Managing Irritable Bowel Syndrome course
About This Course
Learn evidence-based scientific ways for managing irritable bowel syndrome.
Course created and written by
Dr Joseph Kekulawala is a Fellow of the Royal Australian and New Zealand College of Psychiatrists. His last public appointment was at the Royal Melbourne Hospital. He is passionate about improving access to quality mental health care globally.
About this course
Learn evidence-based scientific ways for managing irritable bowel syndrome.
This six week course can form part of your irritable bowel syndrome treatment. It’s designed to work alongside your doctor and dietician’s advice. In this course we cover stress and relaxation management, building a relationship with your doctor, tips for managing social outings, managing flareups and so much more.
By taking this self-help course, you’ll develop psychological skills that can form part of your irritable bowel syndrome treatment. There is a growing scientific evidence base for the use of psychology when managing irritable bowel syndrome. Our psychologists and psychiatrist have used some of that evidence when creating this irritable bowel syndrome treatment course.
This course is designed for someone looking for help with their Irritable bowel syndrome. Week 1 is an introduction before we move into more focused topics.
Why we created this course.
Hundreds of millions of people struggle with irritable bowel syndrome. It is under-recognised and under-diagnosed condition. There is a lot of shame carried by people with irritable bowel syndrome. Millions of people experience it but are unaware. Effective irritable bowel syndrome treatment can lead to improvements in quality of life, satisfaction and overall happiness.
This course has been written by our team. We have looked at different schools of evidence-based psychological and other practices to build this course. We tried our best to explain the different psychology skills so that anyone can understand and start using our course.
We want you to see this course tools alongside advice from your medical doctors and broader support. We believe that it is possible for people to get better at managing their irritable bowel syndrome, with the right mindset and psychological tools.
How this course is different
Each week of our course is divided into five parts:
- Educational lessons at the start
- Quizzes to get you thinking about your mental health
- Aided self-reflection component to increase awareness
- Tailored suggestions depending on your quiz answers
- Action plans plus worksheets
Depending on your quiz answers, you will get tailored suggestions each week. The feedback and suggestions you take away from this course will be unique to you. There is less than a 1 in 100,000 chance that your quiz answers will be the same as someone else’s.
We use a computer matching algorithm to give specific feedback and suggestions based on your quiz answers.
Why do we do this?
People are unique. What causes your irritable bowel syndrome will be different to someone else. The quizzes are there to help you understand your irritable bowel syndrome. To provide you tailored answers, feedback, and solutions.
Key aspects of this course
In this course we cover pain, bloating and diarrhoea management, skills to manage unhelpful thinking, understanding your stress response and so much more. We will share some of our best behavioural strategies, stress management tips and other psychological ways of managing irritable bowel syndrome.
Is that this course will help you with managing irritable bowel syndrome. That it will be a tool alongside professional and other support you get. We want to get you thinking, understanding and eventually improve your irritable bowel syndrome management. We believe that irritable bowel syndrome treatment is achievable with the right approach.
Good News! We have opened access to Week 1 of the learning material
Topics Covered in this section
Introduction to this course
Welcome to the Epsychonline Managing irritable bowel syndrome Course. This is a six-week, self-help program for people struggling with Irritable Bowel Syndrome (irritable bowel syndrome).
Do you suffer from frequent stomach pain or cramps? Do you struggle with regular tummy discomfort, flatulence, diarrhoea, constipation or bloating? What about a lack of energy, tiredness, or feeling sick? Do you feel embarrassed or ashamed about these symptoms? Do they stop you from living your life to the fullest? Lastly, have you been told there is nothing ‘wrong’ with you and no medical reason for your symptoms?
If you answered yes to any of these questions, you may be feeling frustrated, alone, and hopeless. This is undoubtedly holding you back from reaching your full potential and living the life you want. Don’t worry, you’ve come to the right place! Whether you suffer from mild gastrointestinal symptoms or severe and debilitating irritable bowel syndrome, there are sources of support and effective treatment options available to you.
This course is a great place to start, and we applaud you on making it this far in your journey towards freedom from irritable bowel syndrome. All you need to get started with this course are basic reading skills and access to the internet. A good dose of motivation and an open mind will also go a long way. For anyone under the age of 18 years, we suggest a trusted adult be present to guide you through the content. Some of this content might trigger distress, so it is helpful to have some support.
