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Irritable Bowel Syndrome (IBS)Dietary and lifestyle information

Information for patientsSheffield Dietetics

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What is Irritable Bowel Syndrome (IBS)?

The term ‘Irritable Bowel Syndrome’ (IBS) or 'Functional Bowel Disorder' is used to describe a range of symptoms affecting the lower digestive tract. These symptoms can vary in type and severity from one person to another and although not life threatening, can drastically reduce quality of life.

IBS is a very common condition and is thought to affect up to one in five people in the United Kingdom. IBS in adults is a global problem, with prevalence rates of 7–21%.

Although it is more common in people in their 20s and 30s it can affect anyone at any age, and is twice as common in women than men.

What are the symptoms?

The most common symptoms of IBS are:

• Abdominal pain, which may ease after opening your bowels or passing wind.

• Diarrhoea (bowels opening frequently and/or the rapid passing of very soft or liquid stools).

• Constipation (bowels opening infrequently and/or the passing of very small, hard stools).

• Alternating diarrhoea and constipation.• Bloating (swollen stomach).• A feeling of urgently needing to pass stools, particularly on rising,

during and after breakfast.• A feeling of incomplete bowel movement or needing to go to the

toilet after you have just been.• Passing mucus (a clear, slimy substance).

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Other common symptoms can include:

How is IBS diagnosed?

This can be based on symptoms experienced, or as a result of further medical investigations.

If you have any of the following symptoms you should inform your doctor:

• Recent unintentional and unexplained weight loss• Passage of blood in the stools• Fever• Sudden unexplained change in bowel habit if you are 60 years old

or over

Initial investigations

• Your GP will carry out a series of blood tests to identify any other underlying causes of bowel symptoms

• You may also be asked to provide a stool sample

• nausea (feeling sick) • dizziness• vomiting (being sick) • heartburn or indigestion• tiredness • poor appetite• belching or excessive wind • muscle and joint pain• feeling full quickly • bladder symptoms• headaches

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What causes IBS?

Whilst the cause of IBS is unclear, over-activity of parts of the gut may contribute to the condition. During digestion, food is passed from the mouth to the anus by the muscle in the wall of the gut contracting (squeezing). Pain may develop if these contractions become overactive or abnormal, and the area in the gut where this happens may determine which symptoms of IBS develop. Some people with IBS may have normal contractions but have a more sensitive bowel so feel these more strongly.

As symptoms of IBS are often triggered by eating a meal, many people fear that they are intolerant or allergic to a certain food. This is rarely the case. If you think a specific food is causing your symptoms please seek the advice of a dietitian.

Symptoms can be brought on by:

• Anxiety, stress or emotional tension• The after-effects of an infection such as gastroenteritis (an

infection causing vomiting and diarrhoea)• Changes in bowel bacteria following a course of antibiotics

(medicines used to treat infections)• Your dietary intake

Muscles in the gut wallsqueeze together topush food along.

Musculargut wall

Bolus (ball)of food

Contraction

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How can IBS be treated?

The treatment of IBS is usually dependent upon a person’s symptoms, diet and lifestyle. The most appropriate treatment is individual and should be tailored to help you manage your condition. This means that any of the treatments listed below may be given either on their own or together; and treatments may alter depending on how you feel and how your symptoms alter with the changes you make.

Diet and lifestyle

Research has shown that a change of diet may help relieve the symptoms of IBS. These could include:

• Healthy eating• Changing the amount or type of fibre you eat• Probiotics may help to reduce symptoms in some people, although

there is limited evidence. If you decide to try a probiotic, take the manufacturer's recommended dose for a minimum of 4 weeks

• Reducing resistant starches which are found in some processed foods, part baked bread, ready meals and cold and reheated rice, potatoes and pasta. Use fresh ingredients where possible

• Reducing the amount of fermentable carbohydrates in the diet. This is also known as the Low FODMAP diet. It should be undertaken with the direction and support of a dietitian, who will discuss this with you if it is thought appropriate as part of your dietetic care

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To ensure the best possible results, any dietary changes should be made under the supervision of a dietitian. A range of diet sheets are also available to help you make any of these changes to your diet. These include:

• BDA Food Fact Sheet Irritable Bowel Syndrome and Diet• IBS and Probiotics• Modified Fibre Diet for IBS• Food and Symptoms Diary• The low FODMAP diet for IBS (under the direction of a dietitian)• FOODMAESTRO FODMAP App or Monash University Low

FODMAP App

Lifestyle changes may also be beneficial for IBS, such as:

• Stopping smoking• Increasing physical activity• Achieving a good work / life balance• Reducing stress

Medication

A number of drugs are available which may help to relieve symptoms of IBS. You should discuss these options with your doctor:

• Antimotility agents if diarrhoea is the main symptom. These slow down the activity of the muscles in the gut

• Antispasmodic medicines to relax the muscles in the wall of the gut and control pain

• Bulk forming laxatives or fibre supplements if constipation is the main symptom. These soften and bulk up stools and speed up their passage through the bowel

• Tricyclic antidepressant medicines if pain and diarrhoea are the main symptoms and the above medications do not help. These work by reducing the number of contractions of the gut wall

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Complementary therapies

There is some evidence to suggest that the following complementary therapies may be helpful in reducing stress and anxiety and, therefore, symptoms of IBS:

• Psychotherapy / counselling (aims to help you work out your problems by personal development and understanding yourself)

• Hypnotherapy (aims to help you change your behaviour through suggestion while you are in a relaxed, sleep like state)

• Cognitive Behavioural Therapy (CBT) which aims to help you see matters in a different way

If you are considering trying any such therapy it is wise to:

• Inform your doctor• Consult a therapist who is registered with the relevant

professional institute

Most health professionals who practise hypnotherapy belong to a professional organisation such as the UK Council for Psychotherapy (UKCP) and are regulated by the Complementary and Natural Healthcare Council (CNHC).

