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In our latest episode of Wrestling the Octopus: the IBD Patient Podcast, Nigel and I chat with Professor Peter Irving, IBD consultant at Guy’s & St Thomas’ Hospital in London, about the confusing but incredibly common overlap between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).

We were keen to record this episode as many IBD patients have an IBS overlap - and it can be devilishly hard to know if you're having an IBD flare or if it's IBS. Professor Irving shares some great tips on this.

What IBS Really Is

Professor Irving tells us that IBS is “a disorder of the interaction between the gut and the brain” and requires abdominal pain plus changes in stool form or frequency. It’s now classed as a disorder of gut–brain interaction, not a “functional” problem - a term that often leaves patients feeling dismissed.

Why IBS Is More Common in IBD

About 30–40% of people with Crohn's disease or ulcerative colitis experience IBS‑type symptoms. Reasons include:

• 🔥 Post‑inflammatory sensitivity - like post‑herpetic neuralgia after shingles
• 🌀 Altered motility
• 🧫 Microbiome changes
• 🧠 Psychological stress, which affects gut–brain signalling

IBS vs an IBD Flare - How to Tell

It’s tricky. Some clues point more toward active IBD:

• 🌙 Nocturnal symptoms
• 🩸 Rectal bleeding
• ⚖️ Weight loss

Often though, objective tests are needed:

• 🧪 Calprotectin
• 🖥️ Ultrasound or imaging
• 📹 Endoscopy

Bile Acid Malabsorption - A Common Mimic

Especially in Crohn’s disease affecting the terminal ileum.
Testing options include:

• ☢️ SeHCAT scan
• 💊 Trial of bile acid sequestrants

Managing IBS Symptoms in IBD

Treatment depends on symptoms and patient preference:

• 🌿 Antispasmodics (mebeverine, Buscopan)
• 🍃 Peppermint oil (Colpermin)
• 🧉 Ginger
• 🚽 Carefully-supervised loperamide
• 💊 Low‑dose tricyclic antidepressants for pain modulation
• 🧘 Stress‑management and lifestyle support
• 🥗 Dietetic input, which can be transformative

The Low FODMAP Diet

Professor Irving helped bring the low FODMAP diet from Australia to the UK.
It reduces fermentable carbohydrates that trigger gas, bloating, and diarrhoea, and can be useful in helping IBD patients to manage their IBS.

It’s not meant to be long‑term - it’s a structured tool that helps patients regain control over gut health.

A Final Thought

IBS in the context of IBD is real, common and complex. With the right tests, the right conversations, and the right tools - from diet to medication to lifestyle - patients can feel heard, supported and empowered.

Professor Irving also has an IBD podcast of his own - called Digesting - alongside a set of international IBD experts at the BRIDGe Group. Listen here.

Follow Rachel at @bottomlineibd

Follow Nigel at @crohnoid

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In this candid episode of Wrestling the Octopus: The IBD Patient Podcast, Rachel and Nigel dive deep into the lived reality of IBD (inflammatory bowel disease) - from emergency symptoms to complex procedures, new medications, bowel prep dilemmas and the importance of patient‑centred care.

Nigel’s Recent Medical Rollercoaster

Nigel recounts a frightening episode of passing blood while urinating - which led to A&E, scans, and ultimately a cystoscopy.

He also discusses:

• Kidney stones
• An enlarged prostate
• An upcoming OGD with ultrasound to assess his pancreas
• Ongoing issues with low platelets and splenomegaly

This segment highlights how Crohn’s disease and long‑term treatment can intersect with other health conditions, complicating the picture of gut health and overall wellbeing.

Rachel’s Treatment Update

Rachel prepares to start ustekinumab (a biosimilar: Wezenla) for Crohn’s disease:

She also discusses:

• Pre‑biologic screening
• The value of regular contact with IBD nurses
• How patient experience varies widely across the UK

The Great Bowel Prep Debate

Listeners wrote in asking about split‑dose bowel prep—especially when the second dose must be taken hours before an early‑morning colonoscopy.

Rachel and Nigel share their own strategies:

• Nigel: would take the second dose the night before (but stresses this is personal, not medical advice)
• Rachel: prefers setting an early alarm to avoid bowel prep “activating” on the train

They also reflect on how bowel prep is often worse than the colonoscopy itself:
.

The Power—and Pitfalls—of Patient Communities

Rachel and Nigel explore what they see in online IBD groups:

• Anxiety around colonoscopies
• Medication experiences
• Surgery recovery
• Difficulty accessing consultants
• The value of peer support

We also discuss how digital tools like MyChart can both empower and overwhelm patients.

Follow Rachel at @bottomlineibd

Follow Nigel at @crohnoid

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In honour of World IBD Day 2026, Nigel has curated his "best bits" from our Wrestling the Octopus: The IBD Patient Podcast over the last 12 months.

If you're living with Crohn's disease or ulcerative colitis - or caring for those who do - this is a chance to catch up on some clips from our previous episodes - including surgery, living with a stoma, colorectal cancer risk in inflammatory bowel disease, blood clots, and more besides.

Follow Rachel at @bottomlineibd

Follow Nigel at @crohnoid