Irritable bowel syndrome (IBS) is a disorder affecting the intestine. IBS involves problems with motility (movement of digested food through the intestines) and sensitivity (how the brain interprets signals from the intestinal nerves), leading to abdominal pain, changes in bowel patterns and other symptoms.
Irritable bowel syndrome (IBS) is a disorder
affecting the intestine. IBS involves problems with motility (movement of
digested food through the intestines) and sensitivity (how the brain interprets
signals from the intestinal nerves), leading to abdominal pain, changes in
bowel patterns and other symptoms. Although often disruptive, debilitating and
embarrassing, it may be some comfort to know that IBS is not life-threatening,
nor does it lead to cancer or other more serious illnesses.
Canada has one of the highest rates of IBS in the world, estimated 18% vs 11% globally (Lovell et al. 2012). However, it is thought that IBS often remains under diagnosed. More than 70% indicate that their symptoms interfere with everyday life and 46% report missing work or school due to IBS. (Gastrointestinal Society 2016).
People with IBS frequently report feeling depressed, embarrassed and self-conscious. Their inability to predict symptoms places significant burden on daily living. IBS limits productivity and performance at work, has a negative effect on the quality of relationships, and limits participation in routine social activity (Gastrointestinal Society 2018).
IBS also has a personal financial burden with individuals sometimes trying multiple over-the-counter (OTC) treatments and alternative therapies in their quest to be symptom-free; costs can be significant due to the lack of information about the effectiveness of these purported remedies (Gastrointestinal Society 2018).
The underlying cause of IBS is still unclear
and there is no diagnostic disease markers for IBS. Guidelines recommend doctors
make a positive diagnosis using criteria that are based on person’s symptoms.
Subtypes of IBS
are recognised by the Rome IV criteria based on the person’s reported
predominant bowel habit, when not on medications, as follows:
IBS-C: with predominant constipation (Bristol types 1 and 2).
IBS-D: with predominant diarrhea (Bristol types 6 and 7).
IBS-M: with both constipation and diarrhea (Bristol types 1 and 6).
More questions? See our top 10 IBS questions: Answered here.
What is IBS-C?
Irritable bowel syndrome with constipation, also referred to as IBS-C, is a distressing condition that can significantly affect the quality of life of those affected.
Constipation occurs when digested food moves slowly through the digestive tract. As a result, stool remain in the large intestines for prolonged periods of time where the intestines remove excess water causing stool to become hard, dry, lumpy and difficult to pass.
What is IBS-D?
Irritable bowel syndrome with diarrhea is IBS with diarrhea as the primary symptom, also referred to as IBS-D.
People with IBS-D experience frequent abdominal pain and watery bowel movements, and, on occasion, loss of bowel control. In fact, approximately 1 out of every 3 people with IBS-D have loss of bowel control or soiling. This has a strong, negative impact on day-to-day life, however these and other symptoms of IBS-D can be managed.
Sound like you?
You should see your physician. The American Gastroenterology Association (AGA) recommends to patients three steps to improve communication with their physician:
Speak up early: talk to a doctor as soon as possible after the onset of symptoms, not just with a family or friend
Speak up completely: detail the symptoms to your HCP. A great way to do this is by downloading our new app to help you track symptoms daily .
Speak up often: Inform the doctor on the evolution of your symptoms after any new treatment efforts so that alternative treatment approaches can begin.
If you think you may have IBS, click here to download our handy Infographic.
Lovell RM and Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: A meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-21.e4.
Living Positively
Lifestyle
changes for IBS
The following lifestyle changes may help
to prevent or ease your IBS symptoms:
Exercise regularly to promote movement of the colon and reduce stress. Exercise can take many forms, but 20 to 30 minutes of activity at least three times per week can be helpful.
Get enough rest. A lack of sleep and fatigue can worsen the symptoms of IBS.
Minimize stress and tension. The brain and colon are linked through many complex pathways and emotional stress can disrupt intestinal function and cause pain.
Yoga, meditation, and slow, relaxed breathing techniques can help people with IBS manage stress.
Limit intake of caffeine, alcohol, carbonated drinks and fatty foods.
Follow through on an urge to have a bowel movement, if at all possible.
If you have IBS, you know you have to navigate the world a bit differently than most people. Check out our IBS survival guide infographic here.
Dietary changes for IBS
Food intolerances have been linked to
IBS symptoms for many years, however conflicting information often creates
confusion and frustration as to what foods IBS patients should include, or
avoid, in their diet. Managing IBS often takes a combination of approaches, as
each person may be different. Below are some proactive strategies and treatment
options that can help you live your best life!
Rule out lactose intolerance. The symptoms of lactose intolerance (an inability to digest the sugar in milk) and the symptoms of IBS often overlap.
