Irritable bowel syndrome (IBS)
Irritable bowel syndrome (IBS) is a common long-term digestive condition that interferes with the functioning of the large bowel. Common symptoms include: abdominal discomfort, bloating and a change in bowel habit (diarrhoea, constipation or both). Pain may be relieved after passing stool and it may cause lethargy, nausea and backache.
Symptoms may change over time and can last from a couple of days to a few months at a time depending on how they are managed.
On this page we will explore who gets IBS, its symptoms and its diagnosis. We will also discover the types of treatment that are available and how a nutrition professional can help with an IBS diet plan.
Who gets IBS?
Research suggests that IBS affects up to one in five people in the UK at some stage of their life. The condition is most common in 20-30 year olds, with a growing trend in the older population. Research also suggests that it’s twice as common in women. Although IBS is typically a lifelong condition, it may improve over time with changes in diet and lifestyle behaviours.
In most cases, people with irritable bowel syndrome find their symptoms to be a nuisance, but not severe enough to trouble the doctor. However, if you feel your symptoms affect your quality of life, you should visit your GP or see a nutrition professional.
IBS symptoms include:
- Abdominal pain or discomfort. This is the most common symptom of IBS. This pain typically occurs on the left hand side of your lower abdomen. You may also get stomach cramps. This pain can get worse after eating and may ease after using the toilet.
- A change in bowel habits. Your situation can alternate from diarrhoea and constipation and the consistency of your faeces may also vary. Instead, you might pass limited amounts of mucus. It’s common to feel like you need to open your bowels straight away and it can feel strained. After the movement, your bowels might not feel entirely empty.
- Your abdomen may feel and look bloated.
Irritable bowel syndrome symptoms can worsen after eating foods that trigger IBS, stressful periods and food poisoning. Gastrointestinal problems are also a side effect of some medications. In some cases you may not experience any symptoms for months then all of a sudden they flare up.
Other symptoms associated with IBS include:
- feeling sick
- bladder problems
These symptoms might not be linked to irritable bowel syndrome. If you are experiencing any of them, you should book an appointment with your GP.
IBS can be linked to other symptoms such as depression and anxiety. If you think this might be the case, try not to feel embarrassed about them and seek help. Your mental health is as important as your physical health. Your GP will be able to supply you with advice to manage your depression or anxiety.
Unfortunately, there aren’t any specific tests to find out if you have IBS, as the condition doesn’t cause any easily detectable abnormalities in your digestive system.
However, GP’s use the Rome II criteria shown below to diagnose IBS.
For at least 12 weeks in the preceding 12 months of abdominal discomfort or pain, you will need to be experiencing two of the following three features:
- Relief by passing stool.
- Onset associated with a change in frequency of stool.
- Onset associated with a change in stool appearance.
Other conditions will be ruled out
Further tests will be carried out if you present any ‘red flag’ symptoms as these could indicate you have a more serious condition.
‘Red flag’ symptoms include:
- unexplained weight-loss
- bleeding from your rectum
- a lump or swelling in your back passage or stomach.
You may need further tests if you:
- have a family history of ovarian or bowel cancer
- are over 60 and have had a change in bowel habits that have lasted over six weeks.
In such cases, your doctor may recommend a colonoscopy. This can check for abnormalities in your gut.
Keep a food, symptom and situation diary to identify any association between foods, life situation and symptoms. Seek guidance from your GP or a nutrition professional.
Current treatment guidelines from NICE guidance and British Dietetic Association recommend the following:
First line treatment
- Clinical and dietary assessment, healthy eating and lifestyle management.
Second line treatment
- Advanced dietary interventions (includes FODMAPS) and a probiotics trial for four weeks.
Third line treatment
- Elimination or empirical diet for two to four weeks.
It can be frustrating and hard to establish what foods or situations are triggering your symptoms. This is why it can help to have advice from a qualified professional who can work with your likes and dislikes and give advice on ways to keep your diet nutritionally adequate to ease symptoms.
