Welcome to episode 20 of the Inside Knowledge with me, Anna Mapson. This is a podcast for people who have IBS, and I couldn’t carry on without focusing on what to do in a flare up.
This is going to be some helpful advice and things about what you can do, what you can eat, and just some tips, really.
Based on things that I’ve found help my clients, to try and get yourself back to normal as quickly as possible.
You can’t get rid of IBS flares completely
If you’ve got Irritable Bowel Syndrome, it’s not always possible to completely eradicate flares. But what you can do is try to manage them and try to understand your triggers so that you can live the best life that you can. Without spending too many days curled up with a hot water bottle watching Netflix on the sofa.
What is an IBS flare up?
I thought it might be a good place to start talking about what is a flare of IBS. What does it feel like, and how would you know if you’re having one?
You may feel like you’re constantly in this kind of state, but really an IBS attack is normally something that’s an increase of your digestive issues.
IBS typically does come and go, it’s quite normal for it to flare up. Or I shouldn’t say normal, it’s common for it to flare up.
But it could be that a flare is like a sudden rise in your bloating, gas and diarrhoea, or sudden flare up of constipation.
What triggers IBS flare ups?
That could be triggered by something you ate, it could be anxiety, it could be stress, it could be medication, or, you know, you’ve had a big night out and had some alcohol and a few days later you get a flare up.
Or it could just be that you’ve changed some of the foods that you’ve been eating and they have not agreed with you.
This can be so confusing because that’s basically everything. It’s like… What you do, how you live, how you eat, and how you digest the food.
Any of those things could be a trigger and that is what is so challenging to identify the cause.
Even when you’re doing everything ‘right’
The most frustrating thing is that even if you feel like you’re doing everything right. You’re eating in the right way, you’re exercising, you’re sleeping well. You’re trying to pay attention to your stress levels.
These are all things that help and even if you’re doing all of that. There could be something that’s happened that will cause a flare up. Sometimes it’s not actually related to what you’ve been eating at all.
Don’t always blame the food
I find the most common thing that people will do is to blame the last food that they ate. Of course this seems to make sense that the most recent food was the cause of the symptoms.
Or that dash to the toilet that you had. But there are things that are not food related that could also be suddenly triggering these kind of symptoms.
And we must also think about how long digestion takes. It’s very rare that food you’ve just eaten will cause immediate symptoms in diarrhoea.
It’s much more likely to be food that you ate last night that is now reaching the colon and triggering the symptoms.
The gastro colic reflex causing an IBS flare
It is possible that sometimes this gastrocolic reflex, that’s when we eat, it triggers the body to move food along the pipes, like get rid of some food to allow more food in. So this is called a gastrocolic reflex.
If it’s very strong on high alert, and that can be down to anxiety, stress, or nervous system disorders, then you may find that food, as soon as you put something in, that nervous system kicks in.
So that is possible.
We also know that when we are stressed, our body has less energy for digestion, which means foods won’t be broken down as well by the process of digestion, and that can cause more bloating, more sensitivity, and pain. Stress and anxiety are definitely key.
It might not be something that’s immediately happened and caused a flare up. But it’s something that’s been building over a couple of days, and that is really triggering.
Periods and your IBS flare up
For women who have periods, you may find that IBS symptoms are worse just before or after your period, and this is because of the hormones that make the uterus contract to release the lining. These hormones can also affect the gut.
Which are obviously very close to the uterus, all in your same torso. And this can lead to more cramps, pain, and just high sensitivity in your large intestine.
So this is also really key, is thinking about the time of the month.
Food triggers for a flare up
And then, in terms of food, it could be that you’ve had, too much fibre. Maybe too much coffee, alcohol, high level of sweeteners. Maybe more dairy than you’re used to, or very greasy foods. Any of those things could potentially be triggers, but it doesn’t mean they necessarily are your triggers, but just things to be aware of.
Ruminating on each IBS attack
I know when you have a chronic condition that you can spend hours thinking about what was the problem. What was the thing that tipped you over this time. Trying to find out that one trigger that you can now eliminate so you never have to go through this again. I know how tempting it is to spend all that time thinking about it, researching online.
Sometimes you just don’t really know, and you have to just move on, and it is frustrating not to know. But at the same time getting yourself worked up about it is also counterproductive.
It can feel like you’re very stressed searching for this thing which is very elusive.
What to do in an IBS flare
So now I’m going to move on to talk about what you can actually do in a flare up in that acute situation, some little tips that might help you feel better and then what you can eat to try and get over the flare as quickly as possible.
And then I’ll also focus on what over the counter medications may be helpful in those situations.
You’re probably doing a lot of this stuff anyway. But,
Take care of yourself
I suppose my top bit of advice is to really try to be kind to yourself and to allow yourself to recover.
It’s so common to push on through, keep going, and generally, we want to think about what is going to reduce pain, reduce the cramps, and help you feel more relaxed.
So, a couple of things. One is, warmth. And you can get that either through a heat pack or a hot water bottle that you put on your stomach and can just ease any cramps and pain and that feeling of sensitivity.
