Managing IBS and Training Through Flare-Ups

In recognition of Irritable Bowel Syndrome (IBS) Awareness Month in April, I've decided to share my story and the insights I've gained to support those facing similar challenges. By sharing my journey, I aim to demystify IBS and encourage open conversations about managing its impact on daily life and training.

*Please note that I am not a healthcare professional, and seeking advice from a qualified medical expert is essential. My goal is to offer some foundational knowledge to guide your journey!

My IBS Journey

I've probably had IBS symptoms for around ten years, but these were generally mild enough not to raise alarm. Occasional upset stomachs seemed no big deal, especially when they coincided with nerve-wracking moments, like before fitness competitions or races. I rationalised this as normal - everyone gets butterflies, right? 

Every so often, I'd eat something which would cause my (usually flat) stomach to blow up like a balloon, forcing me into huge, baggy clothes. Identifying beans, plums, and pistachios as culprits, I eliminated them from my diet, hoping for a simple fix. Unfortunately, I was still getting flare-ups, so there had to be something else causing them, too - but what? With the rise in popularity of gluten-free diets for digestive issues, I decided to cut out gluten as well. It provided a slight improvement initially, but my symptoms soon returned to full force. The situation escalated to a point where eliminating more and more foods seemed like the only option. You reach a stage where food itself can become a source of anxiety, given the uncertainty of what's causing the symptoms.

Three years ago, my symptoms intensified significantly, prompting urgent medical attention. My stomach was so distended it was causing me back pain - to the point where even walking and driving were uncomfortable, not to mention I had to wear my boyfriend's T-shirts from where I could no longer fit into my own! I permanently looked about ten months pregnant! None of this is ideal when you work as a strength and fitness coach! 

Despite a hospital admission and multiple GP visits, it was a considerable time before the NHS offered all the tests I needed, and wait times were long. The wait time for a colonoscopy was approximately 14 months. During this waiting period, I dedicated my time to researching ways to manage my symptoms and maintain my training regimen, as well as developing a more profound knowledge of IBS and its symptoms.

After nearly a decade of suffering, I would later go on to find that many of my IBS symptoms were actually due to endometriosis (tissue resembling that of the uterus lining growing in places where it shouldn't be) present next to my bowel. Surgery to remove this drastically reduced many of my IBS symptoms.

Understanding IBS: Symptoms and Prevalence

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder that impacts the lower sections of the digestive system, specifically the small and large intestines. It affects people of all ages, but it is more commonly diagnosed in young adults and is often found more frequently in women than in men. It is characterised by a variety of symptoms, which can vary in intensity from mild to severe, such as abdominal pain, bloating or distension, and altered bowel habits. Surprisingly, IBS affects 1 in 7 adults, making it even more common than asthma! This high prevalence suggests that you know someone within your circle of friends who also struggles with this condition.

Other common symptoms include abdominal cramping, painful or trapped wind and nausea. For some people, these symptoms are mildly irritating; for others, they are debilitating and can last days or even weeks. It is often common for sufferers experiencing a flare-up to feel low, partly because of the discomfort experienced but also because over 85% of serotonin, the body's primary 'feel-good' hormone, is produced in the gut, not the brain. If production decreases during a flare-up, it can diminish feelings of positivity.

Triggers such as stress, hormonal fluctuations, certain medications, and consuming foods not well tolerated can lead to a flare-up. There is no known cause for the symptoms of IBS and no cure for the condition. Treatment focuses on managing symptoms, which can be challenging as some strategies may work for some individuals but not others. The psychological toll of IBS, stemming from its unpredictable flare-ups, further underscores the need for comprehensive management strategies.

What is normal when it comes to our bathroom habits?

Let's explore healthy bathroom habits to provide contrast and offer reassurance about what is considered usual.

• You should expect to have bowel movements anywhere from three times a day to three times a week.

• Bowel movements shouldn't be painful.

• You should feel confident you can make it to the bathroom in time.

• It's not unusual for stool consistency and colour to vary sometimes due to diet, hydration, exercise, hormones, and other factors. (However, seeing blood in your stool should prompt a medical check-up.)

