Do you have clients who have been struggling with one or more of the following symptoms for at least six months:

• Abdominal pain or discomfort;
• Bloating; or
• Changes in bowel habits — eg. altered bowel frequency or stool form (to what is normal for them)?

Gut-related symptoms, such as constipation, diarrhoea, abdominal pain and bloating, are very common after a catastrophic injury.  This could be due to changes to: diet, physical activity levels, medication and/or the gut microbiome or it could be due to other medical conditions such as irritable bowel syndrome (IBS), coeliac disease, Crohn’s disease, ulcerative colitis, neurogenic bowel or certain types of cancer.  It is important for clients to see the GP to have blood tests done and for an official diagnosis to be made.

Clients suffering with chronic, gut-related symptoms (regardless of the diagnosis), should always receive advice from a dietitian (NHS or private). A dietitian can advise people on which foods are most likely contributing to their symptoms (and which ones aren’t) and can make sure their diet is nutritionally complete, even if certain restrictions are in place.

How is irritable bowel syndrome (IBS) diagnosed?

There isn’t one specific test to determine if someone has IBS.  A combination of blood tests, medical history and a review of the client’s symptoms will be what differentiates IBS from other conditions (like coeliac disease, Crohn’s, ulcerative colitis and cancer).  According to the NICE Guidelines (CG 61: Irritable Bowel Syndrome in Adults: Diagnosis and Management) these are the blood test which MUST be done before a diagnosis of IBS can be made:

• Full blood count
• C-reactive protein (CRP)
• Coeliac antibodies (sometimes called TTG or EMA). Clients must NOT cut gluten out of their diet until this test has been done! I cannot emphasise this enough.
• Erythrocyte sedimentation rate (ESR)

A dietitian will need to see a copy of these blood test results before making any dietary changes.

What can a dietitian do to help clients with IBS?

Treatment advice – Step 1

After confirming that an accurate diagnosis has been made, a dietitian will then progress onto discussing which foods may be making symptoms worse:

• Fibre – there are two different types of fibre and these can be manipulated to improve symptoms (note: granary and seeded breads are common triggers for IBS symptoms)
• Caffeine
• Alcohol
• Fatty or spicy foods
• Gum, hard sweets, eating quickly, fizzy drinks and drinking from a straw (these make someone swallow more air which can make bloating worse)

Treatment advice – Step 2

If the advice from Step 1 does not relieve a client’s symptoms, a dietitian will then try them on a low FODMAP diet. This diet restricts almost every type of natural and added starch/sugar which could be potentially causing symptoms — restrictions include specific grain products, milk products, legumes, onions,  garlic and certain vegetables and fruit. This is a tricky diet to follow because to the untrained eye, there doesn’t appear to be much rhyme nor reason to which foods are allowed and which ones need to be avoided. Most importantly, a dietitian can help clients come up with ideas of what they CAN eat on this diet.  No one is meant to follow this diet forever. The idea is to follow the diet for approximately 8 weeks to see if symptoms get better, and then add back specific foods one by one to test and see exactly what the person is reacting to.

Note: Do not let clients follow low FODMAP advice from the internet! The research into this diet is constantly evolving and advice changes slightly from year to year.

Treatment advice – Step 3

If the advice from Steps 1 & 2 do not relieve a client’s symptoms, then it is possible that they have a food allergy/intolerance/sensitivity or another condition (eg. small intestinal bacterial overgrowth; malabsorption). These will require additional tests and dietary changes in order to diagnose and manage the condition.  The dietitian will generally liaise with the GP or gastroenterologist about this.

As you can see, diagnosing and managing IBS can be tricky.  Registered dietitians are specifically trained in identifying gut-related problems and working with the GP to resolve or manage these symptoms.  Most importantly, a dietitian can help clients know what to do, how to do it and in what order to try different strategies.

To refer a client who has IBS (or other gut-related) symptoms after a catastrophic injury, contact Sheri Taylor, Specialist Rehab Dietitian at info@specialistnutritionrehab.co.uk or 0121 384 7087.  To receive articles like this straight to your inbox, be sure to sign up for my free monthly newsletter below.