If you suffer from IBS, it is important to try to reduce your stress levels, as an improved state of emotional well-being can improve your IBS symptoms. An improved lifestyle can be achieved in a number of different ways. You may wish to try:
Relaxation - Having a busy life with a stressful job or a family to look after can severely limit time spent relaxing. Reclining with a hot drink and a hot water bottle can soothe the physical pain of IBS as the heat can relax cramping muscles. Lying down will release any tension in the joints and ease the blood flow around the body, thus relieving the physical symptoms of stress.
Exercise - Physical activity releases ‘feel-good’ hormones such as adrenaline and endorphins, both of which offer a natural high. Joining a gym class or sports team is a great way to meet new people and it can also offer a retreat from the source of stress itself. Exercise will also keep IBS sufferers physically healthy and reduce the possible development of high blood pressure, high cholesterol and heart disease. Choosing an activity such as yoga will incorporate both relaxation and exercise.
Diet - Try enjoying a variety of wholesome fresh foods at regular intervals throughout the day and ensure you drink plenty of fluids to keep hydrated. This could help encourage regular bowel movements.
In summary, your IBS symptoms may improve by:
- Reducing stress levels.
- Finding time to relax.
- Taking part in exercise such as going for a walk or joining a sports team.
- Restricting your coffee and tea intake to a maximum of two a day.
- Drinking alcohol within the recommended amounts (your individual tolerance may vary).
- Staying hydrated as this can help relieve constipation.
- Enjoying a varied diet made up of fresh ingredients to ensure you get enough fibre and nutrients.
If you are experiencing symptoms of irritable bowel syndrome, it is advisable to see your GP to discuss possible treatments and medication.
IBS diet plan
Changing your diet can have a big impact on controlling your IBS symptoms. Yet there isn’t a ‘one size fits all’ diet plan for everybody who suffers from the condition. It will all depend on how you react to certain foods and what symptoms you have.
To get the most out of your IBS diet plan, it might be helpful to record what foods make you feel better or worse in a food diary. Then going forward, you will be able to avoid any foods that trigger a flare up of your symptoms. On a positive note, you might not need to avoid these foods for life, as the condition can improve over time.
When starting an IBS diet plan, you may be advised to adjust your fibre intake. There are two types of fibre: insoluble fibre that the body cannot digest, and soluble fibre that the body can digest.
|Foods containing soluble fibre||Foods containing insoluble fibre|
|oats||whole grain bread|
|golden linseeds||nuts and seeds (excluding golden linseeds).|
If you are suffering from constipation, increasing the amount of water you drink and the amount of soluble fibre you consume may help.
If you are suffering from diarrhoea, you might want to cut down on eating insoluble fibre. You could also try to avoid the pith, skin and pips from vegetables and fruit.
Your GP or nutrition professional will be able to advise you on a recommended fibre intake.
Low FODMAP diet
A low FODMAP diet can be incorporated into your IBS diet plan if you experience frequent or persistent bloating.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are types of carbohydrates that are difficult for the gut to digest. This means that they start to ferment in the large intestine where they are broken down by bacteria which produce methane and can result in bloating.
So if you do incorporate a low FODMAP diet into your IBS diet plan, you will be restricting your intake of foods that are high in FODMAPs. Such foods include some vegetables, fruits, beans, wheat products and animal milk.
A nutrition professional can ensure your IBS diet plan is healthy, balanced and tailored to you.
How can a nutrition professional help with IBS?
If you have IBS, you will know that a single meal choice can completely ruin your day by inducing painful abdominal pains or inconvenient bowel problems. A nutrition professional understands this relationship between food and mood. They can keep the symptoms of IBS at bay by applying their expert knowledge to your dietary habits.
A nutrition professional can carry out a full nutrition assessment to establish possible dietary and lifestyle causes. This assessment will be used to devise an appropriate therapeutic diet and will be monitored to ensure that it is effective. Before having dietary consultations ensure that you have seen a GP and all other conditions have been ruled out as this should be the first thing they will ask.
Content reviewed by dietitian, Jo Withers. All content displayed on Nutritionist Resource is provided for general information purposes only, and should not be treated as a substitute for advice given by your GP or any other healthcare professional.
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