The 4 Types of IBS & Best Treatments for IBS-Constipation

Jessie Wong 00:00:00 Welcome to the IBS Nutrition Podcast, your go to source for navigating the complex diagnosis of irritable bowel syndrome. Here, we dive deep into IBS and discover the power of diet and lifestyle to find freedom from your IBS symptoms. I’m your host, Jesse Wong, Fodmap dietitian and a gut expert. For years, I suffered from debilitating gut symptoms that kept me out of work, feeling constant discomfort in my body and anxious around food. Today, I’m in control of my IBS, able to eat the food I love again, travel whenever I want, and spend quality time with loved ones. It is my mission to help you do the same and transform the way you live with IBS. Let’s get started. Hi everyone! Welcome to another episode of IBS Nutrition Podcast. I’m your host, Jesse Wong, and with me is Brooke Keenan, our team IBS dietitian lead. And today we are going to talk about a topic that is super interesting. And we get asked that all the time. So are there different types of IBS and what are the different types of IBS.

Jessie Wong 00:01:05 And today we are going to dive a little bit deeper into IBS constipation predominance. Now there are multiple types of IBS, and we’re going to dive deeper into other types at a different episode. But today we’re going to talk about types of IBS, constipation and how to. More importantly, the last topic will be how to improve your gut motility. What are the things that we usually recommend for our clients? So, Brooke, would you want to take us off and talk about what are the different types of IBS and which are the more common ones?

Brooke Keenan 00:01:36 Yeah, so we have IBS, so constipation, IBS with diarrhea and IBS m, which can be alternating between diarrhea and constipation. So since we’re talking about IBS c today, IBS based on the Rome three criteria, is defined as a recurrent abdominal pain or discomfort at least three days per month in the last three months associated with two or more of the following symptoms. Improvement with defecation onset associated with a change in frequency of stool and or onset associated with a change in the form of stool.

Brooke Keenan 00:02:11 So basically consistently being backed up really.

Jessie Wong 00:02:16 Right. And one of the ways we look at constipation is by looking at a patient’s or a client’s stool picture to identify whether they are constipated or maybe they are backed up. Now, there are different types of criteria, right? When we talk about constipation, I think the previous ones were ones that we’ve always learned in school is that you’re not pooping, at least twice a week. You’re constipated for three days, and then, you may have to strain, you may have rabbit pellet poop. And that’s not necessarily what we see in practice, because sometimes people may be having like, a small poop every single day, but they are not fully evacuated every day. And that unlawfully evacuation or that inability to fully evacuate can cause the store to be packed up and causing they have causing them to have Stu burden in their colon. And that’s too. Burden is what causes a lot of fermentation of gas and can cause trapped gas, which cause pain, and also when the stew is stuck or the stew burden is building up in the colon, it can actually get thicker and thicker and really stretched out a person’s colon.

Jessie Wong 00:03:30 Right. And that’s a lot of what we see is patients may be having a bowel movement, maybe even multiple times a day, but they might just be a pebble or two pebbles or some droplets. And they are not having that full evacuation. And people often also feel like there’s more that’s in there and they are not coming out. So that is one big type of IBS that we actually see a lot. Now, what would you say is the most useful tool for us when it comes to helping patients with different bowel habits or improving their gut motility, leading to a better evacuation.

Brooke Keenan 00:04:10 So first it would be tracking tracking what the bowel movements look like and how many a day and and sometimes how they feel when they’re evacuating. I find what people think is either a full evacuation or like they’re okay. you know, I have a bowel movement every day. Well, it’s important, like you were saying to to ask more questions. Are they full evacuations? Are you having a few rabbit poops a day? Because then that that’s a different story.

Brooke Keenan 00:04:42 So once we kind of for me, it’s seeing, a pattern of bowel movements and then working on gut motility. One of the first steps would be hydration, making sure that you are hydrated. Now I will say some clients come to me and they’re constipated and they’re drinking like 120oz of water a day. Adding more fluid to that is not going to help with your constipation. so that’s important to it’s not always just hydration. But then on the other hand, people come and they’re drinking, you know, 20oz of water a day. So the first intervention would be hydration.

