What is Irritable Bowel Syndrome?
Irritable bowel syndrome (IBS) affects about 15% of the world’s population or 1 in 7 people worldwide. IBS is one of the most common GI conditions seen by gastroenterologists. Although IBS does not typically cause intestinal damage, it can cause a lot of discomfort and have a negative impact on quality of life. Irritable bowel syndrome is a “functional” disorder, which means that while no structural damage to the bowel is seen on endoscopy or biopsy, the function of the digestive system is abnormal. The symptoms typically fluctuate in frequency and severity but usually occur on a recurring basis. Symptoms of IBS can include irregular bowel patterns, diarrhea, constipation, cramping, urgency, abdominal pain, bloating and gas. For some people with IBS, symptoms can improve for a while, but then come back. IBS affects both men and women, but is more common in women.
Causes of IBS
Each person’s case of IBS is different, and there are multiple potential causes including diet, altered gut microbiome, abnormal bowel motility and gut hypersensitivity. For instance altered GI motility can result is constipation or diarrhea. Hypersensitivity in the nerves that connect the GI system to the brain has been seen in people with IBS and can result in abdominal pain. IBS may also be triggered by an infection (post infectious IBS). The infection or antibiotics used to treat the infection can disrupt the balance of healthy bacteria in the gut. Stress and changes in hormones can also worsen IBS symptoms. Finally, food intolerances may be a major culprit of IBS. Regardless of the cause, IBS can be managed effectively to reduce symptoms.
Treatments for Irritable Bowel Syndrome
IBS is a chronic condition, but like many other chronic diseases, there are ways to treat it and to control the symptoms and avoid their effects on daily life. Lifestyle modifications, diet, supplements and medications are all possible treatments for managing IBS. However, each person experiences IBS differently. It’s important to take an individualized approach to managing your IBS. Let’s take a look at some of the recommended lifestyle and dietary modifications for IBS.
Lifestyle Modifications for IBS Relief
Stress can trigger or aggravate many diseases, both functional and organic. Many people notice an increase in their IBS symptoms when they are experiencing a stressful situation. Managing stress can help keep IBS symptoms to a minimum. Techniques for managing stress include mindfulness based stress reduction, breathing exercises, progressive muscle relaxation and taking time for self care activities, like exercise and adequate sleep. Engaging in mental health counseling that involves cognitive behavioral therapy or gut directed hypnotherapy may also help alleviate IBS symptoms.
Eat on a Schedule
Eating small meals on a regular schedule helps regulate GI motility and decrease symptoms. Try to eat a small meal or snack every 3-4 hours and avoid large meals. Use your hunger and fullness cues as a guide to make eating decisions. Try to eat something before you get overly hungry, and stop eating before you feel stuffed. Avoid skipping meals. Even if you don’t have much of an appetite, eating something small can help regulate your GI system.
Avoid Food Triggers
Beverages and foods containing caffeine, such as soda, tea, coffee and chocolate, stimulate the GI tract, In susceptible individuals, caffeine can trigger diarrhea. Greasy foods and high fat meals are hard to digest and are poorly absorbed. They can also lead to diarrhea and bloating. Also, spicy foods are irritating for some people with IBS. It’s important to track your food intake, stress levels and symptoms to better understand your personal triggers.
Try an Elimination Diet
Elimination diets involve excluding a group of foods from the diet, such as gluten, dairy or FODMAPs, for a short period of time to see if they may be causing symptoms. Elimination diets should only be done under the supervision of a dietitian or a doctor, as they can lead to nutrient deficiencies if followed incorrectly.
A commonly recommended elimination diet for IBS is the Low FODMAP diet. FODMAPS are fermentable carbohydrates that include lactose, fructose, sugar alcohols, fructans and GOS (from legumes) that can cause bloating, gas and diarrhea in people with IBS. A Low FODMAP diet temporarily eliminates or reduces foods high in FODMAPs. A low FODMAP diet is pretty strict, but still allows a variety of meat, fruits, vegetables, gluten free grains, and dairy free alternatives. Usually the strict phase of the Low FODMAP diet is only followed for 2-6 weeks.
If a person with IBS feels better on a low FODMAP diet, they can start the reintroduction process. This process typically lasts 8-12 weeks. The reintroduction process helps figure out which FODMAPS are triggering IBS symptoms. The reintroduction phase involves eating progressively large amounts of certain high FODMAP foods, while tracking symptoms. After the reintroduction phase, a modified Low FODMAP diet is followed. This maintenance diet is individualized based on each person’s results. The LOW FODMAP diet approach has been shown to be effective in about 70% of patients with IBS, but should only be initiated under the supervision of a dietitian trained in this approach.
Medical Management of Irritable Bowel Syndrome
Anti-spasmodics, anti-diarrheal medications, motility agents, stool softeners, fiber supplements and probiotics may help manage IBS. Certain anti-depressants used at a low dose can be very effective in decreasing the bowel hypersensitivity and control abdominal pain. Peppermint oil supplements may also be helpful in managing abdominal pain from IBS. Talk to your gastroenterologist and dietitian before starting supplements or medications for IBS. Medication and supplement usage and effectiveness will depend on your specific type of IBS and individual food intolerances,
If you are having unusual symptoms or changes in your bowel habits, talk to your doctor first before treating your symptoms. It’s important to rule out other causes of GI symptoms, such as inflammatory bowel disease, bowel cancer and Celiac disease. Your doctor may order labs, a colonoscopy or other tests to make sure your symptoms aren’t caused by an underlying condition. If you have been diagnosed with irritable bowel syndrome, seeing a dietitian with experience in gastrointestinal disorders can help you find relief from your symptoms.
Our Registered Dietitian, Joanna Eaton, specializes in gastrointestinal disorders and teaching people how to follow the Low FODMAP diet. If you need help with managing your IBS, schedule an appointment by calling 301-288-1319. Now accepting most health insurances and offering telehealth visits.