Irritable Bowel Syndrome (IBS) is a term used to describe re-occurring disruption to the function of the stomach, digestion or colon in the absence of any specific, detectable cause.
It is a common disorder with an estimated 10-20% of people in England suffering from some form of IBS (NICE, 2010).
IBS is considered a ‘functional’ disorder (referring broadly to an impairment in normal function), as diagnostic testing does not reveal any visible disease process. Doctors therefore make a diagnosis of IBS based purely on a patient’s symptoms, which can include a combination of any of the following:
- Abdominal pain/ cramping (often worsened by eating and relieved by passing a stool)
- Changes in bowel habits (such as frequent diarrhoea and/ or constipation)
- Flatulence (including wind and gastrointestinal reflux) and bloating
- Abdominal spasms / stomach rumbling
Symptoms may be intermittent and will often vary in severity from day to day. Several conditions may present with symptoms similar to IBS, including coeliac disease, inflammatory bowel disorders (such as Crohn’s Disease or Ulcerative Colitis) and parasitic infections. It is therefore important to see your doctor for tests to rule out these conditions. If you have any signs of blood in stools or experience significant, unexplained weight loss then it is particularly important that you seek advice from your GP.
The exact cause of the impaired digestive functioning seen in IBS is unclear, but possible triggers include:
- Food Intolerance – lactose (milk sugar), fructose (fruit sugar) and sorbitol (an artificial sweetener) are common triggers in IBS patients. In addition wheat, dairy, coffee, eggs, corn, potatoes, onions and yeast can often cause problems.
- Psychological factors – It is thought that IBS is a disorder of the interaction between the brain and the gut, with sufferers experiencing increased sensitivity within the gut to external stimuli such as stress. The frequency of depression, stress, anxiety and other psychiatric disorders in IBS patients is high (DeNoon, 2010).
- Use of certain medications – antibiotics, non-steroidal anti-inflammatory drugs such as ibuprofen (e.g. Nurofen) and diclofenac (e.g. Voltarol) plus stomach acid suppressing drugs/ antacids may worsen symptoms.
- Gender – women tend to be more susceptible. Many women with IBS find their symptoms are particularly bad around the time of their period, suggesting that female hormones may play a part.
There is no cure for IBS, but symptoms can often be eased by changes to diet and lifestyle. No treatment is guaranteed to eliminate symptoms completely; instead the goal is to relieve them sufficiently to prevent them from interfering with daily activities. The following suggestions may be helpful:
Treatment plans for IBS are highly individual, but symptoms are generally improved by alterations in food intake. It may firstly be helpful to complete a 2 week food and symptom diary in order to establish links between food consumption and IBS attacks. This can be a tedious process, but a simple record of what you eat and how you feel may help to identify one or more foods that are problematic. These triggers can then be reduced or eliminated.
A nutritionist or dietician can provide further advice on specialised exclusion or rotation diets that may help to identify triggers and ease symptoms.
Current national guidelines (NICE, 2010) regarding IBS include the following general suggestions which may also help to minimise symptoms:
- Have small, regular meals and take time to chew each mouthful well. Avoid large meals which can place stress on the digestive system and trigger spasms in the gut.
- Avoid missing meals or leaving long gaps between eating.
- Drink at least eight cups of fluid per day, especially water or other non-caffeinated drinks such as herbal teas. This helps to keep stools soft and easy to pass along the gut.
- Restrict tea, coffee and alcohol consumption (caffeine and alcohol are gastric irritants and act as a triggers in some individuals)
- Restrict carbonated drink consumption, which may contribute to bloating or cramping.
- Be mindful of fibre consumption. Fibre can often help to regulate IBS symptoms, but large amounts of insoluble fibre (found in whole grains, bran and fruit and vegetable skins) may worsen symptoms in some individuals. Try introducing gradually and monitoring symptoms until the desired effect is achieved. Soluble fibre (found in rice, pasta, oats, potatoes, beans and barley) may be easier to tolerate.
- Avoid artificial sweeteners such as sorbitol (found in sugar free sweets, chewing gum and slimming products), particularly if you have diarrhoea.
- FODMAP diet – FODMAP is the acronym for a group of osmotically active, rapidly fermentable, short-chain carbohydrates, thought to be a common IBS trigger. The FODMAP diet is a plan that temporarily eliminate FODMAPs from the diet, and is thought to be very effective.
