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NHS Choices Condition

Content supplied by NHS Choices

Diet

Making changes to your diet can help to control the symptoms of irritable bowel syndrome (IBS). However, there is no 'one size fits all' diet for people with IBS. Different individuals will respond better to individually tailored diets.

Keeping a food diary and making a note of whether certain foods make the condition better, or worse, may be helpful. Once you have identified any 'trigger foods' you can avoid them.

People with IBS are often advised to modify the amount of fibre in their diet. For some people, this will be a case of reducing the amount of insoluble fibre (the type that make stools bulkier and soft) in their diet. This may mean reducing your consumption of wholemeal bread, cereals, and whole grains, such as brown rice.

Other people with IBS may need additional fibre in their diet, usually soluble fibre. This may mean taking a fibre supplement, or eating more foods that are high in soluble fibre, such as oats.

Your GP will be able to advise you about what your recommended fibre intake should be. The dietary advice listed below may also help you to control your symptoms of IBS.

  • Have regular meals, and take your time when eating.
  • Avoid missing meals, or leaving long gaps between eating.
  • Drink at least eight cups of fluid a day, particularly water, or other non-caffeinated drinks, such as herbal teas.
  • Restrict tea and coffee to three cups a day.
  • Reduce your intake of alcohol and fizzy drinks.
  • Reduce your intake of 'resistant starch' (starch that resists digestion in the small intestine and reaches the colon intact). It is often found in processed, or re-cooked, foods.
  • Limit fresh fruit to three portions (80 g each) a day; a suitable portion would be half a grapefruit, or one apple.
  • If you have diarrhoea, avoid sorbitol, which is an artificial sweetener that is found in sugar-free sweets (including chewing gum) and drinks, and in some diabetic and slimming products.
  • If you have wind and bloating, consider increasing your intake of oats, for example, oat-based breakfast cereal, or porridge, and linseeds (up to one tablespoon a day).

Do not undertake a single food avoidance and exclusion diet (a diet where you avoid a class of food, such as dairy products, or red meat) unless you are under the supervision of a dietician.

Exercise

Exercise can help to relieve the symptoms of most (but not all) people with IBS. However, regular exercise has many associated health benefits and should form part of your daily and weekly routine regardless of whether you have IBS or not. Your GP will be able to advise you about whether exercise is suitable for you.

If exercise is suitable for you, you should aim to exercise for a minimum of 30 minutes of vigorous exercise a day, at least five times a week. The exercise should be strenuous enough to increase both your heart rate and breathing rate. Walking briskly and walking up a hill are both examples of vigorous exercise.

Probiotics

Some people find that taking probiotics help to relieve the symptoms of IBS. Probiotics are dietary supplements that are available at most supermarkets, which contain so-called 'friendly bacteria'.

You will need to take probiotics for at least four weeks to see if they have a beneficial effect. When taking it, make sure that you follow the manufacturer's instructions and recommendations.

The use of prebiotics - dietary supplements that encourage the growth of certain types of bacteria in the intestine - is not recommended as a treatment for IBS.

Stress

Taking steps to reduce the levels of stress in your life may hep to reduce the frequency and severity of your IBS symptoms.

Some ways to help relieve stress include:

  • relaxation techniques, such as meditation, or breathing exercises,
  • physical activities, such as yoga, or Tai Chi (a Chinese martial art), and
  • regular exercise.

If you are finding that stress is a problem in your life, you may benefit from a talking therapy, such as stress counselling, or cognitive behaviour therapy (CBT). See below for more information about CBT.

Medication

A number of different medications are used to help treat IBS. These are.

  • Antispasmodic medicines, which help to reduce abdominal pain and cramping,
  • Laxatives, which help to treat the symptoms of constipation,
  • Antimotility medicines, which help to treat the symptoms of diarrhoea, and
  • Tricyclic antidepressants (TCAs), which were originally designed to treat depression, but also help to reduce the feeling of abdominal pain and cramping.

See below for more information on these medications.

There is also a medicine called Kolanticon, which contains an antispasmodic drug and three other ingredients. The other ingredients are simeticone, which relieves trapped wind, and two different antacids, which reduce stomach acid and treat heartburn. Kolanticon is available from your pharmacy without prescription.

