Irritable bowel syndrome: what is it, and what is the best approach to management?
The terms ‘irritable bowel’ or ‘IBS’ are thrown around a lot... but what actually is IBS?
Is this a true diagnosis or is this just a term for labelling your everyday gut gurgles and occasional bloating?
Our dietitian Abbey talks through the ins and outs of IBS, how it is diagnosed, when gut symptoms become a problem and how we can best manage IBS through dietary and lifestyle approaches.
What is Irritable Bowel Syndrome or IBS?
Irritable bowel syndrome (IBS) is a very common gastrointestinal disorder that affects 1 in 7 people worldwide.
IBS is more common in females accounting for two thirds of sufferers as well as those with mental health disorders such as anxiety, depression and PTSD. IBS is chronic in nature and symptoms tend to fluctuate overtime. Unfortunately, the cause of IBS is not well understood, however, a range of factors are thought to play a role including gut hypersensitivity, altered gut motility, imbalance of gut bacteria known as ‘dysbiosis,’ or in some cases IBS occurs after infections such as gastroenteritis or antibiotic use.
Symptoms of IBS
Symptoms of IBS are different among individuals and often change over time.Common symptoms include:
Abdominal pain and discomfort
Bloating
Excess wind
Altered bowel movements e.g. diarrhea, constipation, or fluctuations of both
Urgency with bowel movements
We understand these symptoms can be extremely uncomfortable and have significant impacts on quality of life and daily activities. Studies have found IBS places significant burden on daily life and has negative impacts on productivity, relationships, and limits participation in routine social activity. Many people with IBS frequently report feeling depressed, embarrassed and self-conscious due to their symptoms.
How is IBS Diagnosed?
We know many people struggle with these symptoms, but it is important not to self diagnose IBS! If you suspect you may have IBS make sure to check in with your GP to ensure more serious causes of bowel symptoms are ruled out. Your GP will often run tests to first exclude conditions such as coeliac disease, inflammatory bowel diseases or bowel cancers
Common tests that may be required include:
Blood tests
Stool tests
Colonoscopy/gastroscopy
There are also a variety of other tests widely available and marketed to the public, however, these are often not very reliable or useful for diagnosing IBS. Some may include:
Breath tests
IgG food intolerance tests
Faecal microbiota testing
Once medical tests are performed and more serious causes of bowel symptoms have been ruled out, symptoms are compared against a certain criteria - ‘the Rome IV criteria’ for a diagnosis of IBS. See below:
What can trigger IBS symptoms?
IBS symptoms often fluctuate day to day and change over time. IBS symptoms can be triggered by a range or dietary and lifestyle factors including:
Stress
Sleep patterns
Physical activity levels
Dietary fibre intake
Caffeine and alcohol intake
Diet quality
FODMAPs - fermentable carbohydrates
Meal patterns - i.e. irregular meals, large meal portions and eating too quick with meals.
What approaches are available for managing IBS?
Management of IBS requires a very holistic approach addressing a range of dietary and lifestyle factors.
The best strategy for you will depend on your own symptom triggers, types and patterns of symptoms you experience, your lifestyle and dietary patterns.
Dietary Strategies:
Adequate fibre intake - It is recommended that adults consume 25-30g fibre per day. This can often be achieved through consuming plenty of fruits, vegetables, wholegrains, nuts and seeds.
Adequate fluid intake - drinking at least 8 cups of fluids (non-caffeinated) through the day is important to assist gut motility (the rate at which contents pass through the digestive tract).
Limiting rich high fat meals such as fast foods, fatty meats, cream based dishes and pastries. These may slow gut motility and are often low in fibre.
Limiting alcohol - alcohol can also impact on gut motility and many people with IBS report alcohol to worsen their gut symptoms.
Low FODMAP diet - this is a therapeutic diet that can be an effective form of managing IBS symptoms in up to 75% of people with IBS. This should be done under the guidance of a dietitian.
Lifestyle Strategies:
Managing stress - implementing stress management techniques such as meditation, yoga, breathing techniques and exercise can play a significant role in managing gut symptoms.
Increasing physical activity - low physical activity levels can worsen symptoms of constipation and bloating. Moving our body in ways we enjoy can help speed up gut motility and improve digestion.
Adequate sleep patterns - sleep can play a major role in managing stress hormones and in turn digestive symptoms.
Meal patterns - ensuring we are consuming regular meals through the day, taking time to chew foods well and consuming balanced meal portions can assist with the digestion process and may help improve symptoms of wind and bloating.
Gut directed hypnotherapy - this is a form of psychological therapy targeted toward the gastrointestinal system. Clinical studies have found this to be as effective as a low FODMAP diet in improving symptoms of IBS.
Medications - medications may can be utilised by your medical practitioner for managing common IBS symptoms of diarrhoea and constipation.
Probiotics and herbal supplements - some probiotics may have benefit in IBS, however, these are very dose and strain specific. It is best to chat to a health professional such as your doctor or dietitian about these.
Herbal supplements - such as peppermint oil and Iberogast can also be effective for managing abdominal pain in IBS.
What is the low FODMAP diet?
The low FODMAP diet is a therapeutic dietary approach for managing IBS and should be done under the guidance of a dietitian. FODMAPs stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols. In short these are types of fermentable carbohydrates which are poorly absorbed in the gut. In people with IBS they can be highly sensitive to these leading to symptoms of gas, bloating, pain and altered bowel movements. A few examples off oods that are high in FODMAPs include:
Onions and garlic
Certain vegetables (e.g. cauliflower, brussel sprouts, mushrooms)
Certain fruits (e.g. apples, pears, avocados, cherries, mangoes)
Fructans in wheat, rye and barley
Lactose in dairy products
As you can see these are all very healthy foods, these FODMAPs actually provide an excellent fuel source for the beneficial bacteria that populate our gut. These beneficial bacteria also have a range of health benefits including reducing risk of chronic disease, improving our mood and maintaining a healthy weight. Often people with IBS will only be sensitive to certain types of these FODMAPs. The low FODMAP diet is a three phase test diet used to determine exactly which ones are causing your symptoms.
Low FODMAP diet:
the aim of this phase is to reduce all foods high in these FODMAPs until you achieve adequate relief in symptoms. This should only take 2-6 weeks
2. Challenges:
the aim of this phase is to test your tolerance to each different group of FODMAPs and determine exactly how much you can tolerate. Your dietitian can guide you through set challenge foods and doses. This should take about 8-12 weeks
3. Personalising your diet:
this is the most important stage where your dietitian can work with you to personalise your diet so you can control your symptoms to a level you can tolerate whilst maximising the variety of foods and nutrients in your diet.
Why I shouldn’t follow a Low FODMAP diet long term
It is important to remember that the low FODMAP diet is not a long term diet. Many people often feel their symptoms have improved so much during the elimination phase, they do not reintroduce these FODMAPs. Restricting these in the long term can lead to reduction in beneficial gut bacteria and worsening in symptoms down the track. Following restrictive diets can also impact on our social life and mental wellbeing.
Due to its restrictive nature, a low FODMAP diet may put you at risk of nutritional deficiencies if not done properly under the guidance of a health professional such as an Accredited Practising Dietitian. Our Dietitian Abbey is trained in the use of a low FODMAP diet for managing IBS - with Monash University.
You can book a consultation with Abbey if you would like guidance in managing your IBS.
Further resources:
Monash University – FODMAP Diet
NICE Guidelines – Irritable Bowel Syndrome in Adults
British Society of Gastroenterology guidelines on the management of irritable bowel syndrome