What to expect from this course?
This course will guide you through an evidence-based information and skills package to help you manage your irritable bowel syndrome. The aims of this course are to help you:
- Better understand irritable bowel syndrome and how it impacts you
- Set some realistic goals for improvement
- Get to know and understand your symptoms
- Know how to find the right support
- Learn about and manage stress more effectively
- Learn about and change unhelpful ways of thinking and behaving
- Learn how to reduce the impact of your symptoms day-to-day
- Make a plan to maintain your gains and recover from setbacks
The course runs for 6-weeks in total, with each week broken down into three sections:
- Section 1 provides educational content to help boost your knowledge of irritable bowel syndrome and get you thinking about how the information applies to you. It also includes activities, or ‘action plans’, to help you put the principles you’ve learned into practice
- Section 2 guides you through an aided self-reflection in the form of multiple-choice questions and tailored feedback. This builds on Section 1 by helping you develop deeper insight into the nature of your difficulties
- Section 3 uses your responses from Section 2 to provide you with additional self-help recommendations and resources that are targeted to your unique needs.
How to get the most from this course
Having a vision for life changing improvement is great, but it is also important to have realistic expectations for this course. Learning the skills in this course will take time and practice. The more effort you put in, the more you will get out of the course. You are likely to start noticing benefits as you make changes in your own life, however, your difficulties are unlikely to resolve completely or be ‘cured’ within a short timeframe. To get long lasting benefits, you will need to continue your hard work well into the future.
When addressing complex health issues, it is not uncommon for things to get worse before they get better. Growing as a human being means stepping outside your comfort zone. With that said, feeling uncomfortable is often a sign of progress! We encourage you to redefine your view of success. Down the track, success might look like being completely irritable bowel syndrome symptom free. But right now, success might look like simply engaging with the course content each week and making a series of small changes in the way you think about and relate to your irritable bowel syndrome symptoms. You may not immediately feel better, but we encourage you not to make this your aim.
On the flip side, failure does not exist in this course. Every so-called ‘failure’ provides you with useful information. You may learn something new about yourself, a situation, or a new skill you’re trying out. Remember, knowing what doesn’t work is just as valuable as knowing what does work. So, we encourage you to reframe setbacks as ‘opportunities for learning’. When things don’t work out as planned, reflect on what got in the way and make the necessary changes to improve next time. The most important thing is that you keep trying (and learning).
Irritable Bowel Syndrome (irritable bowel syndrome)
What is irritable bowel syndrome?
Before we jump into the skills content for this course, we must first define what irritable bowel syndrome is. irritable bowel syndrome is often confused with other conditions, so it is important to know what we’re talking about. Before we move on, take a moment to think about what irritable bowel syndrome means to you. When you think of this word, what thoughts and feelings arise? What symptoms do you associate with it?
Irritable bowel syndrome (irritable bowel syndrome) is a largely misunderstood disorder. It’s symptoms are inconsistent and not easily explained, which can add to the distress for sufferers. Put simply, irritable bowel syndrome is a disorder that results in stomach discomfort and a series of other unpleasant symptoms. irritable bowel syndrome symptoms can fluctuate over time and differ from person to person. Symptoms of irritable bowel syndrome can range from mild to completely debilitating.
irritable bowel syndrome is a ‘functional disorder’ of the bowel and digestive system. A functional bowel disorder is a term used to describe problems with how your stomach and bowels function or work. Medical tests show no signs of structural disease in functional bowel disorders like irritable bowel syndrome. In other words, despite the symptoms, associated organs appear to be healthy and normal by medical standards. This leaves disordered bowel function as the only way to explain the symptoms. With that said, the symptoms are real and do have a physical basis.
To get a diagnosis of irritable bowel syndrome, you need to have experienced the symptoms for a minimum of 6-months. The main symptom of irritable bowel syndrome is ongoing discomfort in the stomach area (e.g., pain, cramping or bloating). Associated symptoms commonly include changes in bowel habits, which may include diarrhea, constipation or both. You may feel a sense of urgency to go to the toilet or a sense of being unable to completely empty your bowels (incomplete evacuation). We will discuss specific symptoms in more depth below.