• It is not uncommon for older adults to experience dryer stools due to their bowel and stomach muscles weakening and slowed intestinal motility. 

• Bloating is normal and is experienced by 10-30% of the population, especially after a large meal. A 'normal' amount of bloating should subside within a few hours. It differs from distension, which significantly increases the circumference of the gut.

• You may experience more wind than usual after eating certain foods (like beans or cabbage), but this is still entirely normal. People with IBS produce a similar amount of gas to those without it, but IBS sufferers often have an increased awareness of it because it causes pain or becomes trapped.

• Stomach noises, or borborygmi (bawr-buh-rig-mai), are a normal part of digestion. They occur as food is moved through the gut and tend to be louder when you're hungry because there is less material in the stomach to muffle the sounds. Releasing the hunger hormone ghrelin may cause these contractions to become more pronounced. While these sounds can sometimes be embarrassing, they are a sign that your digestive system is functioning correctly!

Why a Proper IBS Diagnosis Matters

It is important not to self-diagnose IBS because its symptoms can mimic those of several other conditions, including Coeliac disease, bowel cancer, and Inflammatory Bowel Disease (IBD)—which includes Crohn's disease and ulcerative colitis. For women, these symptoms might also coincide with gynaecological conditions like endometriosis.

Additionally, if your symptoms worsen (like mine did), an existing diagnosis of IBS can facilitate quicker access to further testing. Diagnosing IBS involves the Rome IV criteria, which suggest IBS is probable when a patient has experienced recurrent abdominal pain at least one day a week for the last three months, accompanied by at least two of the following: pain associated with bowel movements, changes in the frequency of bowel movements, or changes in stool appearance. If these criteria are met, further tests, such as blood tests, stool samples, and colonoscopies, are conducted to rule out other conditions. After ruling out other conditions, a doctor can then diagnose IBS.

*Important: Before getting tests like a blood test for coeliac disease (an autoimmune response to gluten), don't change your diet, as removing gluten too soon can lead to incorrect test results since your body needs to react to gluten to show if you have the disease.

** It is worth noting that eliminating endometriosis as the cause is tricky. Often an NHS scan only checks the reproductive organs, so any endometriosis on or near the bowel will not be seen. This can sometimes be identified on a private scan done by somebody specially trained in detecting endometriosis. However, sometimes, if it's superficial it can only be definitively diagnosed through surgery. If you notice your IBS symptoms are cyclical, or you have other symptoms of endometriosis, it is important to advocate for yourself and push to have this properly ruled out.

With a proper diagnosis in hand, the next step is to identify your specific IBS subtype, which is essential for tailored treatment.

Determining Your IBS Sub-Type

IBS can be classified into three main subtypes based on the predominant symptoms: IBS-C (constipation-predominant), IBS-D (diarrhoea-predominant), and IBS-M (mixed, where patients experience both constipation and diarrhoea). ​

Identifying your subtype is crucial as it influences the treatment strategy. Typically, you can determine your subtype by maintaining a stool diary over a few weeks to identify patterns in bowel movements. The Bristol Stool Chart is a valuable tool in this process. Please see the attached cartoon version! Type 4 on the chart represents the ideal stool consistency, with types 3 to 5 within the normal range. Types 1 and 2 indicate constipation, while 6 and 7 indicate diarrhoea. Professional guidance in diagnosing and understanding your subtype can be essential to prevent self-misdiagnosis and ensure accurate treatment strategies.

Determining IBS-D is relatively straightforward since the stool consistency predominantly ranges from normal to watery (diarrhoea), with constipation rare.

Identifying IBS-C can be more complex, and a detailed stool diary is essential. Symptomatic days will primarily show hard or lumpy stools (type 1 or 2) or no bowel movement; however, sometimes, diarrhoea can be present too. Individuals with chronic constipation may experience overflow diarrhoea, where watery stool leaks around a hard stool blockage; this can mistakenly lead some to believe they have IBS-M. Typically, IBS-C is characterised by a pattern of mainly types 1 and 2, with occasional occurrences of types 6 and 7 from overflow diarrhoea before returning to hard or lumpy stools.