You can also find a hypnotherapist by searching the website of the National Hypnotherapy Society. This organisation has a register accredited by the Professional Standards Authority.

For more information on CBT, hypnotherapy and psychotherapy, speak with your doctor and visit the NHS Choices website: www.nhs.uk

Sheffield also has the IAPT (Improving Access to Psychological Therapies) Service.

IAPT can provide one to one counselling and group sessions; you can discuss this with your doctor and/or call 0114 226 4380.Visit http://iaptsheffield.shsc.nhs.uk/ for more information.

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Further help and advice

The IBS Network is the national charity supporting people living with Irritable Bowel Syndrome. It provides information, advice and support for people with IBS.

• www.theibsnetwork.org• 0114 272 3253

BDA: The Association of UK Dietitians

• www.bda.uk.com • Telephone: 0121 200 8080

CORE: a national charity which funds research into diseases of the gut, (and includes IBS), liver and pancreas

• www.corecharity.org.uk• Telephone: 020 7486 0341

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Dietary advice for patients with IBS

Diet and lifestyle may be factors that trigger the symptoms of IBS or make them worse.

The first step in its management is to ensure that you are eating a healthy and well balanced diet.

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Fruit and vegetables

Aim to have at least five portions of fruit and vegetables each day.

If you suffer from diarrhoea limit your intake of fruit to two portions per day, but increase your intake of vegetables.

Potatoes, bread, rice, pasta and other starchy carbohydrates

Try to include a portion at every meal. Choosing wholegrain varieties may help to improve the symptoms of constipation. For people who experience diarrhoea predominant IBS and/or bloating, wholegrains may not help to improve symptoms.

Beans, pulses, fish, eggs, meat and other proteins

Try to include two portions of these foods each day.

Try to choose lower fat versions where possible such as lentils, chickpeas, white fish, lean mince or meat with the fat and skin cut off.

Dairy and dairy alternatives

Try to have three portions of these foods each day.

Choose lower fat versions where possible such as skimmed / semi-skimmed milk, reduced fat cheese or diet / light yoghurts.

Oils and spreads

Although some fat in the diet is essential, generally we eat too much saturated fat and need to reduce how much of this we eat. Unsaturated fats are healthier fats therefore aim to get yout fat intake from these sources instead; for example vegetable oil, rapeseed oil and olive oil.

Food high in fat, salt and sugar

These include foods such as biscuits, chocolate, sweets, full sugar soft drinks, butter and ice cream. These foods are not needed in the diet so if included, should only be eaten infrequently and in small amounts.

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The Eatwell Guide (continued)

Drinks

Aim to have a minimum of eight cups (about 2 litres) of fluid each day.

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Tips to help you manage IBS symptoms

• Try not to skip meals or leave long gaps between eating.• Try not to eat large meals too close to bed time.• Always sit down when eating and chew your food well.• Take time when eating.• Aim to have at least 8 cups of fluid per day (about 2 litres). Try to

drink more water and non-caffeinated drinks such as herbal teas like green tea and peppermint tea.

• Reduce your caffeine intake. Caffeine can be found in tea, coffee, cocoa, cola, chocolate, pain relief medications, energy drinks, and weight management products.

• Try not to have more than two to three cups of tea or coffee each day.

• Reduce your intake of alcohol and fizzy drinks (including sugar free fizzy drinks)

• Reduce rich or fatty foods such as pasties, sausage rolls, pies, pizza, chocolate, cake, biscuits, cheese, creamy sauces, cream, sausage and burgers.

• Reduce spicy foods.• If you suffer from diarrhoea, avoid having food and drinks that

contain sorbitol, mannitol and xylitol. These are artificial sweeteners often found in sugar free sweets, mints, chewing gum and some drinks.

• Take regular exercise - for more information see www.nhs.uk/livewell/fitness

Take time for yourself, find something which you know helps you to relax.

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Top tips for IBS patients on a waiting list

• Start a food diary and symptom tracker : http://www.theibsnetwork.org/symptom-tracker/

• Focus on self-management. Aim to take control of your symptoms. Are you doing everything you possibly can to help improve your condition?

• Try not to look for instant cures and quick fixes. Be sensitive to things that help

• Look for a self-help group in your area (http://www.theibsnetwork.org/what-we-offer/self-help-groups/)

• Recognise that it is ok to feel frustrated by your symptoms• Aim to be open and honest with other people about your

symptoms• Try to not put all your hope in the medical professional you are

waiting to see. This is a complex illness and the answers may not come all at once

• Be more mindful of how you eat “little and often”• Perhaps try some approved complementary therapies e.g.

hypnotherapy, yoga, reflexology• Consider buying a “Can’t Wait Card” to help you during times of

emergency

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PD6279-PIL2047 v4 Issue Date: March 2018. Review Date: March 2021

Produced with support from Sheffield Hospitals Charity

Working together we can help local patients feel even better

To donate visitwww.sheffieldhospitalscharity.org.uk Registered Charity No 1169762

Alternative formats can be available on request.Please email: [email protected]© Sheffield Teaching Hospitals NHS Foundation Trust 2018Re-use of all or any part of this document is governed by copyright and the “Re-use of Public Sector Information Regulations 2005” SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email [email protected]

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