Before we move on, it is important to clarify a few terms. Throughout this course, you will need to get comfortable with your poop. Yep, that’s right, your poop! For some people, this is an unsettling topic. As children, we are taught that our toileting habits are private and off limits as a subject for general discussion. We grow up thinking of toileting as ‘yukky’ or ‘disgusting’. However, we all gotta go. Whether you’re a newborn or a member of the royal family, toileting is a part of life. In fact, your toileting habits and the state of your poop can tell you a lot about your health.
A note on poop-related terms: Throughout this course, the terms stool or stools, feces, defecation, evacuation, bowel movement, and opening your bowels all relate to going to the toilet and the stuff that comes out of your bottom, your poo! You’ll become more comfortable with these terms as we go along.
Whilst there is no cure for irritable bowel syndrome, there are effective ways to manage the condition. Symptoms can often be controlled through diet and lifestyle, psychological strategies and some medications. It is important to know that irritable bowel syndrome can not cause death and will not turn into a worse medical condition like cancer. If left untreated, however, the symptoms will often remain and continue to cause you distress and discomfort.
Symptoms of irritable bowel syndrome
The term ‘syndrome’ refers to a collection of symptoms, not just one or two. Irritable Bowel Syndrome describes a group of symptoms, which includes lower stomach discomfort that may go away after having a bowel movement. Stomach discomfort is commonly painful and associated with changes in bowel movements. It is also associated with several other symptoms, which are described below.
Main symptoms of irritable bowel syndrome include frequent:
- Stomach pain, cramping and discomfort
- Constipation, diarrea, or periods of both
- Bloating or excessive gas
- Excessive wind (flatulence)
- Experiencing the urgent need to move your bowels
- Feeling of incomplete or unfinished bowel evacuation
- Changes in stool consistency or appearance (e.g., becoming softer or harder than usual, changes in colour)
- White mucus in your stool
- Lack of energy and fatigue
Less common symptoms of irritable bowel syndrome include (not required for a diagnosis):
- Muscle aches and pains
- Bad breath or taste in mouth
- Frequent urination (needing to pee often)
- Feeling sick or nauseous
- Heartburn or acid reflux
- Heart palpitations
- Pain during sex
- Sleep problems
irritable bowel syndrome symptoms are different between people and affect some people more than others. Symptoms can become worse, often during periods of high stress or after eating certain types of food. You may also have periods where you are relatively symptom free. It is unclear why people with irritable bowel syndrome often suffer a range of other symptoms that appear to be unrelated. The most likely explanation is that there is some shared biological or psychological cause behind it all.
In severe cases, the symptoms of irritable bowel syndrome can restrict your ability to travel, go to work/school, attend social functions and engage in leisure activities. In other cases, they may be more of a minor hassle that simply takes away from your ability to enjoy life sometimes. Either way, over time these symptoms can take a serious toll on your mental health and may lead to other conditions like low mood and anxiety. Take a moment to think about your own symptoms and how they impact your life.
Before we move on, there are a few important symptoms that are not part of irritable bowel syndrome but might be confused with it. If you have low iron (called ‘anemia’), fever, blood in your stools, frequent vomiting, a swelling/lump in the stomach or bottom area, or unexplained weight loss, then you should seek medical attention as soon as possible. These symptoms may suggest the presence of another, more serious medical condition. It is important that you get checked out by a qualified doctor and receive the right advice.
You’re not alone
You may be surprised by just how common irritable bowel syndrome is. Around 10-15% of people worldwide are said to suffer from the condition. The rates of irritable bowel syndrome differ by region, but are as high as 20% amongst adults in places like South America, the US and the UK. Not everyone with irritable bowel syndrome seeks medical care, but irritable bowel syndrome does account for millions of medical appointments each year. irritable bowel syndrome is the most common disorder diagnosed by doctors that specialise in treating stomach problems (called ‘gastroenterologists’). In fact, it is one of the most common health disorders in general!
More women than men suffer from irritable bowel syndrome, however, men can have the condition too. Around 35-40% of people with irritable bowel syndrome are male, with the remaining 60-65% being female. Most people with irritable bowel syndrome are under the age of 50 years. Symptoms often present in their twenties to forties. Alarmingly, one study found that it took close to 7 years on average for patients to receive a diagnosis of irritable bowel syndrome after their symptoms began. So, clearly, if you have been suffering with this condition yourself, you are not alone.