Limit insoluble fibre. Insoluble fibre (cannot dissolve in water) which is found primarily in wheat bran, brown rice, seeds, nuts, dried fruit and whole grain breads, adds bulk to the stool and can aggravate IBS symptoms in some people. Peeling fruits and vegetables to remove the high insoluble fibre skin or peel can be beneficial.
Increase soluble fibre. Poorly fermentable, soluble fibre remains an evidence-based treatment for IBS. Try slowly increasing dietary fibre by 2 to 3 grams per day to prevent discomfort and to promote soft, painless stools.
Try the low FODMAP diet. Fermentable carbohydrates (also known as FODMAPs), are small carbohydrate (sugar) molecules found in everyday foods that may be poorly absorbed in the small intestine of some people. FODMAPs are fermented (digested) by intestinal bacteria, which can lead to symptoms of abdominal pain, excess gas, constipation and/or diarrhea.
Try a probiotic. Probiotics are live microorganisms that, when taken in adequate amounts over sufficient time, may provide a health benefit. They are natural, ‘healthy’ bacteria that may help with digestion and offer protection from harmful bacteria in the intestines. Studies have found that, in some cases, probiotics may help to improve symptoms of IBS. If other dietary strategies have not been successful, a 4-week trial of a probiotic (in the dose recommended by the manufacturer) may be helpful. Probiotics are not medicine. They are available to purchase as capsules, tablets or powders, and can also be found in some fortified yogurts and fermented milk products. However, not all probiotics are the same. It is important to choose a product that is reliable, proven to be safe and offers benefits for the specific symptoms you want to relieve. Speak to your doctor, dietitian, or pharmacist about which probiotic may be right for you. It is important to take the probiotic in the dose and duration recommended by the manufacturer to achieve the best results.
Lifestyle
Changes for IBS-C
Sometimes making simple changes to your
lifestyle can be helpful for managing mild IBS-C symptoms such as:
Regular exercise not only increases your strength, it can
also boost bowel activity.
Get enough rest. This allows your body to maintain basic
function, repair and manage stress.
As already mentioned, stress can affect bowel function.
Try to find ways to manage your stress at home, work or school through good
time management practices and prioritizing your health.
Limit alcohol consumption
Don’t smoke
Dietary
Changes for IBS-C
Some foods support good bowel health
while others can increase constipation. It is important to recognize the impact
certain foods have on your digestive and overall health. Below are a few
suggestions that may be helpful:
Reduce gassy foods: If
bloating is bothersome or you are passing more than usual amounts of gas, your
doctor may suggest eliminating trigger foods such as: carbonated beverages,
greasy, fried foods, and refined sugar.
Increase fluids: Try to
consume adequate amounts of non-caffeinated, low sugar liquids each day.
Healthy fluids include water, juices, milk and low sodium soups. Avoid liquids
high in refined sugar or artificial sweeteners.
Increase Soluble fibres: Soluble
fibres are derived from plants and cannot be broken down or absorbed. This
fibre attracts water and turns into gel during digestion, slowing digestion and
making stools soft and easy to pass.
Increase Insoluble fibres: Insoluble
fibres are not broken down or absorbed by the digestive system. These fibres
add bulk to stool, which helps move stool through the digestive tract.
Explore a low FODMAP Diet: Some
individuals are sensitive to types of carbohydrates such as fructose, fructans,
lactose and others. These are called FODMAPs (fermentable oligo-, di-, and
monosaccharides and polyols). FODMAPs are found in certain grains, vegetables,
fruits and dairy products.
Lifestyle
and Diet Changes for IBS-D:
Identify food triggers –
Tracking foods you eat and logging the times you experienced symptoms/distress
may help reveal connections between food and IBS-D. You should take detailed
notes that should include the types and amounts of foods eaten and the time of
consumption. It’s important to also record the time and description of
distressing bowel events or related pain and discomfort. Below are some dietary
considerations which you may want to discuss with your doctor and/or registered
dietitian.
High-fat foods may worsen
symptoms of IBS-D
Dairy products – lactose free
products may be better tolerated
Avoid alcohol
A reduction of caffeine may be
beneficial. This includes caffeinated drinks, such as coffee, tea, colas and
energy drinks
Sorbitol sweeteners (found
in some chewing gum) may be problematic
Drink plenty of water
Probiotic supplements such
as lactobacillus acidophilus may help alleviate IBS symptoms including
abdominal pain, bloating, and bowel movement irregularity. Ask your health care
professional for more information.
A diet low in FODMAPs (fermentable
oligo-saccharides, di-saccharides, mono-saccharides, and polyols), a group of
short-chain carbohydrates, may help relieve symptoms. The diet is used in the
short-term followed by re-introduction to assess tolerance to individual foods.
Consult your health-care professional for more information.
Eating large meals also may trigger abdominal cramping and
diarrhea. It’s best to eat smaller meals.
