. .In today’s episode, we’re diving into the experience of four of my previous clients who suffered from constipation predominant IBS. You’ll hear how they improve, improve their bowel regularity, changed their diet, diversity, and reduced bloating.
Welcome to episode nine of The Inside Knowledge. I’m Anna Mapson. Today, I really wanted to focus on four people who’ve managed to really get to grips with their digestion and feel a lot better at the end of the three months of working with me.
The reason I wanted to pull this out for you is to show you what’s possible. To show you how people can improve. And how sometimes it’s not always the most obvious things that you would think of that actually helped them.
They’ve all got different ways of approaching the diet, changes that I suggested and they’ve all got different symptoms. The key thing that held them all together was that they all had IBS constipation to begin.
Tilly’s Triumph over IBS Constipation
Our first person we’re going to focus on is Tilly. Her main symptoms were constipation, as in not going to the bathroom very regularly.
In fact, you might relate to this, she started each day thinking, “If I go to the toilet and I start the day okay, my day will be all right. And if I don’t go, my whole day is ruined.”
Do you ever feel like that? I’ve actually had other clients say something similar, like your morning trip to the toilet can set the scene for the rest of the day and how you feel. And it can really start to create a lot of feelings of anxiety, if you don’t manage to go first thing in the morning.
Constipation & nausea could be linked to SIBO
Now, the other symptom that was really key for Tilly was nausea and burping. She felt sick a lot and it was linked to constipation and had frequent burping.
So she didn’t do a SIBO breath test, but I did suspect that she might have small intestine bacterial overgrowth due to some of the symptoms.
When you have an overgrowth of methane producing bacteria in your small intestine, then these can cause feelings of nausea through the high levels of methane. And also it’s quite related to things like brain fog.
But this person, she had a fear of being sick. As well as a constant feeling of being sick, so she was really anxious about the nausea, as well as, you know, feeling uncomfortable with the sicky feeling.
SIBO root cause investigation
So when I think someone might have an overgrowth of microbes in their small intestine. The key next step is to think about why. How could your body have allowed overgrowth to start?
Now what was key here in this person is that she had a rectocele, which is where the bowel can prolapse into the vagina. This can happen sometimes after you’ve had a pregnancy, a difficult birth, sometimes just through changes in your pelvic floor over time that can be hormone driven.
And the other key thing that was really important in this case was that she had a big peak in symptoms around ovulation. So not just at her period, but at ovulation she was getting, more bloating and more gut sensitivity.
So these were the two things that I thought we needed to work on.
Pelvic health physio for IBS constipation
I suggested that she went to a pelvic health physiotherapist and started seeing them. That really helped to try and get some small exercises just to try and help the pelvic floor health.
This can be so helpful when you have ongoing chronic constipation as well because sometimes you can lose… the sense of, the muscles relaxing and contracting at the right time in order to produce a bowel movement. Pelvic health physiotherapists are specially trained in releasing tension and helping you better coordinate the pelvic floor.
A diet for SIBO with constipation
Dietary wise with Tilly, we did the low FODMAP diet. Stripping out all the fermentable carbs in order to get control of her symptoms. Because the burping and the nausea were really driving fear and anxiety about digestion. I wanted to help her quieten down that digestive discomfort and noise.
By taking out FODMAPs and then slowly reintroducing them, we were able to find one or two triggers and things that she should just keep to a low dose.
But… All of the other things that were being restricted unnecessarily could actually be brought back in. And that was really powerful and really beneficial to realize that food isn’t always the biggest trigger. So actually sometimes for her, it was more a question of mental health and also pelvic health, physio.
And actually food, although there was some trigger, it didn’t have the same impact at certain times of the month as it did around her hormones.
Tilly’s closing words
At the end of working together, two things that she said that really stayed with me. The first one was, I’ve stopped undoing my jeans at six o’clock. And the second one is, I think I’m better.
And it’s just so nice to hear people come out the other side of some of these really tough periods in their lives and actually feel like things are better.
Sian’s Vegan Victory
The second person I want to tell you about was Sian. She had a positive SIBO breath test. This person did definitely have an overgrowth of methane, predominant microbes in her small intestine affecting her digestion.