For IBS-M sufferers, bowel habits alternate between constipation and diarrhoea. On days when symptoms are present, they experience constipation at least 25% of the time and diarrhoea at least 25%, indicating a true mixed pattern of bowel movements.

It's important to remember that your IBS subtype may change over time. If you observe any changes in your symptoms, periodically maintaining a stool diary can be beneficial in tracking these shifts.

Among the various symptoms of IBS, constipation often tends to be misunderstood, meriting a closer look.

Constipation Explained

Understanding constipation involves recognising it as more than just experiencing infrequent bowel movements or being unable to go to the toilet. You can go to the bathroom every day and still be constipated if you don't completely empty your bowels. For instance, if you only empty 80% of the waste each time, the remaining 20% stays and builds up. 

Common signs of constipation include dry, hard, or lumpy stools that are difficult or painful to pass, often requiring straining. It's not uncommon for individuals with constipation to experience bleeding or develop haemorrhoids as a result. (If you see blood in your stool or the toilet bowl, you should see a doctor as soon as possible.)

Other symptoms of constipation can vary but often include bloating, nausea, cramping, and abdominal pain. Understanding constipation's role in IBS highlights the importance of managing symptoms based on your specific subtype.

Managing IBS Based on Your Sub-Type

Individuals with IBS-M face challenges due to their fluctuating condition, which requires adaptability to current symptom trends. In contrast, those with IBS-C or IBS-D can adopt specific strategies regarding fibre intake, meal frequency, and dietary choices to manage their symptoms more effectively.

Let's start with fibre. Fibre is crucial in digestive health and is categorised into two main types: soluble and insoluble. Soluble fibre forms a gel-like substance when mixed with water, slowing digestion and increasing water content in the gut, which softens stools and allows them to be passed more easily. Foods rich in soluble fibre include oats, apples, and citrus fruits. Insoluble fibre, by contrast, does not dissolve in water. It adds bulk to stools and accelerates movement through the digestive system, with nuts, seeds, and whole grains being excellent examples.

Incorporating soluble and insoluble fibre into the diet is beneficial for IBS-C sufferers. Starting with soluble fibre can soften hard stools (essential if you're currently constipated), while gradually introducing insoluble fibre will help promote regular bowel movements. Foods like kiwifruit and flaxseed, which contain a mix of fibre types, can be particularly effective additions to the daily diet (assuming there are no allergies to either of these foods).

Those with IBS-D should focus more on soluble fibre to absorb excess water and improve stool consistency. They should be wary about consuming too much insoluble fibre, which may worsen their diarrhoea by quickening food transit through the intestines. Once symptoms are under control, insoluble fibre can be cautiously increased alongside soluble fibre.

Regardless of the IBS subtype, increasing fibre intake gradually and ensuring adequate hydration is essential. Soluble fibre draws water into the bowel, making it crucial to drink plenty of fluids to prevent dehydration.

Next, let's examine meal frequencies. Sometimes, adjusting meal size and frequency can help control symptoms, mainly due to the gastrocolic reflex; this is the natural bodily response to eating that triggers the intestines to move, making space for incoming food by clearing out the old.

Eating smaller, more frequent meals or snacks may benefit those with IBS-C. This regular eating pattern stimulates the gastrocolic reflex, encouraging consistent bowel movements. In contrast, individuals with IBS-D might find having fewer but larger meals helpful in reducing bowel stimulation and decreasing the chance of diarrhoea. However, it's crucial to spread eating across at least three meals daily to avoid overly stimulating the gastrocolic reflex with huge meals. A food and symptom diary can assist in determining the most effective eating pattern for you.

Finally, a few other dietary choices may be helpful depending on your IBS subtype. 

Adopting and maintaining a regular eating schedule can promote more predictable bowel movements for individuals with IBS-C. Also, while caffeine can act as a gut irritant in some people, those who tolerate it well might find that a morning cup of coffee stimulates the gastrocolic reflex, potentially aiding in initiating a bowel movement.