Antispasmodic medicines

Antispasmodic medicines work by helping to relax the muscles in your digestive system. Examples of antispasmodic medicines include mebeverine and therapeutic peppermint oil.

Side effects of antispasmodic medicines are uncommon. However, people taking peppermint oil can sometimes experience occasional heartburn and irritation on the area of skin around their anus (back passage).

Antispasmodic medicines are not recommended for use by pregnant women.

Laxatives

The type of laxative known as a bulk-forming laxative is usually recommended for people who are experiencing IBS-related constipation. Bulk-forming laxatives work by making your stools denser and softer, which means that they should be easier to pass.

It is important to drink plenty of fluids when using a bulk-forming laxative because this will prevent the laxative causing an obstruction in your digestive system.

You should start on a low dose, and if necessary increase it every few days until one or two soft, formed stools are produced every one or two days. You should not take a bulk-forming laxative immediately before going to bed.

Side effects of taking laxatives can include bloating and flatulence (wind). However, side effects can usually be avoided or reduced by gradually increasing the dose.

Antimotility medicines

The antimotility medicine known as loperamide is usually recommended for the treatment of IBS-related diarrhoea. Loperamide works by slowing the contractions of the muscles in the intestines which, in turn, slows how fast food passes through your digestive system. This allows more time for your stools (faeces) to harden and solidify.

Side effects of loperamide include:

  • abdominal cramps,
  • dizziness,
  • drowsiness,
  • skin rashes,
  • bowel obstruction, and
  • abdominal bloating.

Loperamide is not recommended for use by pregnant women.

Tricyclic antidepressants (TCAs)

Tricyclic antidepressants (TCAs) are usually recommended if antispasmodic medicines have failed to control your symptoms of abdominal pain and cramping. TCAs work by relaxing the muscles in your digestive system.

Side effects of TCAs include:

  • constipation,
  • dry mouth,
  • drowsiness, and
  • fatigue.

Due to their potential to cause drowsiness and fatigue, you may be advised to take TCAs before going to bed. You should not drive, or operate heavy machinery, if you are experiencing drowsiness.

If you fail to respond to TCAs, an alternative antidepressant, known as a selective serotonin reuptake inhibitor (SSRI) may be recommended for you.

Complementary therapies

A number of complementary therapies for IBS have been suggested including:

  • acupuncture,
  • reflexology (a type of massage therapy), and
  • the herbal remedy aloe vera (a plant that is native to north Africa).

However, there is no evidence that these complementary therapies are effective at treating IBS. You should also be aware that aloe vera has been linked to a number of possible adverse effects, such as dehydration, and a reduction in blood sugar levels.

Psychological interventions

If your symptoms of IBS are still causing you problems after 12 months of treatment, you may be referred for a type of therapy known as a psychological intervention.

There are several types of interventions available, but they all work by teaching you psychological techniques that can help you to control your condition more effectively.

Psychodynamic interpersonal therapy (PIT)

Psychodynamic interpersonal therapy (PIT) is a type of psychotherapy that has had some success in helping people with IBS. PIT is based on the principle that your unconscious thoughts, beliefs, and attitudes can have an important influence on the way that you think, act, and feel.

During PIT, your therapist will help you to explore your past in order to determine how it might have affected you unconsciously, and they will help you to confront unwelcome, or unhelpful beliefs, attitudes, and behaviour in an attempt to change them.

Hypnotherapy

Psychological interventions for IBS include hypnotherapy. In this type of therapy, hypnosis is used to change your unconscious mind's attitude towards any symptoms that you may have. You may also be taught self-hypnosis techniques.

Hypnotherapy has been shown to be effective in helping some people reduce their symptoms of pain and discomfort.

Cognitive behaviour therapy (CBT)

Another psychological intervention for IBS is cognitive behaviour therapy (CBT). CBT is based on the principle that the way that we feel is partly dependent on the way that we think about things.

Studies into the effectiveness of CBT have shown that people who train themselves to react differently to their condition by using relaxation techniques, and maintaining a positive attitude, report a decrease in pain levels.

CBT may also help you to cope better with stress, anxiety, and depression.

view information about Irritable Bowel Syndrome on www.nhs.co.uk »

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