It’s not ‘all in your head’
As we mentioned earlier, irritable bowel syndrome is a ‘functional’ disorder, meaning that there is something wrong with the way the digestive system is functioning. However, people often misinterpret this to mean that irritable bowel syndrome is not a real or valid diagnosis. People with irritable bowel syndrome are often told by their doctors that there is no sign of disease on their medical tests. In other words, they are told by the medical world that there’s nothing wrong with them. Many people assume that others think they are making things up or that the symptoms are all in their head.
People with irritable bowel syndrome often feel frustrated and misunderstood when navigating the medical system and trying to seek help. When you’re feeling ill, it is extremely disheartening not to be given any answers. Similarly, when there is no explanation for your symptoms, there are no solutions. As such, feelings of hopelessness, isolation and despair are also common. The belief that ‘it’s all in your head’ creates a lot of stigma for people with irritable bowel syndrome and can act as a barrier to getting help.
Remember, irritable bowel syndrome is a very real disorder of the digestive system with serious implications for people’s health and quality of life. While mental health plays a role in irritable bowel syndrome and may trigger symptoms, conditions like depression, anxiety and stress do not cause irritable bowel syndrome.
Causes of irritable bowel syndrome
As with most health conditions, there is no single cause for irritable bowel syndrome. Furthermore, the causes of irritable bowel syndrome are not well understood. Because there is no visible sign of disease on medical tests for irritable bowel syndrome, doctors don’t know why some people develop this condition and others don’t. The most likely scenario is that multiple factors interact to cause irritable bowel syndrome. You need to have a combination of several factors to develop the condition. These factors can be broken down into biological, psychological and social factors.
There may be a genetic link to irritable bowel syndrome, however no single gene causes the condition. The irritable bowel syndrome symptoms themselves are caused by altered muscle contractions in the intestines and increased sensitivity to food, stress, gas or poop in the bowel. irritable bowel syndrome is also associated with nervous system and gut bacteria changes that might be partly responsible for producing symptoms. The interaction between the brain and the gut is of particular interest in irritable bowel syndrome.
It is not uncommon for people to report that their irritable bowel syndrome symptoms started just after a stomach bug or infection of some kind. An imbalance in gut bacteria may cause symptoms of irritable bowel syndrome, impact inflammation and alter gut-brain communication. Although there is no sign of digestive inflammation in medical tests for irritable bowel syndrome, it is possible that undetectable inflammation is playing a role. We discuss some more of the biological processes that contribute to irritable bowel syndrome in the sections below.
There is a link between irritable bowel syndrome and certain mental health conditions, including depression and anxiety. These conditions do not cause irritable bowel syndrome, but they have the potential to trigger or worsen symptoms. There is also a link between irritable bowel syndrome and early life trauma. People exposed to stressful events, particularly in childhood, are more likely to experience symptoms of irritable bowel syndrome. Other psychological factors, including personality and coping styles, may also play a role in the development of irritable bowel syndrome.
A chronically stressful life may contribute to or worsen the development of irritable bowel syndrome. Stress itself does not cause irritable bowel syndrome, but it can worsen or trigger symptoms. Stress may come from things like relationship breakdown, lack of social support, work or financial difficulties, housing problems, loss of a loved one, or other daily hassles. These may interact with other biological and psychological factors to worsen the symptoms of irritable bowel syndrome.
Getting to know your gut
Here, we give you a brief overview of the digestive system. Given that irritable bowel syndrome involves problems in the way the digestive system functions, it can be helpful to know a bit about the digestive system and how it works. The image below shows the different parts of the digestive system.
The digestive system is made up of the digestive tract and other organs that help the body break down and absorb food. It includes the mouth, oesophagus, stomach, small and large intestines, and the anus (your bottom). Food is digested as it enters your mouth, travels down the oesophagus into your stomach, and then through the small and large intestines. Nutrients are extracted along the way and are absorbed into the body through the wall of the small intestine. Finally, your poop is formed, stored in the rectum, and passed out of your body through the anus when you go to the toilet.
The bowel is made up of the small and the large intestines. The large intestine is the part most affected by irritable bowel syndrome. The large intestine includes the colon and the rectum. The colon is responsible for converting the liquid waste from your small intestine into stools (aka poop). Your poop is made up of dead bacteria from the digestive process and the parts of food that can’t be digested. Muscle movements in the colon push your poop towards the rectum. The rectum is usually empty until just before you do a poo.