Fibre may be helpful in reducing symptoms of
IBS-D. If a trial of a fiber supplement such as psyllium is used, fiber should
be added gradually, because it initially may worsen bloating and gassiness. If
you have IBS-D, look for foods with more soluble fiber, the type that takes
longer to digest (such as that found in oats).
Stress is considered one of the triggers of
IBS symptoms. Here are some healthy habits that may also help reduce IBS
symptoms.
Exercise may improve and could reduce stress.
Get enough rest. This
allows your body to maintain basic function, repair and manage stress.
Use relaxation techniques: deep
breathing, visualization, Yoga.
Consult a professional trained in Cognitive Behavioral Therapy or Gut Directed Hypnotherapy.
How do I
prepare to talk to my doctor about IBS?
Good communication with your doctor is an important part of effective management of a functional GI disorder like IBS. Before your appointment, take the time to track your symptoms in the CDHF app that can help you and your doctor see patterns in your activities and identify specific triggers for your symptoms.
Include the following information in the CDHF app:
Jot down key personal and medical information, including any recent changes or stressful events in your life in the notes section of the app.
Make a list of the triggers (food, stress, activity, menstrual cycle) that seem to make your symptoms worse in the notes section of the app.
Track the medications are you taking, including the conditions you take them for. Also note if any of your medications seem to affect your symptoms.
Talk to your family members and note if any relatives have been diagnosed with IBS, inflammatory bowel disease (IBD), celiac disease or colon cancer.
You may want to ask your doctor:
What do you think is causing my symptoms?
Are there other possible causes for my condition?
What diagnostic tests do I need?
Do these tests require any special preparation?
What treatment approach do you recommend trying first?
If the first treatment doesn’t work, what will we try next?
Are there any side effects associated with these treatments?
Statistics
Canada has one of the highest prevalence of irritable bowel syndrome (IBS) in the world – estimated 18% vs. 11% globally. (Lovell et al. 2012)
More than 70% indicate that their symptoms interfere with everyday life and 46% report missing work or school due to IBS. (Gastrointestinal Society 2016)
54% of those with IBS experience symptoms of fatigue. (Gastrointestinal Society 2018; Han et al. 2016)
40 to 60% of those with IBS experience psychological symptoms, including anxiety disorders and depression. (Gastrointestinal Society 2018)
On average, IBS patients reported they would give up 25% of their remaining life (15 years) to live a symptom-free life. (Gastrointestinal Society 2018)
Data from the US suggest that on average, costs are US$2,026 more per year per patient among those with IBS as compared to those without IBS. (Buono et al. 2017)
On average, it takes 4 years for an individual to receive a definitive diagnosis of IBS. (Gastrointestinal Society 2018)
In Canada, 45% of the direct costs for IBS treatment are attributed to diagnostic tests. (Fedorak et al. 2012)
Citations:
Buono JL et al. Economic burden of irritable bowel syndrome with diarrhea: Retrospective analysis of a U.S. commercially insured population. J Manag Care Spec Pharm. 2017 Apr;23(4):453-60.
Fedorak RN et al. Canadian Digestive Health Foundation Public Impact Series 3: Irritable bowel syndrome in Canada. Incidence, prevalence, and direct and indirect economic impact. Can J Gastroenterol. 2012 May;26(5):252-6.
Han CJ and Yang GS. Fatigue in irritable bowel syndrome: A systematic review and meta-analysis of pooled frequency and severity of fatigue. Asian Nurs Res (Korean Soc Nurs Sci). 2016 Mar;10(1):1-10.
Lovell RM and Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: A meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-21.e4.
Signs and Symptoms
IBS is not a single entity. It’s a collection of abdominal and bowel-related symptoms. Symptoms common in IBS that support a diagnosis are:
Abdominal pain
Abnormal stool frequency
Urgency
Cramps
Bloating
Abnormal stool from
Straining at defecation
Feeling like you haven’t completely emptied your bowels
Mucus in stool
While most people experience digestive
troubles once in a while, what sets IBS apart is abdominal pain and diarrhea or
constipation that comes back again and again. At times, the pain and discomfort
of IBS symptoms may be severe and debilitating, and at other times, they may
improve or even disappear completely.
Signs & symptoms of IBS with constipation
(IBS-C)
When living with IBS-C, symptoms may suddenly
worsen (flare) and then improve for no apparent reason. When symptoms flare,
they may be severe, debilitating and last for days or months. Possible signs
and symptoms of IBS-C are:
abdominal pain or discomfort
gas, bloating and abdominal distention
straining when having a bowel movement
a sense that something is blocking your
rectum
infrequent bowel movements (less than three
per week)
feeling like you have not completed your
bowel movement other illnesses so that those can be ruled out.
diarrhea or loose, watery stools, especially
in the morning or after meals
passing stools three or more times per day
sudden urgency before bowel movements
feeling of incomplete emptying after bowel
movements
abdominal pain or cramping
loss of bowel control or soiling yourself
What causes irritable bowel syndrome (IBS)?