Jessie Wong 00:05:18 Yes. Hydration is so important because that one of the function of our colon is actually reabsorption fluid from the time that goes. So a small intestine absorbs the nutrients and then the kind which is the liquid food that’s passing through from the small intestine going into the colon. And one of the main function of the colon is absorbing fluids from the time so that it helps to form. Right. And then if we are not having enough fluids, if we are dehydrated, our colon will have a tendency of reabsorb more fluids from the kind so that your stool will be harder and more difficult to pass.

Jessie Wong 00:05:59 So hydration is always the first step. What else are the foundation of what we recommend?

Brooke Keenan 00:06:05 The next one I like to focus on is fiber intake. and most Americans eat about 10 to 12g a day of fiber sometimes, if that. And we really do want to get more towards the 3035 range, 25 to 30 for women, 30 to 35 for men. But importantly, you don’t just want it if you’re eating ten grams of fiber a day, the next day, go out and eat, you know, 30 plus grams of fiber. That will definitely make your constipation worse, not better. So we slowly want to increase fiber intake. That can definitely help. and sometimes a fiber supplement, a soluble fiber supplement can help to soften some of that stool if you’re drinking enough, water soluble fiber supplement can help. But of course, we want to really get our fiber from food first.

Jessie Wong 00:06:57 Right. And I love that you mentioned the soluble fiber. And usually the first line of defense would be psyllium.

Jessie Wong 00:07:03 Because psyllium is a water soluble it’s gel forming. So it’s it’s that’s something else we look at as well as viscosity or solubility viscosity and ferment ability. So is water soluble is gel forming. But it’s not fermentable meaning it may not cause more symptoms or more bloating if you are already very bloated. However, psyllium is not something everybody tolerates, so, you know, start trialing at a very low dose and then slowly increase. But you still like what Brooke just said. You still want to get the majority of your fiber from food sources. So that could be a whole grain, fruits and vegetables if possible, because variety really matters when it comes to improving your gut function and improving your gut microbiome composition. All right. So those are I would say hydration fiber. Those are the two solid foundation for having better motility. And then the last one would be exercise right. Having routine exercise also really help improve our gut motility now. But if you are someone who is really, really constipated or very backed up, very bloated, then it may not be the best time to do something very strenuous, but maybe more so.

Jessie Wong 00:08:13 Introduce gentle exercise to help your body calm down first, and then actually help things move along and then exercise that. Especially have that up and down motion that can help things move out a little bit easier and a bit faster as well. So that could be slow jogging and or walking. So speed walking as well can be very helpful. And when we talk about gentle exercise we’re really talking about, exercise where you will breathe a little bit deeper, but then you can still form sentences without having to break. Whereas very strenuous exercise, if you are having got symptoms, it may not, it may trigger more symptoms because we are drawing blood away from your guts and that can lead to more inflammation if there’s already irritation going on. All right. So what are the things we often talk about when we work with our clients to improve their gut motility? Yeah.

Brooke Keenan 00:09:10 So lifestyle factors would be sleep. That can be a big one. And and I find too with the lifestyle factors that they’re very important. But they’re not going to necessarily change things overnight.

Brooke Keenan 00:09:22 So they have more certainly sleep managing stress. Those things are going to be a cumulative effect, but also meal timing. So trying to eat regular meals instead of, you know, one giant meal a day, if you are having gut issues, probably doing intermittent fasting for 18 hours a day might not be the best idea. And those are all things we address in the program to and over the, the three months that we share together. Yeah.

Jessie Wong 00:09:57 Right. In a small group program, we worked together for three months with our clients. Now with new timing, I think with constipation type of IBS, what we usually promote is three good meals a day. So you don’t want to skip the meals because it can cost more symptoms, and then it can cause you to maybe overeat and cause more symptoms when you eat. and then three good news is really important, especially breakfast time, because that’s when our guts most active and we, What is that word? The color.

Brooke Keenan 00:10:27 Cholinergic. I would say that wrong.

Brooke Keenan 00:10:30 Cholinergic. Yeah.

Jessie Wong 00:10:32 Reaction.

