Irritable bowel syndrome (IBS)

What is IBS?

Irritable bowel syndrome (IBS) is a common, long-term condition that affects the functioning of the digestive system. It can cause abdominal discomfort, bloating, and a change in bowel habits (constipation or diarrhoea).

IBS has no specific cause and, whilst there are many treatment options available, there is no one single effective treatment. What works for you may not necessarily work for someone else. Symptoms may change over time and can last from a couple of days to a few months, depending on how they are managed.

In this video, registered nutritional therapist Lucia Stansbie (Dip CNM, mBANT, mCNHC) explains how IBS can affect us and how working with a nutrition professional can help.

Who gets IBS?

IBS is a common condition that can affect people of any age. It's twice as common in women, and usually develops between ages 20-40. There are many reasons why it may occur, and you could develop the condition at any stage in life.

Symptoms of IBS

The symptoms vary between individuals and affect some people more severely than others. In some people, the symptoms are triggered by something they have had to eat or drink, stressful periods, or food poisoning. You may find some of the symptoms of IBS ease after going to the toilet and opening your bowels.

Flare-ups can last a few days, but after that, symptoms usually improve. Whilst symptoms can come and go in episodes, they may not disappear completely.

Some of the most common symptoms of IBS include:

• Abdominal (stomach) pain or discomfort. This pain can occur anywhere in your abdomen, and may get worse after eating and may ease after using the toilet.
• A change in bowel habits – this can alternate from constipation to diarrhoea. The consistency of your faeces may also vary, and you might pass limited amounts of mucus.
• Experiencing an urgent need to go to the toilet. Or, after the movement, your bowels might not feel entirely empty.
• Your abdomen may feel and look bloated.

Additional symptoms can include excessive wind, tiredness, feeling sick, painful sex, bladder problems or incontinence, backache, or indigestion. 

While some people with IBS may experience a number of these problems, symptoms may not be directly linked to irritable bowel syndrome. If you're experiencing any of them, you should book an appointment with your GP.

What causes IBS?

The causes of IBS are unknown. It has been linked to factors including food moving through the gut too quickly or too slowly, increased sensitivity in the gut, gastroenteritis, stress and a family history of IBS.

IBS triggers

Certain foods and drinks, as well as stress and anxiety, can trigger or worsen IBS symptoms for some people. Triggers vary from person to person, so understanding what affects your symptoms can help you find ways to manage them.

Diagnosing IBS

Unlike some medical conditions with specific tests, IBS doesn’t have a single diagnostic test. This is because the condition doesn’t cause any easily detectable abnormalities in your digestive system. Everyone is affected differently, with varying severity.

When diagnosing IBS, your GP will ask about your symptoms, including how long you've had them and how often they occur. They may also arrange tests to rule out other possible causes.

To help with a diagnosis, it might be helpful to record a note of your symptoms in a diary. This will help to highlight the frequency of your symptoms and to note any patterns. You can use this for reference when consulting your GP.

Ruling out other conditions

Many cases of IBS can be diagnosed in this way, based on your symptoms alone. However, sometimes further tests may be needed to check for other possible causes or conditions. For example, you may have blood tests to rule out other conditions with similar symptoms, such as an infection or coeliac disease. Depending on what you're being tested for, it may also be necessary to take a sample of your stools.

The process of getting a diagnosis might be uncomfortable, but it's nothing to be embarrassed about. This is the first step towards getting you the right treatment to help ease your symptoms.

Diet and IBS

Symptoms of IBS are often managed through dietary and lifestyle changes. Understanding what may be triggering your IBS can help you know which methods to use to manage symptoms. In some cases, medication and/or psychological treatments may be recommended.

Certain foods and habits are thought to trigger symptoms, such as alcohol and fizzy drinks, and smoking. If you’re experiencing symptoms of IBS, your first port of call should be your doctor. If no underlying health issues are found, they may refer you for nutritional support. A nutrition professional can help you understand what's triggering your symptoms and guide you through necessary lifestyle changes.

There is no one-size-fits-all approach to diet and IBS, so keeping a food diary can help. The diet that works for one person may not work for you – knowing how you react to different foods can help control symptoms. If one food makes symptoms worse, write it down. If a certain food appears to ease symptoms, add it to the list.

Once you have a list of potential trigger foods, your nutrition professional can devise an IBS diet plan, tailored to you and your symptoms.

Fibre

Fibre can affect IBS symptoms, and a nutrition professional may suggest adjusting the amount and type of fibre in your diet.

There are two types of fibre: insoluble and soluble. Insoluble fibre does not dissolve in water, while soluble fibre does. Some people with IBS may find that reducing insoluble fibre helps their symptoms. If you have constipation, increasing soluble fibre alongside drinking enough water may be helpful.

Low FODMAP diet

If diet and lifestyle changes haven't helped to manage your IBS symptoms, a qualified professional may suggest trying a low FODMAP diet.