Those with IBS-D should look to avoid or limit foods that can worsen symptoms. When consumed in large amounts, artificial sweeteners can have a laxative effect, exacerbating diarrhoea. It's also beneficial to moderate alcohol and caffeine intake to avoid dehydration, which becomes a more significant concern with frequent bouts of diarrhoea.

Dietary management is a cornerstone of IBS care, with the Low FODMAP diet being a particularly effective approach for many.

Exploring the Low FODMAP Diet

The Low FODMAP diet, created by scientists at Monash University, is designed to help those with IBS. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols—hence the abbreviation! These are short-chain carbohydrates poorly absorbed by the small intestine. Poor absorption can lead to fermentation in the gut, causing gas, bloating, abdominal pain, diarrhoea, and constipation in sensitive individuals. While everyone absorbs these carbohydrates poorly (explaining the common reaction to foods like baked beans), they cause discomfort and painful symptoms in those with IBS.

The Low FODMAP diet is not for the faint-hearted due to its restrictive nature. It temporarily eliminates many common foods to identify which FODMAPs a person can tolerate and in what quantities. By systematically removing and reintroducing foods high in FODMAPs, individuals can determine which foods cause their IBS symptoms and adjust their diet. Individuals should only follow this diet under the supervision of a registered dietitian due to the level of guidance and support needed.

I have put together a chart showing how the FODMAP groups are categorised:

The diet begins with an elimination phase, lasting 2-6 weeks. This phase involves removing all high FODMAP foods to allow symptoms to settle fully. (This includes eliminating gluten, lactose, onions, garlic, legumes, apples, mushrooms, watermelon and cauliflower, among many other foods!)

Next is a re-challenge phase, during which foods from each FODMAP group are reintroduced. Testing one food from each group can indicate tolerance: if no symptoms arise, all foods within that group will likely be well-tolerated. If symptoms occur, they happen 6-8 hours after eating once the food reaches the intestines. The process involves consuming the food in gradually larger quantities over three days to monitor for symptoms. For instance, during my test of the sorbitol group, I reintroduced peaches: a quarter on day 1, half on day 2, and a whole peach on day 3. The absence of symptoms indicated a good tolerance to sorbitol, suggesting I can also enjoy blackberries, avocados, and apricots from the same group without issues.

The re-challenge phase of identifying food triggers should take about 6-8 weeks, though it may extend longer. If introducing a food group doesn't cause symptoms, you can move on to the next group after three days. But if you experience symptoms, you must wait until they clear up before trying the next group. For example, when I tested fructan-containing vegetables, I added one tablespoon of raisins to my porridge and had severe symptoms for three weeks. Needless to say, I didn't proceed to day two, and I should avoid that group entirely, which includes foods like fresh beetroot, Brussels sprouts, savoy cabbage, and grapefruit.

One of the most challenging aspects of this diet phase is adhering to the elimination diet throughout. Even if a tested food causes no symptoms, you can't immediately reintegrate it into your diet; it must wait until the re-challenge phase is fully completed. This restriction can complicate dining out and home cooking, especially if you hate bland foods! Using the green tips of spring onions (and avoiding the bulb) or garlic-infused oils can be a good way to make your food tasty while keeping to low FODMAP parameters. I found companies like Fodmarket and Lovemore Foods extremely helpful during this process. Access to onion- and garlic-free stock and curry sauces (and the occasional low-FODMAP custard cream!) made a massive difference in my morale and enjoyment of food, and it also encouraged loved ones not following the diet to enjoy meals with me.

Another challenge is managing the precise quantities required for testing. While it was enjoyable to reintroduce certain foods after weeks without them, the specific amounts could be frustrating. For example, on day 1 of testing bread, I was limited to 26g, which isn't even a whole slice! Reluctantly handing over the remainder for Paul to finish was heartbreaking! On the flip side, some portions were surprisingly large. Day 3 of testing apples called for 166g, equivalent to more than two apples. Regardless of quantity, all test foods must be consumed in one sitting without being spread throughout the day.