Now she was only having a poo once a week. It was really… really constipated and very fed up of it. She’d had it for a couple of years.
A vegan diet lacking vegetables
She also was on a vegan diet. I would say it wasn’t a particularly healthy vegan diet. As in, there were very few vegetables in it, quite a lot of vegan fast food, like vegan pasties, vegan sausages.
She didn’t necessarily know much about cooking as well. So, some of the work we did together was just thinking about how to create healthy, simple meals at home that actually didn’t lead to additional bloating.
Does fasting slow down your gut?
Now, the other key thing with Sian is that she was working on intermittent fasting in order to try and manage the bloating.
She felt better when she didn’t eat. And so she was cutting out meals. But I think actually that was helping to promote constipation because she had less and less food inside her and it was slowing down her digestion.
And it was also affecting her energy levels because she just wasn’t getting enough food in.
She said right at the beginning, “well, when I went healthy, it was bad. Things got worse when I went healthy. It’s better when I eat vegan pizza, fajitas, burgers, things like that.”
The first thing we did together was to try and get Sian eating more fruit and vegetables.
Using low FODMAP foods to increase fibre
I started with lower FODMAP foods that were less likely to increase her bloating. And also started her on some magnesium oxide, which is a really good gentle laxative that draws water into the bowel. It helps to promote bowel movements.
She did sometimes take laxatives as well. I really wanted to get the blockage cleared and then we could start introducing more food. So part of the way to do that is just introduce low FODMAP fibres, and also just introduce some laxative supplements and things to get things moving.
Then once she was starting to have a bit more regular bowel movements and the bloating was a little bit better because she was less backed up, then I started to encourage her to eat more FODMAP containing foods.
Increasing fibre to help constipation
Because she was on a vegan diet, she really did need to start eating a lot more plants and like fruits and vegetables. Starting to be a little bit braver with them and as she saw that it wasn’t as bad as she thought. She got more confidence and started to eat a bit more of a balanced vegan diet.
By the end of the three months working together she wasn’t having a bowel movement every single day. But she was going every other day, at least.
And I think that was a huge improvement and a huge win.
Sian’s Gut Reset thoughts
And two things that she said at the end, which was really pleasing. The first one was eating some garlic bread. And so she was a little bit scared at the beginning, but she said, “Oh my God, it was so lovely”.
She just hadn’t had any garlic for such a long time! To be able to enjoy garlic bread. was a real treat for her.
And the second thing was that she went out for a meal with friends. It was like a mixed Asian restaurant and she was able to eat something. And she said, “I would never have done this three months ago”.
So by the end of it, she’d got confidence enough to try eating in a restaurant where she’d never been before. And she hadn’t spent all week looking at the menu before she got there. Just the confidence to be able to go out and eat without feeling like she was going to explode.
Her tummy would be huge the next day because she had ways of managing the constipation. She had managed to get it down to every day or every other day.
She knew the things that helped her. When I see people getting back to living their lives again, instead of… Sitting at home feeling bloated and miserable. It’s just so encouraging.
It’s the best part of what I do. I love writing down some of the things people say at the end about how they’re feeling because it’s great to compare that to how they started.
Now the third person is Claire. She was cutting out a lot of different foods. Was cutting out anything with sugar in it, she wasn’t eating dairy, any gluten. Cutting out a lot of FODMAP foods as well.
Also only eating one main meal a day, and what I would call two light meals. Which were again similar to Sian, not necessarily feeding herself with the right amount of energy. I think that was also really triggering some of the symptoms.
Now, with Claire, what we did, was to go through the FODMAP process. As part of reintroducing the foods, we didn’t necessarily find many key triggers for the bloating. But what we did do was massively change her digestive transit time.
IBS Constipation resolved, but not bloating
So by the end of the three months working together, she wasn’t constipated at all. She was going every day, pretty normal bowel movements.
But, I have to say, she was still getting the bloating, so that was unresolved. We used the FODMAPS a bit like a kind of reset, just to try and get a new baseline, try and see if there were any triggers.
And what was also really interesting through this is that she discovered that gluten was not a trigger for her. She thought that gluten was always a big problem. But actually bringing back in gluten containing foods. Then thinking about wheat containing foods and actually doing it in a really careful, considered way helped her understand that gluten wasn’t the problem. Wasn’t the enemy. That allowed her to just enjoy eating, a wider selection of foods again and particularly when going out or going on holiday.
