How to manage your IBS

Irritable bowel syndrome (IBS) is a common digestive problem that may lead to uncomfortable symptoms.

Here, we look at ways to deal with them, from diet and lifestyle changes to medication.

IBS is a chronic condition that affects a person’s stomach and intestines. It’s thought that around one in 5 Australians experience symptoms of IBS at some point in their lives.¹

These symptoms include:

• pain and bowel changes, including diarrhoea or constipation
• abdominal bloating and gas
• nausea
• indigestion or acid reflux
• backache
• fatigue
• anxiety or depression
• bladder problems.

While the exact cause of IBS isn’t completely known, some reasons may include:

• issues with the muscles lining your bowel
• increased sensitivity to signals being sent from the gut to your brain
• inflammation in the intestines
• an over or under-active immune system
• changes in gut bacteria
• genetics.

There's no test to confirm IBS, but your doctor may diagnose the condition based on symptoms such as:

• weight loss
• blood in your stool
• a family history of bowel problems
• diarrhoea without other symptoms
• anaemia.

Unfortunately, there’s no cure for IBS. But treatments and lifestyle adjustments can help reduce the symptoms. Understanding your IBS and coming up with a good self-management plan can make a huge difference.

Once you know your personal triggers (which might be certain foods, ingredients and/or stress), there are things you can do to take control and ease your symptoms.

For many people with IBS, a healthy lifestyle can improve symptoms. While everyone’s IBS is different, some common diet changes that might help include:

• eating regular, smaller meals and snacks
• eating until you feel full but no more
• having plenty of water or non-caffeinated drinks
• limiting soft drinks and caffeinated drinks
• limiting alcohol to no more than 10 standard drinks per week and no more than 4 on any one day.

It may also be crucial to limit your intake of ‘trigger’ foods and drinks which might cause your IBS to flare up. While everyone is different, some common ones include:

• caffeinated drinks like tea and coffee
• alcohol
• spicy foods
• rich and fatty foods
• garlic
• onions.

Diarrhoea is a common symptom of IBS. To manage IBS-related diarrhoea, you might:

• reduce sugar-free or diet products that contain sorbitol, mannitol or xylitol. These are used in some sugar-free sweets, drinks, mints, gums and diet products, and can have a laxative effect
• drink lots of fluids. Replacing lost fluid by drinking enough throughout the day is important to keep hydrated following periods of diarrhoea
• manage wind and bloating. If you experience these, it might help to reduce gas-producing foods like beans, legumes, Brussels sprouts and cauliflower. You can also add a tablespoon of linseeds each day to foods like yoghurt, porridge and salads
• stop eating gluten. Some people report improvement in diarrhoea if they stop eating gluten, which is found in wheat, barley and rye.

As well as diarrhoea, constipation is another common symptom of IBS.

It’s important to ensure you get adequate fluids throughout the day, and it can help to incorporate a wide variety of high-fibre foods into your diet. These include:

• oats
• oat bran
• brown rice
• wholemeal or wholegrain bread and pasta
• potatoes with skin
• quinoa
• fruit and vegetables.

You may find that soluble fibres such as psyllium improve your symptoms more than insoluble fibres, which include wheat grain and whole-wheat flour.

Researchers from Monash University found that eating a diet low in certain carbohydrates helped alleviate symptoms for 75% of people with IBS.²

These are fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP). They’re typically found in foods that aren’t easily digested and absorbed by people with IBS.

A low-FODMAP diet must be done under the guidance of an accredited practising dietitian. It’s also not advised to remain on it for too long, as the diet can change the balance of your gut microbiome (the community of bacteria living in your stomach). Your dietitian will advise you when to slowly introduce FODMAP foods again.

Regular exercise is a good way to help reduce symptoms of IBS, as it can keep your bowel movements regular and reduce stress. Likewise, stress management or relaxation techniques like yoga can make a significant difference.

It can also help to keep a food diary to log your symptoms and eating habits. You might also jot down certain life events to find any emotional connections and triggers.

There are several over-the-counter medicines available to help manage and relieve some symptoms of IBS, including:

• anti-diarrhoea medicines. You should only take these as needed and not on a regular basis
• laxatives. Certain laxatives may help relieve constipation. Bulk-forming laxatives include psyllium-containing products. Bowel-stimulating laxatives, such as senna, tend to be stronger. Speak to your GP before taking any laxative routinely
• antispasmodic medicines. These may help with stomach cramps and wind
• peppermint oil. This typically comes in capsules and works as a natural antispasmodic that can relax the smooth intestine muscles, providing short-term relief for IBS
• probiotics. These supplements contain helpful bacteria and yeasts, which you can also find naturally in fermented foods like yoghurt and kimchi
• painkillers. If you need to use painkillers, use paracetamol. Anti-inflammatory medicines such as ibuprofen or aspirin may make your symptoms worse.

Your GP can also prescribe medication for IBS, including prescription-only versions of those mentioned above. Low-dose antidepressants may also be prescribed to help calm symptoms that act on nerve cells in the gut.

Your gut and brain are strongly linked. Psychological therapies, such a cognitive behavioural therapy, mindfulness meditation, hypnotherapy or psychotherapy, have been shown to improve or resolve IBS symptoms.

If stress is an IBS trigger for you, talk to your GP to discuss your options.

Check out the Gastroenterologist Society of Australia’s patient resources for information about gastrointestinal issues.