Upon completing the re-challenge phase, you move on to the final phase, your adapted diet. Your dietician will interpret your results and give you personalised recommendations for foods you can eat freely, foods you can tolerate up to a limited quantity and foods to avoid. It is important to add back in the high FODMAP foods you can tolerate, even in small quantities, as they positively affect gut bacteria. 

Apps like the Monash University Diet app can help identify which FODMAPs are present in certain foods and in what quantities. It uses a traffic light system to display whether foods are likely to be a problem for people who struggle with that FODMAP group. In the example shown, we can see that apples may cause issues in anyone who is sensitive to fructose or sorbitol but can be eaten freely by those who tolerate these groups well.​

​Collaborating with a registered dietitian is crucial to avoid nutritional deficiencies while following such a restrictive diet. The diet's complexity lies in categorising foods by the length of their carbohydrate chains rather than by conventional food groups. For instance, I can eat sugar snap peas freely, but must be cautious with mange tout. Peaches are safe for me, whereas plums are off-limits. Navigating this diet definitely requires professional guidance! However, it can transform your relationship with food, moving you from fear to confidence by precisely identifying what you can and cannot enjoy.

A gentler version of the low FODMAP diet is also available. This less restrictive diet reduces high-FODMAP foods without eliminating them, offering a more manageable approach for individuals experiencing milder symptoms. Your dietician will help you decide which version is best for you.

Beyond diet, innovative therapies like gut-directed hypnotherapy offer another avenue for symptom relief, focusing on the brain-gut connection.

The Role of Gut-Directed Hypnotherapy in IBS

Gut-directed hypnotherapy is an innovative method for IBS management that emphasises the brain-gut connection. It uses hypnotherapy techniques to lessen the gut's sensitivity and reduce stress without any known side effects. It's suitable for nearly everyone across all IBS subtypes and symptom severities, making it a highly recommended option. However, it's not suitable for individuals with certain psychiatric conditions, such as psychosis or significant cognitive impairments. Clinical research by Dr Simone Peters at Monash University in 2019 indicates that six weeks of daily gut-directed hypnotherapy can significantly relieve IBS symptoms for six months or longer in 72% of participants.

Gut-directed hypnotherapy induces a state of deep relaxation akin to guided meditation, where individuals remain fully conscious and alert to their environment. The Nerva app is a standout resource for accessing gut-directed hypnotherapy, requiring less than 20 minutes of your day for effective use.

Therapy affects the nervous system, specifically the activation level between the sympathetic and parasympathetic systems. These two systems are responsible for increasing and decreasing our stress levels. It's a complex subject and beyond the scope of this article, but simply put, the sympathetic nervous system excites our bodies, getting us ready for action; that is why we call it the fight or flight response, whereas the parasympathetic nervous system does the opposite, it relaxes our body, which is why we call it the rest and digest system. Both systems are outside of our conscious control; this is unfortunate for IBS sufferers as they tend to spend too much time in this "fight or flight" mode, which gets triggered by non-threatening everyday concerns like financial worries, work pressures, or the stress from dealing with IBS itself. During the fight or flight response, blood gets redirected from the gut to the heart and muscles ready for action. If blood is frequently directed away from the gut, it disrupts digestion, leading to IBS symptoms. Therapy such as gut-directed hypnotherapy can help shift activity to a more relaxed "rest and digest" state when needed.

Therapy, like that in the Nerva app, works by targeting the vagus nerve, which sends messages between the gut and the brain and helps to control our parasympathetic nervous system. It works by reducing the heightened sensitivity many IBS sufferers experience, which causes them to feel pain or discomfort from regular gut movements; it can also affect gut motility, the speed at which food travels through your gut. Gut-directed hypnotherapy can lead to physical changes in the body beyond how patients perceive pain. Scientists have yet to learn exactly how this works, and it's the subject of ongoing study.

