Last week, Mohammed had to go to Sana’a for some urgent official work. The very thought of going to Sana’a made him sick. On that day, he visited the toilet several times. He developed diarrhea, cramps and bloating of the abdomen. This was not the first time he had these problems. He had a similar experience when his daughter was sick and admitted in the hospital sometime ago. Whenever he is anxious, he has to make several trips to the bathroom. He does not know exactly what causes it. Even his doctor could not make a definitive diagnosis, but suggested that this could be due to Irritable Bowel Syndrome (IBS).

IBS is a functional bowel disorder, and not a disease. It doesn’t cause any permanent damage or progress to serious illness. The symptoms can come and go, or bother sufferers for months or years.

Our intestines are lined with muscles that contract and relax in waves called peristalsis, which push the food you eat through the system. Along the way, nutrients are absorbed, and the residue is eventually eliminated in feces. In people with IBS, normal rhythmic waves are disrupted because the nervous system is not communicating effectively with the muscles that control the gut. This results in the pain, discomfort, and embarrassing inconvenience of symptoms, which include diarrhea or constipation, cramping, bloating, excess gas, and mucus in the stool. Sometimes, the bowel contracts too much or too forcefully, so food moves through the intestines too quickly, resulting in diarrhea. Other times, the intestinal muscles contract but don’t relax again, or they contract very slowly, resulting in constipation. These crazy muscle movements are behind the pain of IBS. In addition, the intestinal nerves of people with IBS are highly sensitive. Even minor bloating can cause severe pain. There is no test for messed-up intestinal waves.

IBS can be managed with appropriate diet and lifestyle changes and sometimes medications or behavioral therapy. It’s important to remember that although IBS can be uncomfortable, it won’t progress into anything more serious. Thanks to some new medications, the condition is less disabling than ever before.

Triggers

There are some triggers for IBS. Food and stress are very big trigger issues. Stress can make food-triggered IBS symptoms worse. Some doctors even talk about an IBS personality, one that is noticeably tense and anxious. The first time I saw Mohammed, I was struck by his rigid body language – every move he made told me that he was a very controlled person. Mohammed was always on the run doing things during work or at home. Mohammed seldom sat down to eat his food. He never cared for hygiene – he ate wherever food was available be it home, restaurants or street vendors.

On a very basic level, eating quickly is risky because you are more likely to swallow air, which can directly lead to bloating and distention. And stress can also stimulate spasms in the gastrointestinal tract.

Identifying trigger foods

Identifying your particular trigger foods can be difficult. Even people without IBS will have a gastrointestinal reaction to certain foods once in a while. A sensitive stomach should be treated like a fussy baby — you have to put it on a regular feeding schedule, keep it calm, and protect it from potential irritants.

Maintaining a Food Diary is the best way to identify a trigger. An elimination diet - a meal plan that avoids all potential offending foods for five days and then slowly reintroducing the same foods one by one is rewarding. Keep track of reactions to foods you are reintroducing in a food diary. Any new food has to be tried with caution.

When you have an IBS attack, consult your food diary to see which foods you ate in the previous 24 hours and start a list of your potential triggers. Keep eating normally, always noting which foods you ate in the 24 hours prior to an attack and adding new items to your potential trigger list.

Good foods to choose

The best foods for IBS health are those that are gentle on the digestive system and encourage “smooth passage” through the intestines. Vegetables, fruit, and whole grains should be limited until your symptoms subside and you identify foods that are problematic for you.

Soluble Fiber: During digestion, soluble fiber dissolves in water and turns into a kind of gooey, gummy consistency just like oatmeal after it sits in a pot of water for a time. Soluble fiber, promotes gentle regularity, regardless of the type of IBS you have. Most foods high in soluble fiber are considered safe, and even beneficial, for people with IBS.

Insoluble fiber is tougher. It doesn’t dissolve and pretty much keeps its form and hence, can be hard on the intestines of people with IBS. Insoluble fiber food moves quickly through the colon causing diarrhea.

Raw vegetables – whether rich in soluble or insoluble fiber – tend to be difficult for IBS sufferers to digest. They can often trigger diarrhea, gas, and bloating. When you’re ready to introduce vegetables into your diet, better stick to cooked vegetables.  You can slowly experiment by adding small amounts of raw vegetables to your diet at different times.

IBS-friendly foods for soluble fiber: “Koosa”,  turnips, sweet potatoes, green peas, “bamiya”, eggplant, barley, oats, oranges, grapefruit,  strawberries, blackberries, raspberries, bananas, white potatoes, avocado, cooked carrots, cooked green beans, cooked “sabhana”, cooked cabbage, ground flaxseed (yelsee).

Apples, peaches, plums, nectarines, pears, mango, apricots are acceptable fruits for IBS.

Liquids: All people with IBS should strive to drink water regularly throughout the day. If constipation is your problem, water will help keep your stools moist so they pass more easily; the soluble fiber in your diet will help too. If diarrhea is your problem, you’ll need to replenish the water you lose through loose stools. Plain water and decaffeinated tea should be your first choices. Carbonated beverages are not advised because the gas from the carbonation can get trapped in your intestines, amplifying discomfort.

A few mealtime guidelines that can make your life easier:

1. Try to eat meals at approximately the same time each day to get your body used to a schedule.

2. Eat smaller, more frequent meals so you don’t overload your gut at any one time.

3. Slow down – sit, relax, and take time to thoroughly chew your food. Think of it as time invested in training your digestive system to behave.