Send us Fan Mail

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

Send us Fan Mail

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

Send us Fan Mail

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

Send us Fan Mail

In Episode 34 of Wrestling the Octopus IBD, the tables are turned. This time, Rachel asks Nigel about his battery of recent tests and what the reality is like of managing multiple health conditions that stem from his Crohn's disease. Living with inflammatory bowel disease is a full-time job in itself, and Nigel illustrates this well in this highly relatable episode.

Follow Rachel at @bottomlineibd

Follow Nigel at @crohnoid

Send us Fan Mail

In Episode 33 of Wrestling the Octopus IBD, Rachel chats with Nigel about her feelings on getting inflammatory bowel disease symptoms after 15 years of Crohn's remission - the last five years being without drugs.

Follow Rachel at @bottomlineibd

Follow Nigel at @crohnoid

Send us Fan Mail

In Episode 32 of Wrestling the Octopus: The IBD Patient Podcast, we meet Crohn's disease patient, Neil Barker. Neil recounts his history of living with IBD, bowel and brain cancer. His story offers an honest, deeply human look at what it means to manage a chronic illness while trying to maintain hope, identity and everyday life.

Neil reflects on the early signs of Crohn's, the long road to diagnosis, and the emotional and physical toll of living with unpredictable symptoms. He shares how IBD shaped his relationship with food, work and social life, and how he learned to advocate for himself within the healthcare system. Hear Neil's practical insights on managing gut health, coping with flare ups and finding support.

Our discussion then moves into Neil’s experience with bowel cancer, including how his IBD history influenced detection, treatment and recovery. He speaks candidly about the shock of later developing brain cancer, the resilience required to face multiple life altering diagnoses, and the importance of community when navigating long-term illness.

Whether you live with inflammatory bowel disease, support someone who does, or want to better understand the complexities of Crohn's, ulcerative colitis and cancer, this episode offers compassion, clarity and connection.

Follow Neil on Instagram @bigwoofa_agus_siarach

Follow Rachel at @bottomlineibd

Follow Nigel at @crohnoid

Send us Fan Mail

Blood clots are not the first thing most people think of when they hear Crohn’s disease or ulcerative colitis - but they should be on the radar of each one of us living with inflammatory bowel disease. This episode of Wrestling the Octopus IBD dives into clots and thrombosis in inflammatory bowel disease.

Our guest is Professor Beverley Hunt OBE, consultant in thrombosis and haemostasis at Guy’s and St Thomas’ Hospital in London, UK. She joins us to explain why IBD increases clot risk, what this means for our gut and overall health, and what, as Crohn's and ulcerative colitis patients, we can practically do to protect ourselves.

We cover:

• What a blood clot actually is, and the difference between deep vein thrombosis (DVT), pulmonary embolism (PE) and more unusual clots like portal vein thrombosis (PVT) and superior mesenteric vein thrombosis (SMVT)
• Why people with Crohn's disease and ulcerative colitis have a higher risk of clots - including the role of inflammation, “sticky blood” and autoimmune conditions
• When the risk of thrombosis is highest in inflammatory bowel disease: flares, hospital admissions, surgery and long periods of immobility
• How to reduce your clot risk in everyday life: movement, travel tips, smoking, weight, hormones and looking after your general gut health
• What to ask your hospital team about clot prevention if you’re admitted or having an operation
• Red flag symptoms that should make you seek urgent medical help
• The impact of modern biologics and other IBD medicines on clot risk
• Women’s health: contraception, HRT, iron deficiency and how to make safer choices if you live with IBD

Nigel also shares his experience of living with portal and mesenteric vein clots and portal hypertension from a patient perspective.

This episode is for anyone with Crohn’s or ulcerative colitis who has ever wondered, “Am I at risk of a clot - and how would I even know?” Our aim is not to frighten you, but to give you clear, sensible information so you can feel more confident advocating for yourself.

If you find this useful, please consider leaving a rating or review, and share it with someone else living with inflammatory bowel disease. The more people understand about clots, thrombosis and IBD, the safer our community becomes.

Follow Thrombosis UK.

Follow Rachel at @bottomlineibd

Follow Nigel at @crohnoid

Send us Fan Mail

For Episode 30 of Wrestling the Octopus: the IBD patient podcast, we are joined by Lead Stoma Care Nurse, Natasha Rolls at University Hospital Foundation Trust Bristol and Weston. Natasha provides brilliant tips and practical guidance for everyday life and gut health for people with Crohn's disease and ulcerative colitis.

🌟 Key themes discussed

• 💬 Why stomas are not a last resort
  Natasha explains how early conversations about stomas can reduce fear and help inflammatory bowel disease patients understand that stomas can be life changing in positive ways.
  “I wish I had not been so frightened of this because I now feel well.”
• 🏥 Emergency vs elective surgery
  Emergency stoma formation can be emotionally challenging. Patients often need time to process shock, adapt and grieve for the life they expected.
• 🧠 Psychological impact
  Support is vital, yet access varies. Stoma nurses provide listening, reassurance and guidance even when formal psychological services are limited.
• 🧩 Temporary and permanent stomas
  Reversal depends on healing, safety and patient choice. Many people choose to keep their stoma because their quality of life improves significantly.
• 🧴 Learning stoma care
  Confidence develops at different speeds. Some patients manage their stoma within days, others need weeks depending on recovery and emotional readiness.
• 🏡 Support after discharge
  Follow up varies across the UK. Some services offer home visits and long term support, while others are more limited.
• 💊 Medication changes
  After surgery for ulcerative colitis, some patients may no longer need previous treatments. Those with Crohn's often continue shared medical and surgical care.
• ⚠️ Common physical issues
  High output, leaks, sore skin, hernias, blockages and prolapse are discussed with reassurance that most problems are manageable with simple interventions.
  “There are very few things in stoma care that are an emergency.”
• 🍽️ Diet and gut health
  Early low fibre diets help ileostomy patients, but long term eating can be flexible and enjoyable. Food diaries help identify triggers for gas or disrupted sleep.
• 🏃 Exercise and activity
  Most activities, including swimming, running and even mountain climbing, are possible with a stoma once recovery is complete.
• ❤️ Intimacy and body image
  Stomas can affect confidence, but Natasha emphasises autonomy, communication and the importance of sharing at your own pace.
• 🛠️ Bags and accessories
  Stoma nurses help patients choose products based on clinical need and personal preference. Needs may change over time.
• 💷 Prescriptions
  Stoma supplies are exempt from prescription charges. Some patients may also qualify for full exemption.
• 🤝 Support organisations
  Colostomy UK, Ileostomy Association, Urostomy Association and local groups offer community, advice and peer support.

Follow Rachel at @bottomlineibd

Follow Nigel at @crohnoid