Some individuals may achieve their desired symptom relief solely through gut-directed hypnotherapy, which can enhance their tolerance to foods that previously caused issues, eliminating the need for dietary adjustments. However, those with more severe symptoms might find more significant relief by combining gut-directed therapy with a Low FODMAP diet. I have found gut-directed hypnotherapy to be hugely important as part of my IBS management. Still, for me, it had to be in conjunction with identifying and eliminating my trigger foods. All the hypnotherapy in the world wouldn't shield me from the effects of a spoonful of raisins!

While gut-directed hypnotherapy provides substantial benefits, exploring additional management techniques can offer more comprehensive support for IBS.

Additional Strategies For IBS Management

Other strategies can also help alleviate IBS symptoms. Let's explore these further. Experimenting with them individually can help you gauge their effectiveness, or you might apply several at once for greater symptom relief.

Medications

There are a few different medications or supplements available which can help with IBS; however, these can give mixed or unpredictable results and may come with side effects.

• Laxatives can help relieve constipation. However, taking advice from a registered dietician, doctor, or pharmacist is helpful, as they all work differently. Dosing advice is also essential to avoid issues with diarrhoea, and it is also worth noting that some types contain lactose (which is unsuitable for those on a Low FODMAP diet). 

• Antidiarrhoeal agents can reduce the frequency with which IBS-D sufferers need to go to the toilet, thus improving stool consistency. They can be helpful for sudden symptoms or for managing long-term, chronic diarrhoea.

• Antispasmodics can help to relax the muscles in your gut and prevent abdominal pain and cramping.

• Probiotics can help keep our gut microbiota healthy. They can be a fantastic addition to your diet and become especially important during the elimination phase of a low-FODMAP diet. Ask your dietician to recommend one, as this is not a one-size-fits-all approach, and you should use one that complements your IBS subtype.

• Fibre supplements can be an option, but certain types may not be tolerated well by IBS sufferers, and they may exacerbate symptoms of bloating and gas. It is best to seek advice from your dietician before introducing one.

• Peppermint capsules have also been shown to have antispasmodic properties, which may help with IBS symptoms; however, the science on this is limited, and I experienced no decrease in symptoms when I tried them. They may be helpful for people with milder symptoms.

• Lactase enzymes can be useful for people sensitive to lactose. Most people produce this naturally in their bodies, but those sensitive to lactose don’t produce enough of it. Supplementing these enzymes helps you break down lactose, allowing you to still enjoy lactose-containing foods.

Fibre-Tracking

I'm a big fan of fibre tracking for IBS management. I log my daily food intake on MyFitnessPal, which allows me to view my total daily fibre intake, among other things. Optimal fibre differs from person to person, usually in the 25-35g per day region. If I consistently consume within 1 or 2 grams of my daily target, my symptoms are generally well controlled. 

Hydration

Drinking enough water and keeping the right balance of electrolytes is essential for keeping your digestion smooth, which can help prevent constipation and diarrhoea. Aim to drink at least eight glasses of water a day. If you have IBS-D, adding salt to your food or an electrolyte supplement can help replace minerals lost during flare-ups. But remember, it's a good idea to talk to a doctor first, especially if you have any health issues or are on certain types of medications.

Avoiding Gut-Irritants

Some foods, like caffeine, alcohol, carbonated drinks, spicy food, and high-fat foods, don't necessarily contain FODMAPs but can still act as gut irritants in certain individuals. Identifying if any of these lead to symptoms and cutting back on them can help control your IBS symptoms.

Toilet Routine

Going to the bathroom at the same time every day can help your digestive system get into a rhythm, making things more regular and less painful, especially if you have IBS-C. Sitting the correct way, e.g., leaning forward and ensuring your knees are higher than your hips (you may need to place something under your feet to achieve this), can help encourage a bowel movement and reduce the need to strain.

Deep Breathing

While we naturally use diaphragmatic breathing for deep breaths at birth, many people shift to shallow chest breathing over time. Diaphragmatic, or belly breathing, allows for more efficient lung filling and can reduce the heart rate, lower or stabilise blood pressure, and stimulate the vagus nerve to activate the parasympathetic nervous system, enhancing gut motility and pain management. Diaphragmatic breathing prevents the sympathetic nervous system's takeover, countering the fight or flight response characterised by quick, shallow breaths.

