Have you got ‘hot girl’ gut issues?

By Niki Bezzant

If you're not a regular on TikTok, you may never have heard of 'hot girl gut issues'. You may well have experienced what this refers to, though. The numbers of young, healthy-seeming women using the platform to discuss their bloating, constipation, wind, and other gut issues - typically associated with Irritable Bowel Syndrome or IBS - has been growing over the past year or more. The tag #hotgirlshaveibs currently has over 29 million views.

That possibly reflects the prevalence of IBS, especially among women. It's thought to affect around one in 10 people, mostly women aged 20-50. Symptoms can range from mild abdominal bloating to severe pain, with some sufferers reporting they're unable to leave home when the condition is at its worst.

What is IBS?

IBS is what's known as a functional gut issue: a group of symptoms relating to the movement of the intestinal walls. These contract and relax to push food through; in IBS people this gets disrupted and either contracts too much - causing diarrhea - or too slowly, causing constipation. People with IBS can have one predominant symptom, or both, or they may switch between the two. Symptoms may come and go over time, and include bloating and distention, nausea, and pain.

What causes it?

It's not really known what causes IBS, but there are a few theories. Registered dietitian Nickie Hursthouse sees a lot of people with IBS in her practice and says it's not usually one cause.

"There's usually a lot of things going on that are impacting the gut-brain connection," she says, referring to the enteric nervous system (the collection of nerve cells lining the digestive system that communicate with our brain). Scientists sometimes call this the 'second brain'.

IBS can start as the result of an infection - sometimes a bout of gastroenteritis. It may be due to a change in the microbiome (the population of bugs that live in the gut). It may be due to food intolerances. But stress can also be a common trigger, making symptoms worse.

"Stress is one of the biggest factors that's going to affect that gut-brain connection because it's going to activate the nervous system," Hursthouse says.

"It puts us into that fight-or-flight state, and in that state, the gut-brain connection is always going to be more sensitive. You're going to be more sensitive to pain, you're going to respond more to the types of food that may cause problems."

It's thought people with IBS have a hypersensitivity to pain, cramping and bloating in the gut.

It's also possible IBS-type symptoms may be a result of disordered eating. Eliminating foods for perceived health or weight loss might make gut symptoms worse, as may dieting. Hursthouse says this may be a reason why people might think they have IBS when they don't.

How do you know if you're a disordered eater? Hursthouse explains what a disordered eating pattern might look like.

"Someone might have very, very small amounts of food during the day. They might be restricting food because they might be following a diet or a meal plan. Then they get home, hit a wall; exhausted, and then just have this insatiable primal hunger that they cannot control. So, then they might end up binging out on food. And because they've just eaten a significant amount of food in one go, they're going to feel bloated. They're going to get gas; they could get some diarrhea. The gut is going to respond because it hasn't had regular amounts of fibre and food to process during the day, and then it's had this huge load all in one go."

The gut is also affected by hormonal change, especially in women. IBS can be worse at certain times in the menstrual cycle and during perimenopause.

How is IBS diagnosed?

Not from a TikTok video! IBS is a diagnosis of elimination since there's no real test to definitively diagnose it. Other serious reasons for gut symptoms - like cancers, inflammatory bowel disease and coeliac disease - need to be eliminated first before IBS can be determined. A doctor will usually order blood tests and examine you and may refer you to a gastroenterologist.

Hursthouse notes a certain amount of bloating is normal; when we eat food, it's normal for the belly to distend.

"Some bloating and gas are a normal part of digestion. If you ate a huge meal, yes, you're going to have a bit of bloating and gas, or if you ate a huge amount of stone fruit because it's summertime - yes, you're going to have some bloating and gas. It doesn't always mean that there's something bigger going on."

How is IBS treated?

IBS can be lifelong, and there's no one treatment; it tends to be symptom specific. For diarrhea and pain, there are some medications that might be useful. For constipation, laxatives, and fibre supplements (or a change in the diet to boost fibre) might be useful. Peppermint oil capsules have been shown to give relief for some people in reducing pain and bloating. Dietary change can be effective, too. Adopting a low-FODMAP diet is a well-established treatment. FODMAPs are types of carbohydrates found in common foods that some people can find hard to digest. Hursthouse stresses, though, that this diet is not about permanently restricting all high-FODMAP foods; most people will have levels of tolerance and it's important to establish these.

"People think low FODMAP is a way of eating - a diet you'll follow for the rest of your life. That's not the case."

Since there's a mind-body link with IBS, Hursthouse says whatever else you do, focusing on the gut-brain connection and stress is important.

She says gut-directed hypnotherapy is one approach that's been found to be as or more effective than a low-FODMAP diet in clinical trials.

"It's got good research behind it, but it also allows people to get on with life and use food in normal social situations and with family and friends and for all the other reasons we eat, as well as working on managing their symptoms at the same time."

Why is IBS suddenly trending on Tiktok?

It's unclear - though it might be part of an overarching trend of normalising speaking about health issues (especially women's health issues) that have been previously thought to be a bit icky to talk about.

"I've worked with clients who feel so embarrassed to talk about [gut issues] even in a private consultation," says Hursthouse.

"So if this a way to normalise gut issues, then great. Women do get diarrhoea or constipation, get bloated and have gas. In the past, no one talked about that."

*Niki Bezzant is a writer, speaker, journalist and author focusing on health, wellbeing and science.