Bowel and Bladder

[Tracey_E]

Hi, I have IBS and Overactive bladder syndrome, but I am getting no relief from symptoms at all at present..i take solifenacin for bladder, but am up at least 2/3 times in the night....and the IBS is getting me so down, I have constant swollen and painfull stomach, mainly high up just under my breast bone (I also have stomach ulcers)....so at the moment I don't which is causing me pain and swelling! I get lots of lumps that I can feel all over my stomach and intestines...ive tried Buscapan, fibregel/mebeverine, im using peppermint oil caps at the moment, but nothing is working....I eat a healthy diet, with lots of fruit veg and fibre....so I don't know what to do next?

[christine bailey]

Many thanks for your question. I am sorry to hear that nothing appears to be helping the IBS and / or over active bladder (OAB)

Looking from a functional perspective there are many factors to consider with IBS. Coeliac Disease should be ruled out - this is an autoimmune disease to gluten. Even if this is negative many people are gluten sensitive and a trial removal of gluten may help alleviate symptoms.

However in some cases of IBS there is an imbalance in the gut flora - in some cases there may be an infection - yeasts, bacterial overgrowth and / or parasites are common. A comprehensive stool test with parastiology may be helpful in this respect. These tests are available from many private labs in the UK. Small intestinal bowel Overgrowth known as SIBO can also contribute to bloating and pain and this can be investigated via a hydrogen breath test. Stress is also known to aggravate IBS symptoms and OAB so looking at lifestyle triggers may also be beneficial.

Dietary wise you may have heard of FODMAPS. FODMAPs is an acronym for Fermentable, Oligo-, Di- and Mono-saccharides and Polyols, used to describe a group of fermentable short-chain carbohydrates. Some evidence suggests that reducing global intake of FODMAPs to manage functional gut symptoms provides symptom relief many patients with Functional Gut Disorders such as IBS.

FODMAPs are prevalent in the diet and are composed of oligosaccharides (fructans, galactans), disaccharides (lactose), monosaccharides (fructose), and polyols (sugar alcohols).

Experts have known for some time that lactose can contribute to gas, bloating, and diarrhea in those with hypolactasia. With the advent of sugar-free products, they found that the overuse of sugar alcohols can lead to diarrhea. More recently, they established that fructose can be malabsorbed and mimic symptoms of lactose intolerance.

Collectively, FODMAPs, as short-chain sugars, can be easily fermented and exert an osmotic effect, increasing fluid delivery into the large bowel and resulting in gas, pain, and osmotic diarrhea. Those with visceral hypersensitivity or gut motility disorders appear to be more distressed by these side effects. The colonic microflora feast on the malabsorbed sugars and create gas, which contributes to abdominal bloating. Growing evidence reveals the beneficial role of minimizing FODMAPs for those with FGDs such as IBS. Lactose-rich foods such as ice cream, milk, condensed milk, and most soft cheeses (eg, cottage cheese). High Fructose foods include honey, apples, pears, watermelon, agave syrup. Foods high in fructans includes wheat / gluten foods and galactans foods include beans, pulses, broccoli and soy. Polyols include xylitol. Your best sweetener if you are reacting to these foods may be molasses or maple syrup. Other common problem foods include onion, garlic and leeks. Taking a food diary for a week and monitoring what you eat together with signs and symptoms can be helpful. A trial removal of some of these foods may be helpful in reducing your symptoms although if there is an underlying gut imbalance this will need to be addressed for long term relief hence why further investigations are recommended. In addition removal of "bladder irritating" food and drinks (such as caffeine, alcohol and highly spiced foods) can be helpful for some people with OAB symptoms. Potentially an infection may also be triggering your OAB symptoms so do speak with your GP further

As you have mentioned stomach ulcers it is important you speak to your GP about testing for Helicobacter pylori - this bacteria is commonly linked to stomach ulcers, pain and reflux and can be treated if present.

I hope this is helpful
Christine Bailey

[Debbie Stuart]

You may find it helpful to speak to a specialist continence adviser at the Bladder & Bowel Foundation. Call 0845 345 0165, leave your name and number and an adviser will call you back.

[Julie Thompson]

Hi

Christine has provided some useful advice. If you wish to try the Low FODMAP diet ask your GP to refer you to a registered dietitian, the following is a list of dietitians that are trained in providing treatment to follow the Low FODMAP diet. The research evidence around this diet is that around 70% of people feel symptom improvement in following the diet and it is useful to identify which foods are problematic for you - this data is only applicable to those who are treated by a dietitian competent in using the Low FODMAP diet.

http://www.kcl.ac.uk/medicine/research/ ... 201306.pdf

I would also have a look at The IBS Network Self Care Plan, which will help you to have a look at other treatment that is available.

http://www.theibsnetwork.org/the-self-care-plan

Hope this helps.