An estimated 13 million people at least in the UK suffer irritable bowel syndrome (IBS). And if you’re one of them you'll know how tricky it is to deal with the uncomfortable and embarrassing symptoms.
A typical flare-up can be irritating at best and debilitating 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.
The 3 types of IBS
IBS can manifest itself in three main ways each of which requires a different approach in terms of management and treatment.
1. IBS-C - IBS with Constipation
2. IBS-D - IBS with Diarrhoea
3. IBS-M - Mixed constipation and diarrhoea
Although scientists still haven't identified the exact causes of IBS or come up with a cure, there's a lot you can do to minimise symptoms and get your life back on track. Here are 11 tried-and-tested fixes.
Check what you eat
Modifying diet is a cornerstone of keeping on top of your IBS. Eat regular meals, take time to eat, avoid skipping meals or going too long without eating. It may help to limit high-fibre foods – think wholemeal breads, cereals and whole grains if diarrhoea is the main symptom – as well as processed or re-cooked foods.
And it may help too to limit fresh fruit to three portions a day, especially if diarrhoea is a dominant symptom, although you should still get at least two portions of veg a day to make sure you get your 5-a-day. If wind and bloating are problems you may find porridge or an oat-based breakfast cereal helpful. Keeping a food diary may help you identify potential triggers.
See a dietitian
If simple steps don’t help your GP may referA you to a dietitian. They can look at your diet and help identify potential triggers. The dietitian may suggest an ‘exclusion diet’, which as the name suggests excludes potential trigger foods, before adding them back to see if they spark symptoms.
One exclusion diet that has proved a game changer for some is the low FODMAP diet (short for fermentable oligosaccharides, disaccharides, monosaccharides and polyols), or to put it simply carbs that ferment in the large bowel. When eaten to excess are thought to produce symptoms in susceptible people who have a sensitive gut. Common culprits include garlic, onions, honey, apples, pears, pulses, beans, stone fruits and some sweeteners.
Note: Never exclude foods or food groups from your diet for any length of time without professional advice as you could risk going short of essential nutrients.
Find out more about the FODMAP diet
Depending on the type of IBS you have, upping your fibre intake may dramatically improve symptoms or end up having the opposite effect. “If constipation is a problem, fibre may help, especially the soluble type found in oats and fruits, vegetables, beans and pulses, which help to soften stools. For others, however 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, cabbage, onions and wheat bran are best kept to a minimum during a flare-up unless you find that you can tolerate them okay.
Watch what you drink
Staying well-hydrated is key if you want to calm IBS symptoms and enjoy better digestive health. 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 eight cups – around two litres - of water and other non-caffeinated drinks such as herbal teas a day but try not to drink too much just before, during and right after mealtimes as this can exacerbate bloating.
Limit tea and coffee to three cups a day. It’s also a good idea to avoid fizzy (carbonated) drinks which can exacerbate bloating. And keep an eye on your alcohol intake.
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Take gut-friendly medication
Your GP is likely to offer you medication to help alleviate your symptoms. Antispasmodic drugs, such as Buscopan, are prescribed to relieve cramping – peppermint oil is an effective natural alternative. Loperamide is the gold standard treatment for diarrhoea, and laxatives are recommended for patients with constipation.
Incidentally 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.
Rifaximin, an antibiotic currently prescribed for travellers' diarrhoea, has been shown to rebalance gut bacteria and can be used for IBS-D symptoms as a last resort. Meanwhile prucalopride may be useful for IBS-C. Enterosgel, a gut-lining gel is a safe medication which seems to ‘bind’ toxins and is available over the counter for IBS-D.
Herbal remedies are also available but may interact with other prescribed medications, so do always check with your doctor or pharmacist before using them.
Understanding drug interactions
Ask about your GP about low-dose antidepressants
Studies show that both old-fashioned tricyclic (TCA) antidepressants and newer SSRIs at low doses are effective at treating 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 asking your doctor 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.
The facts about antidepressants
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.
While the jury is still out, some 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.
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 (30 minutes most days) a week.
Full-on gym sessions and exhausting long-distance runs are best avoided certainly when you’re having a flare up. 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.
Living with IBS day in day out can be wearing. Enter the IBS Network, a unique self-care programme to support people living with IBS. Members have access to a telephone helpline manned by specialist nurses, an email response service, quarterly mag with recipe ideas, a ‘Can’t wait’ card for those ‘must go’ moments. Visit www.theibsnetwork.org or call 0114 272 3253 to find out more. The digestive diseases charity Guts UK is also a mine of information gutscharity.org.uk
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