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are types of carbohydrates that are difficult for the gut to absorb and digest, meaning they ferment quickly while in the large intestine. This fermentation process causes gases to be released, resulting in painful bloating. 

Typically, a low FODMAP diet involves restricting your intake of certain foods high in FODMAPs, including some fruits, vegetables, wheat products and dairy. Because of this, if you're considering a low FODMAP diet, it's advised that you seek the support of a qualified professional. Without support, this diet can be very difficult to follow and, in some cases, can lead to more digestive problems or nutritional deficiencies.

Why work with a nutrition professional for IBS?

Living with IBS can be challenging, particularly when certain foods appear to trigger uncomfortable symptoms. A nutrition professional can help you explore the relationship between your diet and symptoms and offer personalised support to help you manage IBS.

A nutrition professional can help you explore whether certain foods or lifestyle factors may be affecting your symptoms and suggest changes based on your individual needs. If you have ongoing or unexplained symptoms, speak to your GP to rule out other possible causes.

Lifestyle changes for IBS

The symptoms of IBS can affect everyday life. For some people, making changes to their diet and lifestyle may help to manage their symptoms.

If you have IBS, it's important to learn as much as you can about the condition from your GP or a nutrition professional. They can teach you about the best ways for you to reduce your individual symptoms.

In addition to specific advice, there are some more general ways to reduce the impact of symptoms on your lifestyle, such as changing your relationship with food and making more time for relaxation and exercise.

Be more mindful with food

Food forms a huge part of our lives – we need it to survive. But, wider than that, food and drink form a large part of our lifestyles, too. Not only do we plan our days around mealtimes, but food often features as part of our social lives – such as eating out with friends and family.

If there are foods that cause a flare-up of IBS symptoms, you may want to consider reducing or avoiding them to limit your discomfort. 

When faced with this decision, it’s important to weigh up the balance of whether eating the food will be worth the symptoms you experience afterwards. Be aware of the symptoms you're likely to experience and where you will be – for instance, if you’ll be in the comfort of your home.

There are some common adjustments you can make to your diet, such as:

• restricting your coffee and tea intake to a maximum of three cups per day
• drinking alcohol within the recommended amounts (your individual tolerance may vary)
• staying hydrated.

In addition to these, try to enjoy a varied diet made of wholesome, fresh foods, at regular intervals throughout the day. As well as considering your diet, finding ways to manage stress may help ease IBS symptoms.

Relaxation

Having a busy life, with a stressful job or a family to look after, can limit the time you have to spend relaxing. But did you know that stress and anxiety may be factors that are causing or aggravating your IBS symptoms? There are many complex connections between the brain and the gut, so stress management can be effective in easing your symptoms.

Make the most of your leisure time and create time for relaxation. You could try:

• Hot non-caffeinated drinks, or a hot water bottle. This can soothe the physical pain of IBS, as the heat can relax cramping muscles.
• Lying down can release tension in the joints and ease blood flow around the body.
• Ensure you get enough sleep.
• Relaxation therapies such as mindfulness or meditation.

Exercise

Moving our bodies and making time for regular physical activity is so good for us, both in body and mind. We experience the release of ‘feel-good’ hormones such as adrenaline and endorphins, both of which offer a natural high. Joining a sports team or gym class can be a great way to meet new people and can also offer a break from sources of stress, particularly if you choose an activity such as yoga, which incorporates both relaxation and exercise.

But more than this, regular exercise can help keep your digestive system moving. This can be particularly helpful if constipation is one of your symptoms. In addition, exercise will keep you physically healthy and reduce the possible development of high cholesterol, high blood pressure, and heart disease.

If you don’t enjoy exercise, you could try combining it with something you do enjoy, such as spending time with friends or listening to music. If your symptoms make you hesitant to exercise in public, try exercising at home.

While symptoms of IBS can often be managed by a change in diet and lifestyle habits, some people may benefit from further treatment.

Managing stress

Stress can trigger or worsen IBS symptoms for some people. Finding ways to manage stress may help, whether through relaxation, lifestyle changes or speaking to a professional for support. 

Other forms of support for IBS

Alongside diet and lifestyle changes, other treatments may help to manage IBS symptoms. Depending on your symptoms, your GP may recommend medication or psychological therapies.

Medication

Different medicines can help with symptoms such as constipation, diarrhoea and stomach cramps. Speak to your GP or pharmacist about which options may be suitable for you.

Psychological treatment

Psychological therapies, such as cognitive behavioural therapy (CBT) and gut-directed hypnotherapy, may help some people manage IBS symptoms. Learn more about hypnotherapy for IBS.

Finding nutritional support for IBS

If you're living with IBS, a nutrition professional can help you explore how your diet and lifestyle may be affecting your symptoms and find an approach that works for you. Use our advanced search to find a nutrition professional who supports people with IBS.