- Dr. Susan
I Am So Bloated!
How many times have you said that? You think, "I ate to much" or "I shouldn't have eaten that," you know from experience that this bloating and gas will last a while, but it'll be gone by tomorrow-hopefully.
If you have IBS and specifically, IBS-C, your feelings of being miserable are going to last awhile, potentially weeks and months not hours. IBS sufferers have a near constant barrage of symptoms that ebb and flow with little relief in sight.
Do I Have IBS-C With This Bloat, Gas and Constipation?
We all experience mild gastrointestinal (GI) symptoms now and then. Symptoms like:
· Chronic bloating
IBS is a relatively common with 10% to 20% of the US population affected by it. When occasional gas, constipation, diarrhea and bloating become persistent, lasting four to six months and longer, IBS is often the diagnosis. Most IBS sufferers have had variations of these symptoms for years.
IBS is further classified by abdominal cramping or pain and associated with changes in bowel movements and consistency. There are four types of IBS:
IBS with constipation as the predominant symptom (IBS-C)
IBS with diarrhea as the predominant symptom (IBS-D)
IBS mixed with constipation and diarrhea symptoms alternating (IBS-M or IBS-A)
IBS unclassified with neither constipation nor diarrhea being the predominant symptom (IBS-U)
What is IBS-C?
IBS with constipation (IBS-C) is a chronic gastrointestinal (GI) disorder which causes gas, bloating, abdominal pain and hard, infrequent bowel movements.
All types of IBS are lifestyle issues more so than life threatening but the degree of pain should not be taken lightly.
There is no cure for IBS-C but diet, stress management and lifestyle changes can be helpful.
What are the symptoms of IBS-C?
The most common symptoms of IBS-C is:
Infrequent bowel movements, three or less a week
Feeling of not completely passing stool
Stool that is hard, often small lumps can be seen in the toilet
With IBS-C passing gas or having a bowel movement can relieve some of your pain and discomfort but only temporarily.
IBS-C differences from occasional constipation by the severity of the bloating and pain and also the length of time you experience these symptoms.
What Causes IBS-C?
As with IBS in general the cause is unknown. It is associated with some inflammation in the gut but is not considered an inflammatory condition. While a correlation can be seen in families, I believe a whole-body approach should be considered. Here are some considerations to cause of IBS-C:
1. Genetics is a consideration since IBS-C can be seen in families. If you have a family member with IBS you are at a higher risk of developing it.
2. Hypothyroidism, or having low thyroid function can contribute to constipation but not all people that are hypothyroid also have IBS-C so it may have a causative relationship.
3. Poor hydration and decreased water consumption can add to the compact hard lumpy stools associated with IBS-C.
4. A diet low in fiber accompanied by dehydration may also be contributing factors to IBS-C.
5. Low stomach acid, hypochlorhydria or no stomach acid production, achlorhydria, are also possible contributors to developing IBS-C.
6. Iron treatments used for heavy menstrual flow of for iron deficiency anemia are known to be quite constipating as well.
How is IBS-C diagnosed medically?
There is no specific test to diagnosis IBS-C. It is often a diagnosis of exclusion, meaning other conditions have been ruled out and what’s left is, it must be IBS-C.
Helpful blood tests to help rule out infection and other causes are:
· Candida antibodies
· Parasitic testing
Imaging studies can be helpful as well. Those include:
· CT scan
After a physical exam with your doctor pushing on or palpating your abdomen (this may elicit pain), in combination with the above tests being run with negative results, a diagnosis of IBS-C is usually made.
How is IBS-C treated?
Usually over the counter (OTC) medications are used for symptom relief. They can include:
· Stool softeners
· Fiber supplements
I would always recommend getting your bowel movements moving to normalize your bowel function and to ease your constipation before adding in any fiber supplements. Fiber can be a great aid but it can also add to constipation if hydration is low.
Natural and Lifestyle Remedies for IBS-C
1. Consider increasing your hydration by using water or herbal teas only.
2. Refrain from sodas and carbonated drinks. Carbonation can increase the pressure in your belly increasing gas, bloat and pain.
3. Consider decreasing or if possible, stopping, antacid use. Antacids decrease stomach acid production leading to more gas and bloat due to increased fermentation and gas production in your gut.
4. Decreasing the stomach acid from antacid use can also increase transit time, the amount of time it takes your stool to pass through your intestines.
5. If you have a family history of thyroid or have constipation with other frequent thyroid symptoms such as:
a. Thinning hair
b. Brittle nails
c. Cold hands and feet
d. Fatigue and low energy
e. Gaining weight easily
f. I would strongly consider getting a complete thyroid blood panel to check your thyroid as a possible cause of your constipation.
g. Consider specialized stool testing to evaluate your digestive function, absorption issues, inflammation index, enzymatic action and microbiome colony presence and help
Other lifestyle remedies for IBS-C include:
· Stress reduction
· Improved sleep
· Consistent low intensity exercise, like walking is ideal
Consider a reputable testing company for food sensitivity testing. Food Sensitivity testing can identify common foods that are causing inflammation in your GI.
