-up?

WARNING: Not all gut-related symptoms are IBS. Some symptoms can be an indication of another underlying health condition that is worthy of investigation. Be sure to speak to your Doctor if you are experiencing any of the following:

  • Unexplained weight loss

  • Family history of bowel disease

  • Rectal bleeding/anaemia

  • Onset of symptoms at >50 years old

  • Nocturnal bowel motions

  • Persistent daily diarrhoea

  • Recurrent vomiting

  • Fever

  • Progressive or severe symptoms



If you have IBS, why should you care about your mental wellbeing?

You may or may not have heart of the gut-brain axis. This is the connection between the gut and the brain through the vagus nerve, immune system and our circulation, serving as a route for communication and signaling. Signals from the brain can directly impact on weight, bowel movements, nutrient availability and microbial balance. Similarly, information about our internal world and the environment inside our gut is relayed to the brain which can impact on our mood, stress/anxiety and behaviours. The bacteria living in our gut which digest fibre are able to effect inflammation, brain health, weight and gut health, and produce short chain fatty acids which are involved in appetite regulation. Our gut flora may even play a role in controlling blood sugars and heart health.


Since issues experienced in the brain or the gut can be communicated either way, gut symptoms can be both the cause or the product of psychological strain. This is why it is important to care for our minds by managing stress levels, self-care, sleep and exercise.




Practical tips to manage a FODMAP flare


Since there is no ‘cure’ for IBS, and symptoms can come and go, having a tool-kit of a range of possible management strategies for yourself will empower you to comprehensively care for your IBS flares when they hit.


1. Include these symptom soothers

  • Hot packs may help by stimulating blood flow to the bowel. If you don’t have one try a gentle tummy massage.

  • Peppermint tea and ginger tea may help with bloating and a queasy stomach.

  • Plenty of room temperature, still water. Hydration is especially helpful and necessary if you are losing lots of water in your bowels, whereas caffeine tends to worsen symptoms and stimulates water loss.


2. Avoid these trigger traps

  • Keep away from foods that are strong in flavour (rich tomato sauces) and high in fat (oily and fried foods).

  • Go easy on caffeinated and alcoholic drinks.

  • If you have been advised to follow a FODMAP diet, go back to the green low FODMAP foods and/or serves. This will take your symptoms below your threshold as quickly as possible and your symptoms will ease.


3. Reset your mindset

  • Focus on what you can eat rather than what you are avoiding. Stick to simple foods that you know will make you feel good.

  • Seek out fresh air and gentle exercise. Getting out in nature and moving your body can help you to feel better.

  • Rest, meditation and yoga are all great ways to help realign the gut-brain axis. Don’t ever feel guilty for taking the rest you need. Remind yourself of your humanness and that rest is just as important as doing.


Own your story and ask for help

The more you embrace the experience and share your truth, the more comfortable you will be in your own skin, the more honest you can be about how you’re feeling with people in your life, and the less you will worry about what anyone else thinks. With this mindset, you are much more likely to seek help and to equip and empower yourself to manage your condition.


To those of you struggling with your IBS, there are answers out there and you do not have to struggle alone. Find out more about the ‘Master your IBS program’ with Sascha McMeekin here.




References


Monash University. 2019. Online FODMAP and IBS training for Dietitians. https://www.monashfodmap.com/online-training/dietitian-course/


Health Union LLC. 2010-21. What to do during an IBS-Flare up. https://irritablebowelsyndrome.net/living/what-do-during-flare-up


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