Maybe a warm bath might help you relax and just soothe your stomach a little bit. Or just getting a blanket and curling up on the sofa. And just trying to keep warm. Because when you’re cold you feel tense and you tend to hold your body more tightly. So, just trying to relax as much as possible.
Herbal teas for IBS
Then, in terms of relaxing your body from the inside, something that can be helpful is drinking soothing herbal teas for digestion.
And these can be Sipped throughout the day. You can have them cold if you don’t like hot drinks, but the warming liquid is actually quite soothing on your stomach. Peppermint tea is good because it helps you to release gas back up. So it helps you to burp because it relaxes the sphincter at the top of your stomach which can increase your burping.
This means gas doesn’t travel down the digestive system. So this is why it’s best not to drink peppermint tea if you’re lying down or before you go to bed, especially if you are prone to reflux. But peppermint oil is traditionally used as a digestive aid, and you can get capsules, actually, which I will come back to.
But peppermint tea is useful because it’s an antispasmodic, so it helps to relax painful stomach cramps, and it helps to just soothe your stomach. Ginger tea might help with feelings of nausea. It’s often used in anti sickness sort of supplements, and it can reduce inflammation as well. So if you’re more diarrhoea predominant, in some studies, ginger’s been shown to sort of reduce water being drawn into the bowel and also reduce inflammation. So ginger is also really helpful, ginger tea.
Fennel tea for IBS flare ups
The other one that’s less well known, I feel like ginger and peppermint you might have heard of, is fennel. You can just soak some fennel seeds that you get in the supermarket in hot water. Or chew on them after a meal. And if you don’t know much about fennel, it has a licorice-y kind of taste. It’s quite pleasant for some people. Some people don’t like licorice, but It is soothing and it has been shown to relax gas and cramps and bloating. It can be very helpful.
The last one I wanted to mention was lemon balm. It grows really easily in the garden and it’s a little bit like peppermint tea. But it’s also quite calming and it may help feelings of anxiety, sleeplessness. Lemon balm is sometimes used in anxiety supplements.
So it may help to reduce down sort of hypersensitivity. So yeah, give it a go.
Other teas that might be helpful include chamomile, turmeric, maybe lemon, anything really that’s nice warm liquid. That is going to be soothing on your stomach.
Drinks to reduce or avoid
I would stay away from things like hot chocolate, lattes, like a huge amount of high lactose, milky drinks.
And also reducing down your caffeine and tea intake because they can make you feel more sensitive and can also really trigger bowel cramps.
Now, you may feel like you just want to lie down when you’ve got an IBS flare, and you don’t feel like doing anything. However, gentle movement is really helpful.
Not only will getting outside for a little walk help you to sleep better, because you’ve got a bit of fresh air. A bit of outside exposure, and just can help you sleep better. Which will then help you to recover from this flare up. But also, little bit of things like yoga.
Yoga can be helpful in a flare
Anything where you are putting yourself into an inverted position.
So basically your bum’s up in the air and your head is down. So like a downward dog or child’s pose, or anything where you’re lying on the floor putting your bum in the air. That will potentially help to release a little bit of gas. And may help you to soothe any bloating and, trapped wind.
So if you’re doing all of those things, you know a little bit of gentle movement trying to rest. Trying to take time to recover. Keeping yourself warm and cosy, and comfortable.
Wear comfortable clothes
Oh, the other thing I meant to say was a soft waistband. So don’t wear any tight clothing. Stay away from really tight yoga leggings or tight skinny jeans, that sort of thing. Because that is going to constrict your stomach and may add to bloating and trapped gas.
So let’s move on to what to eat during an IBS flare. This will be slightly different depending on your symptoms.
What to eat in a constipation flare
If you are somebody who has more constipation predominant symptoms and your flare up involves not going to the toilet for a few days. Feeling bloated and heavy and just very stuck.
One of the things you want to do is to really focus on fibre.
And also things that are going to help to draw water into the bowel to try and get a softer stool. If you’re not already doing this, I do suggest eating two kiwis a day. They have been shown to really improve constipation and with the least amount of bloating.
So things like psyllium husk, which you can take as a supplement, may be beneficial, but may, in some people, lead to a little bit of bloating and cramps.
Where, in a study, where they compared psyllium husk, prunes, and kiwi. Kiwi had a similar kind of result in terms of bowel frequency but had less side effects like bloating and the cramps. So two kiwi fruit a day is really good for constipation and can be used in a flare or just as a preventative type measure.
Eat cooked foods
I would also really focus on soft warming foods, well cooked because they are easiest to digest and try to also eat things like porridge. Oats, really good because they include a lot of soluble fibre which can help to draw water into the bowel.
If you don’t find a lot of bloating problems with stone fruit, then they can also be really good in a constipation flare. Because they do help, have good levels of fibre. But can also help to draw water in. And that can be really helpful in softening your stool and just keeping you going.
Get your steps in
With constipation I definitely suggest walking as well, or even if you can manage it, running. Because that action will often help to stimulate a bowel movement and can be so helpful. So for people who have constipation, remember you want to try to increase the variety in fibre because you want some bulk forming fibre. And you want some viscous gel forming fibre to try and create a soft stool.