Is there a recommended diet for IBS-C?
Generally, the Low FODMAP diet is used for IBS. The acronym of “FODMAP” stands for fermentation of specific types of sugars, depending on the number and type of sugar molecules contained. These sugars are carbohydrates which are hard to digest for those with IBS-C. These sugars have been found to cause increased pressure, gas and bloating in those suffering with IBS and therefore they are removed from the FODMAP Diet. The problematic sugars for IBS-C are:
1. Fructose is a simple sugar found in:
· Figs, other dried fruit
2. Lactose is a sugar found in milk and dairy products, such as:
· Whole milk
· Skim milk
· Whipped cream
· Sour cream
· Chocolate milk
· Milk chocolate
· Muscle building drinks
· Protein shakes
· Protein bars
3. Fructans are found in certain plants:
· Fruit teas
· Among many others, this list is extensive
4. Sorbitol is a food additive and sugar substitute.
5. Mannitol is derived from mannose, a sugar alcohol used in wine making.
Tips for How to Use a Low FODMAP Diet
By decreasing your intake of FODMAP’s and the sugars listed previously you will be able to see if your symptoms improve.
The FODMAP sugars are difficult to digest in IBS-C causing gas, bloat and abdominal pressure and pain. The FODMAP Tips I share below can be very helpful and put you in control of your IBS-C symptoms but you must be diligent and methodical.
FODMAP Diet Tips:
#1 Use the FODMAP Diet diligently for 8 weeks
#2 Use a food journaling app that also lets you record your symptoms. Use it throughout your FODMAP experience and rate your IBS-C symptoms (gas, bloating, cramping, constipation and diarrhea)
This way you can see if other foods might be involved if you experience symptoms while being diligent with your diet and decreasing FODMAPS in your diet.
#3 Pick one food at a time to add back into your diet. Eat it once and note any increase in symptoms. Wait three days and eat it again. If still no symptoms now have it on back-to-back days and track any symptoms you may experience for the next three days.
#4 If no symptoms occurred eating it on back-to-back days you can now incorporate it twice weekly into your diet. Continue to track any symptoms that might arise and if they do, discontinue the food immediately.
#5 Keep in mind it might be how often you are eating this food and how much of this food you are eating which triggers your symptoms.
#6 Repeat adding in one food at a time by continuing this process, steps #3-#5 above
#7 As you can see this can be a very tedious process. This is exactly why I recommend food sensitivity testing with all suspected IBS cases so we can eliminate common foods causing inflammation and them start to reduce the FODMAP sugars as a second step.
IBS-C is the most common form of IBS.
It is important to keep your bowels moving and track your bowel habits so you can be aware of and report any changes quickly to your healthcare provider.
Managing IBS-C with natural and lifestyle remedies is ideal but medications can be helpful. Paying close attention to your normal body’s rhythms is invaluable. Usually, simple occasions like eating out or traveling to see family can trigger dietary changes that increase your symptoms. It is most important to accept that you have this condition but be diligent in looking for answers outside the normal medical scope especially through wholistic and complimentary medicine channels and well-respected Functional Medicine physicians that do specialized food sensitivity and stool testing frequently.
The internet is a wonderful avenue to research your symptoms and condition but purchasing testing from online companies without a qualified physician to interpret your results can leave you more frustrated, aggravated and without the answers you need and deserve.
IBS-C Basic Laboratory Insights
Protein, albumin and globulin from a blood test called a CMP-14 can be informative as to the production of stomach acid which stimulates digestive motility. Low stomach acid, slow movement and therefore prone to constipation
Calcium also found on the CMP-14 blood panel can indicate a secondary stomach acid deficiency. Calcium needs an acid stomach for proper digestion. Low stomach acidity can lead to osteopenia, osteoporosis and other bone pathology.
Lipase and amylase can be ordered which reveal optimal pancreatic enzyme release. If these are low, gas and bloat leading to constipation can be an issue.
Liver enzymes: AST/ SGOT and ALT/SGPT also found on a CMP-14 blood panel can give insights into gallbladder and liver function. Remember any disruption of upper digestive function will affect the elimination process.
BUN: which stands for blood urea nitrogen can give insights into kidney function and potential for dehydration. Easier methods are to invest in a bariatric smart scale which will give you your metabolic makeup including your hydration level
I believe the gold standard, that is the best IBS-C test to have completed is a specialized stool analysis which will identify your ability to digest, absorb and assimilate the food you are eating and also monitor and evaluate your probiotic colonies and their health with any corresponding yeast or parasitic species.
If you are experiencing frequent digestive symptoms or suspect or have been diagnosed with IBS getting a better understanding of your symptoms and their causes can relieve a lot of pain and embarrassment. Talk to Dr. Plank about your Best Next Step to uncover the cause of your gas, bloat or constipation!
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