To perform diaphragmatic breathing:

• Lie down comfortably with your legs straight out in front of you.

• Place one hand on the chest and the other above your navel.

• Inhale for 5 seconds through your nose, hold for 5 seconds, then exhale for 5 seconds through your mouth. The aim is for your abdomen to rise while your chest and shoulders stay still.

• Do this for 5 minutes at a time.

Physiotherapy

Physiotherapy massage can help with IBS by gently relaxing the muscles in your stomach area, easing uncomfortable feelings like cramping and bloating. It can also help to relieve constipation by stimulating the muscles in the abdomen, improving blood flow, and encouraging the digestive system to move things along. Physiotherapy can also help retrain and coordinate digestive contractions when they're happening out of sequence or not functioning correctly, helping to normalise digestion.

A couple of other considerations include pelvic floor function, which can significantly affect IBS symptoms. The pelvic floor is a group of muscles that support the organs in the pelvis, including the bladder and bowel. If these muscles are too tight or not coordinated well, they can contribute to IBS symptoms such as constipation, diarrhoea, and abdominal pain. A physiotherapist specialising in pelvic floor function can help with this.

Additionally, Joint Hypermobility Syndrome can exacerbate IBS symptoms. Increased elasticity in the body's connective tissues can affect gut motility and sensitivity. If a physiotherapist or doctor has ever diagnosed you with this, this is something to be aware of.

Yoga

Many people report yoga helping with their IBS symptoms, likely through its combination of physical positions, breathing exercises, and relaxation techniques. However, it's important to note that scientific research on yoga's effectiveness for IBS is still evolving, and more studies are needed to understand its benefits fully.

Relaxing Hobbies

Relaxing hobbies like enjoying calming music, taking walks in nature, painting, or reading for pleasure can be crucial in managing IBS symptoms. These activities help lower stress and anxiety levels by shifting focus away from discomfort and promoting well-being and relaxation.

Self Care

Practising self-care, e.g. taking warm baths, using hot water bottles, and avoiding tight clothing around the midsection, can help relieve IBS symptoms. These measures help soothe abdominal discomfort and prevent additional pressure on the gut. Taking naps or opting for earlier bedtimes can help mitigate the fatigue associated with IBS flare-ups. Lying on your left side can offer additional relief as it aligns with the natural positioning of the gastrointestinal tract, thereby reducing pressure on areas affected by IBS. 

While these are great tools for everyday symptom management, what about training? During unsymptomatic days, IBS is unlikely to affect how you train; however, during flare-ups, this can be a different story. 

Adapting Training Around a Flare-Up

Training during a flare-up is HARD. You'll likely be in pain, tired, uncomfortable, and, if you're anything like me, unable to fit into your favourite gym kit! Not to mention, any worries about wind or needing the toilet mid-session! I've found ways to modify workouts to remain active without exacerbating symptoms. Here's how to adjust your training intelligently during these times:

Listen to Your Body: Consider if training is sensible. Light movement can be beneficial, though sometimes rest might be necessary during severe flare-ups. Those with IBS-D experiencing diarrhoea may wish to prioritise rehydration and relaxation above training.

Modify Your Workout Intensity: Lower the weight or volume of your workouts where needed. You can also swap high-intensity exercises for lower-impact versions that maintain fitness without adding too much strain to your body.

Adjust Exercise Selection: Exercises can be scaled down for simpler versions or substituted for an alternative to avoid abdominal pressure or discomfort. For example, these are the substitutions I make in my training when necessary:

• Rowing: Abdominal distension can make rowing uncomfortable. The body leans forward and compresses the abdomen during the recovery phase of the stroke (the return motion to the front of the machine), which can worsen pain and symptoms. Using the SkiErg at times like these can be a great alternative, as the movement is not as deep, and a wide stance creates enough room for a swollen belly. 

• Squats: For milder symptoms, I may lower the weight and opt not to use a belt. If symptoms are more severe, I will substitute squats for reverse lunges, which still target the muscles in my lower body but do not put as much pressure through my abdomen.

