If you're one of the estimated 13 million people in the UK who suffers from irritable bowel syndrome (IBS), you'll know how tricky it is to deal with the uncomfortable and embarrassing symptoms.
A typical flare-up can be irritating at the best of times and debilitating at the worst. You know the drill: your stomach is queasy and crampy, you feel gassy and bloated and half your time seems to be spent on the toilet.
There are actually three types of IBS and each type requires a different approach in terms of management and treatment.
- IBS-C (mostly constipation)
- IBS-D (mostly diarrhoea)
- IBS-M (alternating bouts of constipation and diarrhoea)
Although scientists still haven't identified the exact causes or come up with a miracle cure for IBS, it's not all doom and gloom. In fact, there's an awful lot you can do to minimise the symptoms and get your life back. Here are the eight most tried-and-tested fixes.
1. Follow a low FODMAP diet
This game-changing Aussie diet was devised in 1999 by scientists at Monash University in Melbourne. FODMAPs are carbs that ferment in the stomach, which are thought to irritate the lining in susceptible people when eaten in excessive amounts, triggering the telltale symptoms of IBS.
The diet eliminates or cuts down on fructans – garlic and onions are the chief culprits – fructose foods such as honey, apples and pears; galactans, which are found in pulses and beans, and polyols – common sources include stone fruits and some sweeteners.
It's definitely worth trying if you've been diagnosed with IBS: the low FODMAP diet has been shown to improve symptoms for 75% – 86% of IBS sufferers, regardless of the type.
Related: Find out more about the FODMAP diet
2. Be fibre-wise
Depending on the type of IBS you suffer from, upping your fibre intake may dramatically improve your symptoms or end up having the opposite effect.
“If constipation is a problem, fibre can help, especially the soluble type found in oats and fruits, vegetables, beans and pulses, which help to soften stools. For others, having a high-fibre intake can make symptoms worse,” says registered dietitian and IBS expert Jennifer Low.
Whether you suffer from IBS C, D or M, foods that are particularly high in insoluble fibre such as cabbage, onions and wholegrains are best kept to a minimum during a flare-up unless you find that you can tolerate them okay.
Related: How much fibre do you need?
3. Drink plenty of water
Staying well-hydrated is key if you want to calm the symptoms of IBS and enjoy better digestive health. “The most effective way to improve gut health is to drink more water,” says the 'Digestion Detective' Sam Bearfoot.
This is especially important if you suffer from the constipation-dominant type of IBS, as an adequate intake of H20 will help soften your stools, making them easier to pass.
Aim for at least two litres of water a day but try not to drink too much just before, during and right after mealtimes as this can exacerbate any bloating.
Related: How much water do we really need?
4. Take gut-friendly meds
Your GP is likely to offer you medication to help alleviate your symptoms. Antispasmodic drugs such as otilonium are prescribed to relieve cramping – peppermint oil is an effective natural alternative – loperimide (Imodium) is the gold standard treatment for diarrhoea, and laxatives are recommended for patients with constipation.
Don't be afraid to take a laxative if you're constipated. Contrary to what many people think, laxatives don't make the digestion system 'lazy'. “It’s a fallacy that laxatives damage the bowel,” says Peter Whorwell, professor of medicine at Wythenshawe Hospital in Manchester and one of the UK's leading IBS specialists.
You might also want to ask your doctor about rifaximin, an antibiotic currently prescribed for travellers' diarrhoea which has been shown to rebalance intestinal bacteria and improve IBS-D symptoms, and tegaserod (Tegibs), a new drug that stimulates serotonin levels in the gut to relieve constipation. A herbal remedy* called STW 5 (Iberogast) and Enterosgel, a gut-lining gel may also be helpful.
*Herbal remedies may interact with other medications that you have been prescribed, so do always check with your doctor before using them.
Related: Understanding drug interactions
5. Consider a course of low-dose antidepressants
Studies show that both old-fashioned tricyclic (TCA) antidepressants and newer SSRIs at low doses are effective at treating the symptoms.
If you've made the appropriate dietary changes and haven't had any joy with the front line antispasmodics, laxatives and so on, It's worth talking to your doctor about whether a course of low-dose antidepressants might help.
Professor Whorwell treats his IBS patients who do not respond to first line therapies with TCAs at one-tenth the dose recommended for depression and has a success rate of 50%. It's worth remembering that mood changes and other side effects are minimal at such a low dose, but some patients experience mild insomnia or dry mouth.
Related: The facts about antidepressants
6. Try gut-directed hypnotherapy
Psychological therapy is recommended for patients who haven't responded to the first line treatments or antidepressants. Studies indicate that mindfulness training, cognitive behavioural therapy (CBT) and psychodynamic therapy and can be effective but the evidence is strongest for gut-directed hypnotherapy.
Gut-directed hypnotherapy was developed by Professor Whorwell and his team at Wythenshawe Hospital. The NHS waiting list for the therapy is long, so you might have to look for a private practitioner if you can't face a long wait. In any case, your GP will be able to help with any questions you might have.
Find out more about gut-directed hypnotherapy at the IBS network
7. Stock up on probiotics
While the jury is still out, several studies suggest that probiotics may help relieve IBS-related bloating, calm stomach cramps and alleviate both constipation and diarrhoea, and anecdotal evidence is strong.
If you can't tolerate probiotic foods such as bio-yoghurt, fermented pickles or sauerkraut, you might want to consider taking a good bacteria supplement.
The strain you opt for is important. If you suffer from constipation-dominant IBS, look for Lactobacillus plantarum on labels. Bifidobacterium infantis and Bifidobacterium bifidum work better for people with IBS-D and IBS-M.
Related: What you need to know about probiotics
8. Don't forget to exercise
According to NHS Choices, regular exercise can help relieve the symptoms of IBS, so increasing your activity levels is a must if you're doing less than 150 minutes of moderate exercise a week.
Full-on gym sessions and exhausting long-distance runs are best-avoided. Overdoing it may make your symptoms even worse, so stick to less taxing exercise such as walking, moderate-intensity cycling and swimming.
Many people find that yoga helps and science backs this up to some extent. Studies conducted in 2006 and 2011 found that regular yoga sessions alleviated IBS symptoms in a group of sufferers, so it may be an idea to join a local group or class at the gym. Stress is thought to trigger IBS symptoms so anything you can do to relax your mind, as well as your body should help.
Related: What stress does to your body