Regular and coordinated muscle movements are important for the above process to occur normally. In irritable bowel syndrome, the muscle movements of the colon are irregular. In some cases, they are too fast, resulting in cramping, diarrhoea, and the urgent need to go to the toilet. In other cases, muscle movements are too slow, resulting in constipation and pain. Part of the role of the colon is to remove water from the stool so that it becomes solid. As such, if the stool moves through the colon too fast or too slow, it can become too watery or too hard.
There are other processes that become abnormally altered in irritable bowel syndrome. For example, rapid muscle contractions in the colon (called spasms) can result in stomach pain, cramps and bloating. Similarly, an imbalance of gut bacteria can result in excess gas and wind. Lastly, altered amounts of mucus in the colon can result in either diarrhea (too much mucus) or constipation (too little mucus). The two-way communication between the digestive system and the brain is also altered in people with irritable bowel syndrome.
Your gut and your brain talk
Your digestive system and brain are in constant communication. Using hormones and other brain chemicals (called neurotransmitters), your brain sends messages to either speed up or slow down the muscle movements in your colon. To keep the digestive process running smoothly, your brain needs to send the right signals to your colon. However, stress and other changes in your environment can alter gut-brain communication, resulting in the symptoms of irritable bowel syndrome.
As we discussed above, food waste is pushed through the colon by coordinated muscle movements. The muscle movements of the colon are controlled by your brain and nervous system. Stress and other psychological factors can alter this process by activating the fight-flight-freeze response. As a result, digestive processes are interrupted and result in irritable bowel syndrome symptoms like diarrhea, constipation, gas, and bloating. We will talk more about the fight-flight-freeze response later in this course.
Of course, irritable bowel syndrome symptoms are uncomfortable and often distressing, so people commonly focus on them. However, focusing on your discomfort can re-activate the fight-flight-freeze response and make your symptoms worse. This two-way talk between the gut and the brain forms part of what is called the gut-brain axis. You may have heard this term before, as it has received growing media attention. A full discussion of the gut-brain axis is beyond the scope of this course. However, it is worth doing your own research on the topic if you’re interested.
The vicious cycle of irritable bowel syndrome
As mentioned above, people with irritable bowel syndrome can often enter into an unhelpful cycle of stress, discomfort and worsening symptoms.
Here’s a brief outline of how this negative cycle works:
- Biological, psychological and social factors interact to trigger a change in your digestive functioning
- As a result, you experience irritable bowel syndrome symptoms (e.g., stomach pain, diarrhea, constipation, bloating etc.)
- The irritable bowel syndrome symptoms interrupt your usual activities. For example, you may stop exercising, avoid going out, or change your food intake. As a result, your functioning at work and in social and other important areas of life may be reduced.
- Changes in lifestyle and eating habits can maintain irritable bowel syndrome symptoms, as it can send confusing messages to the digestive system. For example, eating irregularly makes it difficult for your body to maintain regular bowel movements.
- Due to this disruption, you experience psychological symptoms such as stress, anxiety and low mood. You may also worry about your health, feel anxious about when the irritable bowel syndrome symptoms will stop, or beat yourself up for not being at your best. This creates more stress and anxiety, which keeps the digestive system functioning abnormally.
A vicious cycle is created, whereby irritable bowel syndrome symptoms, psychological symptoms and decreased daily functioning interact to keep you stuck. Symptoms may worsen over time as the cycle continues.
Let’s take Jake’s experience as an example. Jake’s irritable bowel syndrome was triggered by a nasty stomach infection. As a result of the infection, Jake’s bowel functioning changed and he experienced a range of uncomfortable symptoms, including persistent stomach pain, bloating, and diarrhea. Jake’s diarrhea would often come on urgently and at inconvenient times, like when he was at work, out to dinner, or in the gym. As a result, Jake stopped exercising and going out with friends to avoid embarrassment. This left a void in his life and he started to feel down.
Exercise was also Jake’s way of managing stress, so without it, he felt more wound up. On work days, Jake would eat less food in an attempt to prevent the diarrhea. In the evening and on weekends, Jake ate more. The irregular food intake sent confusing messages to Jake’s digestive system, and he started to experience alternating periods of constipation and diarrhea. After a while, Jake started to take days off work to cope with his symptoms. As the work started piling up, Jake got more and more stressed. This just further worsened his irritable bowel syndrome symptoms and kept Jake stuck in misery.