• Deadlifts: Reducing the load or raising the height of the bar from the floor to make this a block pull deadlift can be helpful for mild to moderate symptoms. If symptoms are more significant, I like to switch these to Romanian deadlifts to reduce compression in my abdomen.

• Strict press: During bad flare-ups, you can easily modify these to seated dumbbell presses to reduce midsection bracing. For mild symptoms, simply lowering the weight on the bar may be sufficient.

• Bench press: This one should usually still be possible, even with a severe flare-up. While getting up and down from the bench can be painful, the movement itself is generally unproblematic. If bracing is an issue, the weight may need to be reduced.

• Chin-ups/Pull-ups: You can switch these to lat-pulldowns, which are less intense through the mid-section if symptoms make these uncomfortable.

• GHD situps: I remove these entirely during a flare-up and don't perform ab-specific exercises until symptoms are calmer.

Focus on Flexibility and Mobility: You can perform stretches or yoga. These can support gut motility and reduce stress without straining your body, which benefits all IBS subtypes.

Adjust Daily: Your capability may vary day-to-day. Adapt your training accordingly.

Movement is usually very beneficial for those with IBS, no matter their subtype. It can improve gut motility (very useful for those with IBS-C!) and reduce stress, which can be responsible for exacerbating IBS symptoms. Some other great options include gentle swimming or walking (you may want to choose a route with access to toilets!). If you love to train, don't let your IBS stop you! Training smart, not hard, is vital during these times.

Additional Help

Here's a list of resources and experts who could be very helpful if you're dealing with IBS. Click on their names to visit their websites. Remember, if you suspect you have IBS but haven't had a diagnosis, your first step should be to see your general practitioner (GP).

• Gaby Goodchild is a registered dietician specialising in the low FODMAP diet.

• Monash University FODMAP Diet App—This app has it all. It has a symptom tracker with a built-in stool diary. It also helps you check the FODMAP content of various foods and easily track any symptoms during the FODMAP reintroduction phase.

• Fodmarket is an online store offering hard-to-find, low-FODMAP products like stocks, sauces, and gravies.

• Lovemore Foods is an online bakery offering cakes, biscuits, and tarts, some of which are free from gluten, lactose, and soy. This caters to dietary needs not commonly addressed in the supermarket "free-from" sections, which usually only exclude one or two of these.

• Nerva App--This app provides gut-directed hypnotherapy sessions, educational readings about IBS, and daily diaphragmatic breathing exercises to manage symptoms.

• Paul Ray is a physiotherapist with relevant experience in IBS sufferers.

• Crystal Austin is another registered dietician specialising in the low FODMAP diet. She shares valuable insights on Instagram and regularly hosts free webinars.

• BetterHelp--If stress contributes to your symptoms, therapy to help you get on top of this may be a good option. BetterHelp can help match you to a therapist who suits your needs.

• Whoop--This wearable tracking device monitors stress in your body. It can help you identify times when stress is higher, allowing you to focus additional time on breathing exercises or gut-directed hypnotherapy to try and ward off a flare-up.

• MyFitnessPal--This food-tracking app can be a good way of tracking your daily fibre consumption.

Remember, reaching out for help and exploring these resources can be pivotal in better managing IBS.

In Conclusion

​Navigating IBS requires time, patience, and an openness to try different approaches. While IBS is a lifelong condition that can have its ups and downs, adopting the right strategies can significantly minimise the severity and frequency of flare-ups. Sometimes, introducing beneficial habits or foods can be as effective as avoiding those that trigger symptoms.

Managing IBS may come with its costs, but the strategies discussed in this article aim to provide various options. Working with healthcare professionals, like registered dietitians, can offer deep insights into effectively managing your symptoms, making it an extremely worthwhile investment.

I encourage everyone dealing with IBS to seek support and continue exploring management strategies that work for them. Remember, you're not alone in this journey, and taking the first step towards a diagnosis is key to finding relief and reclaiming your life. ❤️