Jessie Wong 00:10:34 Orchestral reflex is the strongest in the morning. And what? Castro reflex means is that when you eat food, it goes into your stomach. Your stomach actually sends a signal to your colon to expel the stool that is in your colon. And that sensation and that feeling is the strongest in the morning. So we really encourage our clients or anybody struggling with ibs-c to have a good breakfast in the morning. And if you can tolerate coffee, coffee’s great in helping things come out faster because there are multiple laxative functions or characteristics that coffee has. And of course, it’s also a hydration source, like, contrary to what most people think, that coffee will dehydrate you. No, coffee does not dehydrate you. It doesn’t hydrate you as much as water does, but it is still a hydration source, and it can be very useful for those of us with chronic constipation. Right. okay. What else? So I think we talked about most of the things. Oh, one thing we did not talk about is hormone.

Jessie Wong 00:11:35 Right. And this is particularly important for those of us who are women. To learn more about our hormonal fluctuations and understand when to intervene, when a problem occurs in our guts with hormonal fluctuations, we are not saying something is wrong with it. It is normal hormonal fluctuations, especially for those of us in our reproductive age. And what usually happens is we have increased progesterone before our menstruation cycle starts. And progesterone is a hormone that helps us carry a baby. And it also actually slows down our GI tract. And when we have a surge of progesterone before our periods, it can slow down a gut so much that some of us will feel very constipated. And that is a normal fluctuation of your menstruation cycle. Nothing you need to do about it, but more so understanding that this happens and you need to maybe intervene a little bit more, eating more fruits and vegetables at this time to help things come out better. Maybe focus more on self-care so that you are not, you are not in that tense states that some of us with PMS are usually in.

Jessie Wong 00:12:47 Because when you are more tense, that can slow your gut down significantly as well. So really focus on self-care, drinking more fluids, eating more fruits and vegetables, or maybe things that are more anti-inflammatory, maybe berries, maybe eating more fish around that time. So understanding your cycle and how it affects your gut is really important. there’s nothing you really need to do to change your hormones. Like some people will try to sell you supplements for balancing your hormone. That’s not evidence based. It’s not a real thing. So run if you see people talk about that, but more so understanding about your body. And one thing we see that tends to happen to women is when their period starts they get diarrhea, what we also call the period poop. And that’s quite common. And what we find in our practice is that if your constipation is well managed, people tend to get less diarrhea or less gut symptoms during this time when things are changing rapidly or when you’re feeling maybe not the greatest. so really focus on, you know, taking care of yourself can help ease your period poop as well.

Jessie Wong 00:13:49 and that’s something we don’t talk about enough when it comes to constipation. But again, you know, nothing you need to change in terms of your hormonal balance, but more so learning about your body. Now, when none of this works. This is when we look into maybe food intolerances causing you to have more constipation. Brooke, do you want to share more about what type of food intolerance we see often that yeah.

Brooke Keenan 00:14:14 So we we see a lot of Fodmap intolerance as well as some gluten intolerance and oat intolerance, and we definitely tailor the interventions to each person. But that’s one of those combinations is where we typically start and how you feel. And your gut symptoms can change pretty, drastically when some of those foods.

Brooke Keenan 00:14:40 Are cut out. But again, the as we’ve discussed previously, you certainly don’t want to do an elimination diet for any absolutely any longer than necessary. And we try and get the reintroduction trial started as quickly as possible, so we can get you back to eating as many foods as possible, right?

Jessie Wong 00:15:00 I love how you frame that.

Jessie Wong 00:15:01 We don’t want people to stay on elimination diet long term, because we know that can be detrimental for long term gut health when we reduce the variety of foods we are eating. And that actually maybe brings me to a client story that I want to share about chronic constipation. Actually, this client, her name is alma. She was the most wonderful lady I’ve met. She was always so grateful. And I remember she has she works in a school system. So she we met really early so that she can get to work on time. And she came to us because she was very, very bloated and she was constipated, but she didn’t quite know that she was constipated to a point where it was affecting everything else. So she was very bloated. And her doctor told her to do the low-fodmap diets, but she didn’t really quite know how to do it and was not offered any guidance. And that’s again a problem we talk about. And we had two episodes before this about the low Fodmap diet. If you want to learn more, listen to those episodes about the low Fodmap diet.