Myths about irritable bowel syndrome
As mentioned, there are many common misconceptions about irritable bowel syndrome. It can be a confusing condition, with symptoms coming and going for no apparent reason. In this section, we clear up some of the misconceptions by discussing some common myths about irritable bowel syndrome.
Myth 1: irritable bowel syndrome is the same thing as Celiac, Crohn’s disease etc.
- Whilst there is some overlap of symptoms between these conditions, they are quite different from each other. As you’ve learnt, irritable bowel syndrome is a functional disorder, not a disease, Celiac disease occurs when your immune system attacks the lining of your intestine after eating gluten. Crohn’s disease occurs when there is inflammation in your intestine. There is no risk that irritable bowel syndrome will turn into either Celiac or Crohn’s disease. However, it is possible to have more than one of these conditions.
Myth 2: Cutting out gluten and dairy will cure irritable bowel syndrome symptoms
- There is no evidence to suggest that cutting gluten and dairy out of your diet will ‘cure’ irritable bowel syndrome. It’s true that some people with irritable bowel syndrome do have gluten and dairy intolerances. These people may benefit from reducing their intake of foods high in these compounds. However, even for these people, the irritable bowel syndrome symptoms will not completely resolve. There are also people with irritable bowel syndrome who do not have these intolerances; they are unlikely to benefit from cutting out gluten and dairy.
Myth 3: irritable bowel syndrome is a psychological problem caused by stress or anxiety
- We touched on this myth above when we talked about the assumption that irritable bowel syndrome is ‘all in your head’. Of course, this couldn’t be further from the truth. However, sadly, some doctors and people in the community still hold this belief. Whilst stress and anxiety can increase symptoms, they are not the cause of irritable bowel syndrome. There is a relationship between your mental health and irritable bowel syndrome, but irritable bowel syndrome is a separate and very real condition in its own right.
Myth 4: A strict diet is the only way to fix irritable bowel syndrome
- There is a lot of talk out there about different types of diets to treat irritable bowel syndrome. These are often called ‘elimination diets’, because they involve eliminating certain food groups from your diet. Many of these diets offer different advice, which can be confusing. In reality, there is no special diet that is ‘proven’ to solve irritable bowel syndrome. Research shows that there aren’t any foods that are ‘bad’ for all people with irritable bowel syndrome. Some people will benefit from eliminating some foods, but you will have to find what works for you.
Myth 5: irritable bowel syndrome is not a serious condition
- Symptoms of irritable bowel syndrome range on a continuum from mild to extremely severe. For people with more severe symptoms, irritable bowel syndrome can significantly reduce their quality of life. Symptoms like unpredictable diarrhea and excessive gas may make people afraid to leave the house. Constipation, on the other hand, can cause intense pain and make usual activities unbearable. As a result, irritable bowel syndrome can lead to social isolation, poor functioning at work/school, low mood and other mental health symptoms.
Myth 6: There is no treatment for irritable bowel syndrome
- This myth can be particularly damaging, as it can cause people with irritable bowel syndrome to feel hopeless. Although irritable bowel syndrome is thought to be a chronic condition, there are treatment options that can help manage the symptoms. Many people find symptom relief and some find complete freedom from irritable bowel syndrome as a result of treatment . Treatment options include things like lifestyle changes, medications, and psychological therapy. The type of treatment you need will depend on your symptoms and the factors that trigger them.
After reading these myths, were there any that you also believed to be true? Perhaps you still believe them to be true. Either way, we encourage you to read on to learn more about the various aspects of irritable bowel syndrome and how to manage it. In the next sections, we talk about conditions to rule out and a model for understanding irritable bowel syndrome.
Conditions to rule out
To get a diagnosis of irritable bowel syndrome, you need to have ruled out a series of other medical disorders. irritable bowel syndrome shares many symptoms with other conditions and it is important to work closely with your doctor to exclude these alternative diagnoses. As such, it is not possible to self-diagnose irritable bowel syndrome. You must have a proper medical evaluation before you can know with certainty that you have this condition. Keep in mind, there is no x-ray, blood sample, or other test for irritable bowel syndrome. The diagnosis occurs after a process of elimination of other possible causes for your symptoms.