- Peppermint oil – has antispasmodic properties and relaxes intestinal muscles (Hadley & Gaarder, 2005). Choose capsules with enteric coating to prevent gastroesophageal reflux.
- Psyllium (soluble fibre) – soothes and regulates the digestive tract, stabilises intestinal contractions and normalises bowel function (in cases of both predominant diarrhoea AND constipation) (Ford et al., 2008)
- Probiotics – may help restore normal bowel flora in the colon and reduce instances of diarrhoea. Faecal samples of IBS patients have showed a reduction in Lactobacili and Bifidobacteria and higher concentration of pathogenic bacteria (Moayyedi et al., 2010). Try Symprove – this clinically proven probiotic contains 4 strains from the Lactobacilli family and works without triggering digestion, ensuring they reach the right area of the gut (unlike other popular dairy-based or freeze dried probiotics)
- Digestive Enzymes such as papaya extract, lactase, ox-bile extract, pancreatic enzymes may aid digestion and reduce bloating.
The relationship between the mind and over activity of the gut is complex. The entire length of the bowel is controlled by a nervous system which carries signals back and forth to the brain, via hormones and neurotransmitters. These signals control the action of the smooth muscle surrounding the intestines and regulate the process of digestion. It is therefore no surprise that emotional issues trigger symptoms of IBS and that people with anxious personalities may find symptoms particularly difficult to control. Intestinal upset is often simply a physical manifestation of stress or anxiety (Kearney & Brown-Chang, 2008., Whitehead et al., 2002).
It is important for IBS sufferers to try to reduce the amount of stress in their lives. Some people find relaxation techniques, stress counselling, cognitive behavioural therapy, psychotherapy or hypnotherapy useful in controlling their symptoms. Regular exercise also helps to helps keep bowel movements regular and reduces stress. Including additional information regarding your mood within a food diary may help to identify emotional factors that are contributing to your symptoms.
There are a variety of drugs that can help relieve specific symptoms of IBS, such as anti spasmodics for abdominal cramps, laxatives to relieve constipation and antidiarrhoeals to prevent diarrhoea. Low doses of tricyclic antidepressants are sometimes prescribed to relieve pain in patients who do not respond to other treatments. Talk to your doctor or pharmacist for more information.
Outlook for patients with IBS
For most people with IBS, the condition will persist periodically throughout their life. IBS does not pose a serious threat to a person’s health, nor does it cause serious damage or disease of the digestive system. However, it can have a considerable impact on a person’s quality of life for those who are severely affected, often leading to work absenteeism (Maxion-Bergemann et al., 2006, Paré et al., 2006). It is therefore important to learn to recognise and avoid individual triggers in order to manage symptoms as effectively as possible.
© Sarah West Nutrition
DeNoon, D (2010). Irritable bowel syndrome in the brain. Web MD. Retrieved from: http://www.webmd.boots.com/ibs/news/20100725/irritable-bowel-syndrome-in-the-brain
Ford, A., Talley, N., Spiegel, B., et al (2008). Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. British Medical Journal. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/19008265?dopt=Abstract
Hadley, S., Gaarder S., (2005). Treatment of irritable bowel syndrome Am Fam Physician 72 (12): 2501–6. Retrieved from: http://www.aafp.org/afp/20051215/2501.html
Hammerle & Surawicz (2008). Updates on treatment of irritable bowel syndrome.World Journal of Gastroenterology. 14, 2639-2649.
Kearney & Brown-Chang (2008). Complementary and alternative medicine for IBS in adults: mind-body interventions.
Paré, P., Gray, J., Lam, S, et al. (2006). Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of Gastrointestinal Symptoms in Canada), a naturalistic study. Clinical therapeutics28 (10): 1726–35.
Maxion-Bergemann, S., Thielecke, F., Abel, F., Bergemann, R., (2006). “Costs of irritable bowel syndrome in the UK and US”. PharmacoEconomics 24 (1): 21–37.
Moayyedi, P., Ford, A., Talley, N., et al (2010). The efficacy of probiotics in the treatment of irritable bowel syndrome. Gut. 59 (3) 325-32. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/19091823?dopt=Abstract
NICE Clinical Guideline (2010); Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care. http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11927
Whitehead, W., Palsson, O., Jones, K. (2002). Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications?. Gastroenterology 122 (4).