Jessie Wong 00:16:00 But what she really struggled with was significant chronic constipation, and that gave her a lot of trapped gas, a lot of pain. And it actually sent her to the E.R. as well. And when her doctor told her to try to try the low Fodmap diet, she became very afraid of food because she wasn’t sure if the food was causing all of her symptoms. And that’s when we started working together to work through the low Fodmap diet together. And what we did together was first understand what was causing her pain and her bloating and all of her gut symptoms. And as soon as we started looking at her food journal of her bowel movement journals and her symptoms, we recognize a pattern that she was not having full evacuations. And that was mainly the reason why she was experiencing a lot of symptoms. And anytime she eats FODMAPs, she gets really bloated and very gassy. So the first thing we did was to help her have better evacuations and really resolving and and work on her chronic constipation first before actually working on the diet piece.

Jessie Wong 00:17:05 Because, you know, oftentimes, you know, people think that, oh, I have to do the low Fodmap diet because that’s what my doctor told me to. Yes, in some cases we want to do that, but it’s not always necessary. So what we did was actually use some over-the-counter laxative every day to help her have full evacuations every day. And then we worked on the lifestyle changes that we talked about earlier. Right. hydration, fiber, exercise, sleep, stress and creating a routine that works for her so that she can continue to have good evacuations every day. and then that’s when we also slowly dose down on her laxative use so that she’s not as reliant on it. Now. Laxative over-the-counter laxative is perfectly safe if you need it for the rest of your life, it’s perfectly safe. Talk to your health care provider. Create a routine that works for you, and you know all of these rights really was a game changer for her to help her have better evacuations. And she actually wrote a testimonial for us.

Jessie Wong 00:18:06 And I want to read it to you because I want to share with you what is possible. So she said, we also worked on increasing my fiber intake daily as well as my water intake, and all of these combined has been a game changer. And since working together, I have not had a flare up. I haven’t had trapped gas or excessive bloating. Now all the things we talk about may seem like, okay, these are so simple. You know I can do this. Yes, you can do this. You know, work on the foundation first before you try and elimination diets. And at the end, when we reintroduce most of the format groups, she was able to tolerate most of them, I think, except maybe 1 or 2 groups at a higher dosage. And what she wrote at the end of working together was that, you know, once she learned about what was really causing her problem, which was significant constipation, she felt like a huge weight lifted off her shoulder. And this is what she wrote.

Jessie Wong 00:19:03 Jesse taught me that many factors can affect your gut motility and how she could support her gut mind connection, and overall, we helped her reach her goal of getting her health back on track and she felt a huge weight lifted off her shoulder. She’s less stressed now. She gained confidence, knowledge and most of all regained her love for food. So for those of you who may be struggling with constipation, you know, work on the basics first and then if it still doesn’t work, then learn more about food intolerance and maybe work with a professional to see if you do have a food intolerance or not. Don’t just cut out food. You know, cutting out food is the last resort, and we want you to be able to eat all the foods you love. As always, you know, expand your diet and really improve your gut function. That way, unless you have something that triggers your symptoms. All right. Did we miss anything about constipation? I think we covered most grounds here.

Brooke Keenan 00:20:00 I think we did. Yeah.

Jessie Wong 00:20:01 Yes. Oh, one last thought is, if you’ve had constipation for a long time, another thing that could help is maybe pelvic floor physical therapy. That’s always. And, interesting topic. I’m actually we will have an episode very soon with a pelvic floor specialist, a physical therapist who works in that area. So if you’re interested, you can listen in. For those of us women, it’s always good to get assessed. And, another area to consider. Okay, well thank you so much, Brooke, for joining me today and sharing all of your wisdom with me and our listeners. And if you are struggling with chronic constipation, I would love for you to work on the foundations first and try to, you know, really work on your lifestyle and find a routine that works for you. All right. Thank you all.

Brooke Keenan 00:20:48 Bye.

Jessie Wong 00:20:48 Thank you for tuning into the IBS nutrition Podcast. We hope today’s episode has brought you closer to understanding and managing IBS. Remember, you are not alone on this journey and finding freedom is possible.

Jessie Wong 00:21:01 For more on IBS, make sure to follow us on your favorite podcast platforms and please leave us a five star review! We would really appreciate that you can access links mentioned in this episode in the show notes to learn more about your type of IBS and how to identify your own food or lifestyle triggers, Register for a free IPS Masterclass. Three steps to IBS relief for our proven, holistic, three steps approach to managing IBS once and for all, head to IBS dietician. Com forward slash masterclass to register and till next time, take good care of your gut and here’s to your health and happiness.