Here are some things to take note of:
- A viral, parasitic, or bacterial infection can cause the same types of symptoms in irritable bowel syndrome. Your doctor can test for the presence of an infection, usually by taking a stool sample.
- Consider getting tested for celiac disease. Celiac disease occurs when you have a sensitivity to products with gluten in them. Even if you don’t have celiac disease, you may suffer from mild gluten sensitivity. You can test this out by going on a gluten free or low-FODMAP diet, which excludes certain foods thought to cause symptoms.
- Inflammatory bowel diseases (IBD) have similar symptoms to irritable bowel syndrome, but can be ruled out with a stool test and/or colonoscopy. IBD includes conditions like Crohn’s disease and ulcerative colitis, which are both characterised by chronic inflammation of the GI tract.
- Excessive amounts of gut bacteria in the small intestine can also cause similar symptoms to irritable bowel syndrome. This is known as a condition called Small Intestinal Bacteria Overgrowth (SIBO). If you commonly have bloating or excessive gas within an hour and a half after eating, you should consider talking to your doctor about a SIBO test.
- If you notice worse symptoms frequently after consuming dairy products, you should get tested for lactose intolerance. Lactose intolerance occurs when your body is unable to digest lactose, which is the main sugar in dairy products. The same can happen with fructose, the main sugar is fruits. Undigested lactose and/or fructose leads to symptoms like gas, bloating and diarrhea.
- There are also a range of other foods that you may be sensitive to. You can find out what these are by monitoring your symptoms as you eliminate different foods from your diet. Common food intolerances include things like nut and soy products, coffee, and eggs. Certain carbohydrates known as FODMAPs have also been linked to irritable bowel syndrome symptoms.
People with irritable bowel syndrome often worry that they have stomach or colon cancer. Whilst these types of cancers can result in changed bowel habits, they also present with other symptoms that are not common in irritable bowel syndrome. These include things like extreme and unexplained weight loss, vomiting, and blood in the stool. If you have any of these symptoms, you should speak to your doctor as soon as you can.
Understanding irritable bowel syndrome in your own life
We have talked a lot about irritable bowel syndrome in general terms. In this section, we want you to apply what you’ve learned so far to yourself. Take a moment to think about how irritable bowel syndrome appears in your own life. Below are some questions to get you started:
- How much do my irritable bowel syndrome symptoms interfere with my life overall?
- In which areas of life do my symptoms impact me the most?
- How would my life be different if I no longer had irritable bowel syndrome symptoms?
Great job on getting this far. We have covered a lot about irritable bowel syndrome, and you’ve done well to stick with us! In the next section, we briefly discuss Cognitive Behaviour Therapy (CBT), which forms the foundation for the remainder of this course.
What is CBT?
Cognitive behavioural therapy (CBT) is an evidence-based psychological treatment. CBT has been tested widely by researchers to ensure that it is a safe and effective treatment. Research has shown that CBT is one of the most effective treatments for a range of mental health concerns. It is also beneficial for managing a range of chronic illnesses. Specifically, there is evidence that CBT is effective for helping people with irritable bowel syndrome.
The aim of CBT is to help you identify and challenge unhelpful ways of thinking and behaving. CBT is based on the idea that your thoughts, feelings, physical sensations and actions are all connected. It assumes that negative patterns of thinking and behaving can keep you stuck and feeling lousy. CBT helps you deal with problems by breaking them down and challenging the negative patterns that maintain them. By teaching you new and more helpful ways of thinking and acting, CBT can help improve the way you feel.
CBT is traditionally delivered in structured, face to face settings with a trained therapist. However, access to this kind of therapy is not always convenient or available to everyone. Our online courses aim to make support more available to those who need it. There is growing evidence to suggest that CBT delivered in an online format is just as effective as face to face sessions. However, this course is not intended to be a substitute for therapy with a qualified health practitioner.
How can CBT help with irritable bowel syndrome?
As we have seen, there are several factors that keep irritable bowel syndrome going. One major factor is related to stress, anxiety and the way you respond to your irritable bowel syndrome symptoms. CBT offers a range of skills that can address each of these factors and help you break free from the vicious cycle of irritable bowel syndrome.