So really focusing on fibre, but juicy fruits, that kind of thing. Kiwi as I mentioned, citrus fruits like oranges and then lots of root vegetables. Things like sweet potato, butternut squash, carrots. As well as grains like oats and rice. These would be great foods for you to eat if you have constipation flare up.
What to eat with diarrhoea
If you have more of a diarrhoea type flare up, and you’re getting bloating, gas, and a lot of frequent stools. Then you might find going low FODMAP for a few days will help to remove some of that fermentable starches out of your diet. If you need a reminder on what the FODMAP foods are, please go back to episodes 17 and episode 18, where I dive into the low FODMAP diet and give you a little overview.
But typical high FODMAP foods would be things like onions, garlic, wheat, mushrooms, red pepper and cherry tomatoes, beans and lentils, stone fruits and also dried fruits. So these are like common healthy foods that you might be eating lots of that may have triggered a symptom flare.
What I would suggest is doing a low FODMAP few days and that would be really focusing on protein.
So chicken, you can have tofu, eggs maybe. Fish as well would be great, as well as some fruits and vegetables that tend to be lower in FODMAPs, like, again, kiwi, you can have berries, blueberries, raspberries, broccoli, and potatoes. Don’t forget potatoes. A good, cheap, and relatively easy to digest food.
So, generally, those are really useful foods. To have when you have got a flareup.
As well as thinking about what you can eat, what you can do.
Pharmacist support for IBS
You might also be interested in some products and things that you can just take in the short term to help you feel better. If you have got constipation and your problem is that you haven’t been for a few days, it’s quite hard and you’re feeling very bloated.
Don’t be afraid to use laxatives if you need them.
Laxatives encourage you to have a bowel movement. Some of them work quite quickly and some of them will take a few days to get going. There are different types of laxatives and so you need to find a solution that works for you.
Some of them, for example, draw water in. They’re called osmotic laxatives and that will soften the stool and create more of a need to go and make it easier to pass. Some laxatives add bulk, like extra fibre, to your stools and some are more gel forming. So, it’s best to find the one that will work for you and your particular symptoms. But do go and check with your pharmacist, if you’re not sure, and trial them.
It’s ok to try laxatives
There’s no harm in trying laxatives, and I know people are often very scared of them. often really avoid them. But if it can clear this backlog and just enable you to feel better. Then you can spend a bit more energy and time getting to work on your diet and longer term changes when you’re feeling better.
It’s very hard to do that when you’re feeling so stuck.
If your problem is the opposite and you’ve got lots of frequent bowel movements you might actually find anti diarrhoea medication helpful. So this is something like loperamide, Imodium.
This is fine again to use in the short term. If you’re having a flare up and you need to go to work or you need to sit in the car for an hour to drive somewhere, then you need to make sure that you’re not going to have an urgent diarrhoea explosion.
So it’s fine to take this in the short term to help yourself feel better in terms of like gas and cramping.
IBS Flare up supplements
There are supplements and things that you can take to ease the gas. You can get peppermint capsules.
That’s one thing that is useful for helping to disperse the gas a little bit and relax It’s like an antispasmodic and that can be helpful sometimes. Do make sure with peppermint capsules though that you’re getting an enterically coated capsule, or it might say sustained release, and that is in order to avoid the capsule opening in your stomach.
You do not want to have a load of peppermint oil in your stomach. It will potentially cause reflux, and these enterically coated ones, so things like colpamine or boscomint, sometimes they’re called.
These are only going to open in the more alkaline environment of your small intestine, and that is where you want them to open. You don’t want it in your stomach.
Gas reducing medication
Other things that help to disperse wind and gas, there are products sometimes, like, Simeticone, which is like an anti foaming agent. So if you have bubbles of gas, it’s basically changing the surface area of the gas bubbles to help them move through the gut.
This medication doesn’t get absorbed. It just goes straight through you. And it can be helpful, just to disperse gas a little bit. Sometimes you can do a similar thing with activated charcoal. You can take it for a short period of time, to see if it helps you. I wouldn’t take it longer term because it can interfere with mineral absorption.
But again, just in the short term, just for the flare up, it’s okay to take activated charcoal tablets. Something else you might have heard of is like another antispasmodic, which is buscopan, useful for when you’re getting a lot of cramping and pain and like, urgent diarrhoea, and they get to work quite quickly.
But, I wouldn’t take something like that when you have constipation, because it can, for some people, slow down the motility of your gut.
Try a low FODMAP meal plan
If you have thought you’d like to try the low FODMAP diet and you don’t know what to do, what to eat, you can download a low FODMAP meal plan from my website.
It’s £10. It’s not available to anybody in America or Canada unless you work with me one to one. But you can download it from elsewhere in the world and that will give you a selection of breakfast, lunch and dinner recipes that can help you to eat in a low FODMAP way that hopefully is doable and not, too challenging.
And then if you want help longer term to try and minimise these flare ups, do get in touch.
I work with people on a one to one basis, over three months in my one to one gut reset, or of course my group gut reset. Which is where I take groups of people through the same gut reset process, but in a group situation.
Right, that is it for this week, I will see you next week, goodbye!