Irritable Bowel Syndrome (IBS)
What is it?
IBS is a common functional bowel disorder. Diagnosis should only be done by a medical doctor as there are certain criteria for IBS to be diagnosed and other conditions must be excluded.
The most common symptoms of IBS are:-
· Wind
· Bloating / Distension
· Diarrhoea
· Constipation
· Lower abdominal pain
· Change in bowel habit
· Change in stool appearance/consistency
· Passing mucus
· Urgency
· Feeling of incomplete defecation
· Perceived worsened symptoms after eating
Management
Management of IBS must be tailored to the symptom profile. You may require a combined dietary, pharmacological and lifestyle approach.
When considering changes to your diet you must change your diet according to your CURRENT symptoms. For in depth help regarding your diet and symptom management see a qualified Dietitian.
Does food play a role?
Yes and no. Some people find changing their diet according to symptoms helps alleviate IBS. Other people however find changing their diet makes no difference.
With any dietary change you must try to have a varied balanced diet. If changes to your diet bring no relief of symptoms, then add the excluded foods back in. There is no point in avoiding foods unnecessarily.
Wind and Bloating
If you have symptoms of wind/bloating reduce your fruit intake.
Reduce your intake of resistant starches. These are foods that are not completely digested by the body; they ferment in the bowel and produce gas.
Examples of resistant starches are:-
· Pulses, whole grains, sweet corn, green bananas, muesli containing bran.
· Undercooked or reheated potato/maize/corn – make sure you eat them freshly cooked and still hot.
· Oven chips, potato waffles, chips, fried rice. Choose baked potatoes or boiled rice.
· Reheated, or part baked breads
· Processed foods such as potato/pasta salads, biscuits and cakes
· Ready meals containing pasta or potato
· Dried pasta – use fresh instead
Diarrhoea
Replace fluids lost by drinking plenty of water, non-caffeinated, or non-alcoholic drinks.
Limit caffeine – caffeine is a stimulant, and stimulates peristalsis (contraction) of the bowel, causing increased bowel motions and a change in consistency. If you want to continue with your caffeine drinks such as coffee, bear the effects in mind.
Try reducing your fibre intake, swap from whole-wheat wholegrain bread, pasta, rice to white, and reduce fruit intake.
Limit intake of foods high in resistant starches (see above).
Avoid ‘sugar free’ mints, lollies and jams, the sweeteners in these can make diarrhoea worse.
Diarrhoea can be caused by a high intake of fatty foods – therefore avoid fast foods, chips, cakes.
Constipation
Dietary fibre can help with constipation, however it tends to generate gas, stimulate peristalsis (contractions in the bowel wall) and therefore make bloating, pain, flatulence and diarrhoea worse.
Fibre therefore needs to be adjusted to suit you, and any changes in fibre intake should only be done gradually. Sudden changes may cause exacerbation of symptoms, therefore introduce 1 extra portion of a high fibre food every 2 days.
If you suffer from constipation alone – try whole wheat, whole grain foods, along with fruit and vegetables.
Ensure good fluid intake! If fibre intake is increased but fluid does not meet your body’s requirements the constipation will be exacerbated. In the bowel fibre absorbs water and helps soften the contents of the bowel. If there is not much fluid available the faeces will ‘dry out’ in the bowel and make constipation worse.
Probiotics
Occasionally in the bowel there can be an imbalance between ‘good’ and ‘bad’ bacteria.
Some people with IBS have found taking a probiotic product in their diet has helped alleviate symptoms.
Probiotics come in the form of fermented milk drinks, yoghurts, tablets, capsules or sachets.
There are many products available in the shops and supermarkets, they are expensive and some products are not effective.
Our bodies are designed to protect us from bacteria getting into our upper part of our bowel by having a stomach which is naturally very acidic. Probiotics therefore must be robust enough to survive the stomach and reach our bowel.
Probiotics are considered safe, however if you have a condition which has harmed your immune system you should seek advice from your Doctor or dietitian.
If you choose to try a Probiotic in your diet to alleviate symptoms, try to avoid changing other aspects of your dietary intake at the same time. Take the probiotic for a period of four weeks and if there is no benefit, either try another brand or stop taking them.
Helpful Hints
· Eat regular meals
· Avoid trigger foods (these are very individual, such as caffeine, alcohol, fatty foods)
· Do not skip meals or eat very late at night
· Take your time when eating - try to sit down to eat, and chew food properly.
· To ensure adequate fluid intake carry a water bottle around with you - Don’t wait till you are thirsty – you will already be dehydrated!
· Be active. Try to incorporate regular moderate activity into your day. Activity can help reduce stress and assist in alleviating bowel function, particularly constipation.
· Make time to relax – anxiety and stress will make symptoms worse.
· Keep a food and symptom diary – but remember symptoms are unlikely to be caused by the food just eaten but the foods eaten earlier in the day or even the day before. Try not to exclude foods unnecessarily.
· Give your bowels time to adjust to changes in your diet. Only make one change at a time.