These skills include:
- Self-monitoring techniques to better understand your symptoms and their triggers
- Stress management and relaxation skills to help calm your nervous system (and gut)
- Cognitive skills to address the unhelpful thoughts that worsen your symptoms
- Behavioural strategies and problem solving skills to help you better manage your symptoms, reduce stress and reclaim your life
- Relapse prevention skills to help you maintain your gains and stay well
As you may have experienced first-hand, irritable bowel syndrome can make your world smaller. You live in a constant state of worry and discomfort, as you try to navigate life with your symptoms. You feel a loss of freedom, as your way of living becomes focussed on your symptoms and avoiding the embarrassment of an accident. Over time, this can take a toll on your health. However, CBT can help you manage your irritable bowel syndrome symptoms better and regain a sense of control over your life.
Making a commitment to change
It is a well known fact that any type of behaviour change is hard. CBT assumes that people must commit to practicing the skills if they are to achieve real improvement. This section includes exercises that aim to help you think about and make this commitment if you are ready. These exercises are included in your homework for this week. You can use the downloadable worksheets at the end of this week to help you complete these tasks. For now though, just read through and take in as much of the information as you can.
Know your reasons for change
To give yourself the best chance of success in this course, you will need to make sure your motivation levels stay high. One way to maintain your motivation for change is to be clear on the reasons why you want to change. Revisiting these reasons will help you to keep going, even when things get tough. So, take a moment to think about your reasons for change. We have provided you with some examples to get you started. We also encourage you to come up with your own reasons.
Example reasons for wanting to change:
- Reduce the impact of my irritable bowel syndrome symptoms
- Engage or reengage in certain activities (e.g., exercise)
- Improve performance in an area of life (e.g., work or study)
- Feel more confident and self-assured
- Improve my self-esteem
- Be able to relax and enjoy social events
- Be able to travel more
- Feel less stressed out and worried
- Gain a sense of freedom and control in my life
Examine the pros and cons of change
Hopefully, you have had a think about your reasons for change. We now encourage you to think about the potential pros and cons of working to change the way you think about and relate to your irritable bowel syndrome symptoms. Doing a pros and cons analysis can help you to decide on the best course of action. You are aiming to compare the benefits and costs of 1) trying the skills you’ll learn in this course versus, 2) not trying the skills and staying the same. Once you have thought this through you can weigh up your options to find out which one will get you closer to your goals. Remember to think about both short and long term pros and cons.
Self-contract and goal setting
If you’ve decided you’re ready to commit to change, congratulations! That is the first step on your journey towards recovery from irritable bowel syndrome. We encourage you to formalise this commitment by making a contract with yourself. You can complete the downloadable self-contract at the end of this week. The self-contract will prompt you to set a goal or goals. Well-set goals are great for motivation and keeping us on track.
When thinking about setting goals, it is important to make sure your expectations are realistic and achievable. We suggest that you don’t make complete symptom resolution your goal, as this is an unlikely outcome of this course. This is what we call a ‘dead man’s goal’, because it can be accomplished better by a corpse. Instead of setting dead man’s goals, it is more helpful and realistic to set goals that focus on something you are moving towards or trying to accomplish. In other words, think about what you would be doing if you had less symptoms, and make this your goal.
For example, instead of saying “I want to have less symptoms”, you could say “I want to start doing regular exercise again” or “I want to leave the house more often”. Once you have your goals, you’ll need to consider the steps required to achieve them and set a reward for when you follow through. You may also want to enlist the support of friends and family on this journey, as they can help keep you accountable and on track towards success.
Big changes start with small steps
Often, we have a vision of what we want to achieve, and we expect ourselves to get there in one big leap. This is not only unrealistic, but it is simply unfair! Throughout this course, we encourage you to acknowledge the small steps you take towards your goals each day, no matter how insignificant they may seem. This is a tough journey, so break it down and be kind to yourself along the way.
We know this is a big ask when you’re in pain or when life seems bleak. However, this approach will be the best one for helping you get the most out of this course. We expect you to make mistakes along the way, in fact, we encourage it. This means you’re jumping in and having a go. Finding what works for you will be a process of trial and error. Continue to remind yourself of this as you move through each week of the course and acknowledge the progress you are making simply by showing up.
Start right now by congratulating yourself on getting to the end of the Week 1 educational content. We think this is an accomplishment in itself that is worth celebrating, so see if you can set aside some time to reward yourself for your efforts.
Great job and see you next week!