Irritable bowel syndrome, commonly known as IBS, is a long-term gastrointestinal disorder. It can lead to multiple problems related to the intestinal tract and cause discomfort. IBS is more likely to occur in women than in men and usually happens in people aged 45 and younger. The causes of IBS are not entirely known, hence its management can be difficult.

Living with IBS can be challenging and embarrassing, and it can affect your quality of life. Most of us don’t think much about our morning routine. We do things automatically without much planning. But for someone with IBS this might be a completely different story. For some people, the symptoms may be severe, to the point where they have to plan carefully each step of their day. Especially mornings can be challenging. These unfortunate ones very often suffer from severe discomfort and feel like they need to be near a bathroom all the time. When they go out, they plan their journey so that they are sure there will be a public toiled along the way. Just in case…

How to recognise irritable bowel syndrome

The official diagnostic criteria are:

• Recurrent stomach pain: On average, at least one day per week in the last three months.
• Stool symptoms: These should match two or more of the following: related to defecation, associated with a change in frequency of stool or associated with a change in the appearance of stool.
• Persistent symptoms: Criteria fulfilled for the last three months with symptom onset at least six months before diagnosis.

Some of the most common symptoms are changes in bowel habits, abdominal pain and cramping (often reducing after passing a stool), a feeling that the bowels are not empty after passing stools. These can also include bloating, passing of excess gas, a sudden need to use the toilet, diarrhoea and constipation.

Some people also experience symptoms that are not considered specific for IBS. Among these are frequent urination, bad breath, headache, joint or muscle pain and fatigue. Sometimes anxiety and depression are observed due to discomfort and embarrassment resulting from IBS.

But these symptoms can be alleviated. There seem to be common triggers for IBS, such as certain foods, stress and hormonal changes.

Managing IBS

There are some tricks that can help improve IBS symptoms.

Fibre: Experimenting with fibre intake is important. Some people may need to increase it, while others should reduce its intake. Increasing your fibre intake may help to improve your symptoms of constipation. Foods that contain fibre include fruits, vegetables, whole grains, and beans.

Probiotics: Probiotics are beneficial bacteria that support the health and proper functioning of our digestive system.

Food diary: Recording our intake and analysing what effect specific foods have can be very helpful in recognising triggers and products that are beneficial.

Managing stress: It’s not just diet that affects the severity of the symptoms. We need to pay close attention to our stress levels as it can aggravate the symptoms.

Eating regular meals and decreasing the pace of eating: This can help with digestion

Limiting alcohol and sugary foods. These can aggravate some of the symptoms

Physical activity: Moderate to vigorous exercise between three and five times per week can significantly improve abdominal pain, stool problems, and quality of life

Psychological wellbeing. Hypnotherapy and cognitive-behavioural therapy can help to create strategies for managing IBS through relaxation and positive approach

Diet

People with diagnosed IBS often follow a low FODMAP diet. FODMAP stands for fermentable, oligo-, di-, and monosaccharides and polyols. These are types of carbohydrates that are poorly absorbed in the small intestine. These poorly absorbed sugars pass through the intestine to the colon, where they are fermented by bacteria. Fermentation as well as water retention in the bowel can trigger the unpleasant symptoms and may result in diarrhoea.

These symptoms very often improve after the reduction of high FODMAP foods, which include many different fruits and vegetables, dairy products and wheat.

The low FODMAP diet involves reducing high FODMAP foods for four to eight weeks and then re-introducing them in a specific and planned way, to identify which ones are problematic.

It is important to bear in mind that a low-FODMAP diet is not for everyone as it needs an individual approach and careful planning. Therefore, a trained dietitian would be the best person to advise you on introducing such diet if you have been diagnosed with IBS by your doctor. It is best if you see your doctor to rule out other more serious conditions, such as celiac disease, inflammatory bowel disease or colon cancer. If you have IBS, consider this diet if you have been experiencing ongoing gut symptoms and you haven’t responded to first-line dietary advice or found stress management strategies ineffective.

High FODMAP foods to avoid are:

• Vegetables: Garlic, asparagus, onions, mushrooms, beans, shallots, scallions.
• Fruits: Blackberries, watermelon, prunes, peaches, dates, and avocados.
• Meats: Sausages, breaded meats, battered meats, meats served with garlic or onion-based sauces and fillings.
• Fish: Breaded fish, battered fish, fish served with garlic or onion-based sauces.
• Fats: Almonds, cashews, pistachios, avocado
• Starches, cereals, and grains: Beans, lentils, wheat, and gluten-based bread, rye, muffins, pastries, and pasta.

Low FODMAP foods to include are:

• Protein: Beef, chicken, turkey, eggs, lamb, pork, prawns and tofu, crab, lobster, salmon, tuna, shrimp
• Starches, cereals, and grains: Potatoes, gluten-free bread, quinoa, brown rice, tortilla chips, and popcorn.
• Fruit: Strawberries, Bananas, grapes, blueberries, kiwi, limes, mandarins, oranges, papaya, pineapple, rhubarb and strawberries
• Vegetables: Bean sprouts, lettuce, chives, bell peppers, carrots, cucumber, eggplant, kale, tomatoes, spinach and zucchini, green beans
• Nuts and seeds: Pumpkin seeds, macadamias, peanuts, pecans, pine nuts and walnuts, sesame, sunflower seeds, linseeds
• Dairy: Cheddar cheese, lactose-free milk and Parmesan cheese
• Oils: Coconut oil and olive oil

Treating IBS usually involves some dietary and lifestyle changes, as well as learning how to deal with stress. It can be challenging but with the proper support it can be managed and the symptoms reduced. If you experience the symptoms mentioned in this article and are concerned that you may have IBS, speak to your doctor who will help you recognise the problem and may refer you to an appropriate specialist or recommend further tests.

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