Using the low FODMAP diet to reset
By going through the low FODMAP process, although she didn’t actually identify any of the key food groups as triggers. What she did do was learn how to use the FODMAP diet as a tool.
So on days when it got really bad and the bloating start kicked off again, she could use the low FODMAP meal plan. Or just some like ways of eating that she’d learnt over the couple of months in order to help her reset.
So when she feels like things are building up and it’s getting a little bit out of control symptom wise she just goes low FODMAP for a few days tries to reset and keep working on it.
A positive SIBO test result and treatment
Claire actually did a SIBO breath test which came back as positive her doctor was able to give her some antibiotics for SIBO. Although not the recommended rifaximin, which is the ideal SIBO treatment. But some other broad spectrum antibiotics that did actually help.
I supported her with some prokinetic herbs that would start capitalizing on the benefits that, she got through the antibiotics.
Again, this person different to some of the other two in that a constipation went, but the bloating didn’t go by the end of the three months.
But what she did get was a learning about her digestion, a real better understanding of potential food triggers. Also she can say she’s been through the low FODMAP process really thoroughly.
So she can go back to the doctor again and say things still aren’t resolved and I’ve done this process. Because often what they’ll say is go off and try the low FODMAP diet.
The fourth person I want to move on to is Jenny. She was having bowel movements a couple of times a week but they would be very large. And she had very large haemorrhoids which are very painful. This was causing quite a bit of fear because of the pain of actually going.
So one of the other big issues for Jenny was trying to get out the door in order to get to work. She was really worried about how long it took to have a poo either in the morning because it would make her late for work. Or she would have to go to work and spend ages in the toilet trying to go.
A little bit similar to the first person I talked about, Tilly, is like, if you don’t go first thing in the morning, actually you feel like your whole day is ruined because you’re thinking about it all the time.
Freeing up headspace
And actually just coming back to Jenny, one of the things she said at the end of working together was, “I don’t even think about it now.
And obviously that is what we’re all aiming for. We don’t want to have to be thinking about how many times we’ve been or how long it’s going to take. So this freeing up of thoughts is really powerful part of getting on top of your IBS and getting your life back again. Just freeing up some headspace that is spending too much time thinking about poo.
Increasing diet diversity for constipation
Dietary wise, things that helped Jenny was trying to get a bit more diet diversity in. Really trying to expand the range of different fruits and vegetables that she ate, and because of the antioxidants that are in these plants and fruits and things, that is really helpful for people with haemorrhoids.
Slowing down to digest food better
The other thing we worked on a lot was eating patterns. And timing of meals and moved her evening meal a little bit further forward. So she had longer to digest her food before she went to bed.
Also really slowing down to eat her meals. Really taking time to chew the food making sure it’s as well mashed up as it can be before swallowing. Actually that has a big impact on your ability to digest your food. Which can help with bloating.
By the end of the three months Jenny really had a very good digestion and was going every day. Was not worrying about the haemorrhoids because they had gone down and hadn’t come back up. That was because the constipation was under control.
She was having regular soft bowel movements every day and just generally felt a lot better.
Everyone with IBS has a different story
I hope you can see with these four different stories, very different people, very different situations in terms of their life, their caring responsibilities, their jobs, very different symptoms.
Even though they’re all IBS and they’re all constipation predominant, they had different needs.
That’s what’s important about working with somebody individually. Just working on what suits you, your life situation, and actually your symptoms. That is what is really key.
And they also had different outcomes, you know, some of them would say they were completely better. Some of them were halfway along that journey in three months. And some of them, you know, still had a little way to go.
But they all understood a lot more about their own digestion and what helps them and what they can continue working on after we finished our journey together.
Do you need help with your IBS?
We just set up half an hour to have a conversation about what you think you need some help with, whether I think I can help you. Then see where we go from there.
If you’ve enjoyed this podcast, please would you share it with somebody else who’s got IBS? This information could help a lot of people, so, if you’ve enjoyed it, please share it with someone you think would find it useful.
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Thanks. Right. I’ll be back next week. Take care. See you then. Bye.