The exact cause of IBS is unknown, however,
it is believed that IBS may be caused by one of several factors. In some
patients, it may be linked to a prior infection or event which disrupts the
normal functioning of the intestines. It is common for people to develop IBS
following a gastrointestinal infection, food poisoning, traveller’s diarrhea,
surgery, a change in diet or the use of antibiotics or new medications. In
others, an imbalance of intestinal bacteria or a change in the body’s level of
hormones, immune signaling in the bowel wall or neurotransmitters (brain
chemicals) may also lead to the development of IBS. Currently, there is a great
deal of interest in possible alterations in the number or type of bacteria within
the intestine, but the exact role this may play in IBS is not yet known. In
people with IBS, bowel function can be altered in several ways:
Motility (movement of contents
through the intestines): Normally,
waves of coordinated intestinal muscle contractions (peristalsis) transport
digested food through the intestines. In people with IBS, the rhythm and
coordination of these contractions may be altered. This altered motor function
can result in the bowel moving too quickly (causing diarrhea) or too slowly (causing
constipation) and can lead to spasm and pain.
Sensitivity (how the brain
interprets signals from the intestinal nerves): The network of nerves surrounding the digestive organs
may become unusually sensitive. For some people with IBS, even a small change
in intestinal activity can trigger the nerves to send messages to the brain
causing abdominal pain.
Brain-gut dysfunction:In IBS, there may be problems in how the brain receives
and processes sensations coming from the intestines. A malfunction may occur
along the many different pathways that connect the brain and gut, interfering
with the normal function of the intestines. Many aspects of everyday living can
trigger or aggravate IBS symptoms. Triggers vary from person to person, but the
most common ones include certain foods, medications, emotional stress and
hormone fluctuations. In particular, foods such as caffeine, alcohol,
carbonated drinks, fatty foods, certain fruits and vegetables, as well as
lactose, fructose and gluten (wheat protein) can cause problems for people with
IBS.
Risk factors of IBS
Age: IBS can affect people of all ages, but it often
begins in the teen years or early adulthood.
Gender: IBS affects more women than men.
Family history of IBS: People with a first-degree relative (parent or
sibling) with IBS are at greater risk of developing the condition.
What causes IBS with constipation (IBS-C)?
The cause of IBS-C is not yet known; however,
there are a variety of factors that may contribute to the disorder. These
include:
Intestinal motility: The walls of the intestines are lined with layers of
muscles that contract and relax in a coordinated rhythm as they move food from
your stomach to your intestines through a process called peristalsis. For those
with IBS-C, contractions within the intestine may be reduced or delayed causing
gas, bloating and stool to move slower than normal.
Nerve Hyper-Sensitivity: Poorly coordinated signals between the brain and the gut
can make your body overreact to the activities taking place during digestion
causing increased sensitivity. This may explain why those with IBS-C experience
abdominal pain and discomfort. Excess fluid absorption: Constipation results
when the intestine absorbs too much fluid from the stool, which can occur
because of reduced or delayed contractions. Brain-bowel connection: There is a
strong connection between our brain and bowel. This is sometimes called the
brain-gut connection. In individuals with IBS-C, a possible disconnect or
miscommunication between the mind and gut, may impact motility, pain
sensitivity and fluid absorption. This disconnect may result in abdominal pain,
discomfort and constipation.
Risks associated with IBS-C
If left untreated, IBS-C can potentially lead
to additional health complications. These include:
Hemorrhoids: enlarged veins (blood vessels) in the rectum that
may bleed or descend through the anus
Anal fissure: a crack in the lining of the anus caused when large
or hard stools stretch the anal sphincter
Fecal impaction: a mass of hard stool that cannot be excreted by a
normal bowel movement and may need to be removed manually
Rectal prolapse: rectal tissue pushes out through the anus
Lazy bowel syndrome: caused from frequent use of laxatives to have bowel
function properly
What causes irritable bowel syndrome with
diarrhea (IBS-D)
Although the exact cause of IBS-D is unknown,
it is believed that IBS-D may be caused by one of several factors:
Brain-gut dysfunction: There is a dynamic bidirectional communication between
the gut and the brain. A malfunction may occur along the many different
pathways that connect the brain and gut and changes in one pathway ultimately
cannot affect others.
Bacterial Infection: Food poisoning, traveler’s diarrhea. These infectious
agents are cleared from the body typically within days but lead to chronic
alterations in motility (gut too fast or too slow) and abnormal sensory
signalling to the brain.
Bile acids: These are normally absorbed in the small bowel but some
patients spill too many into the large bowel (colon) and this can trigger
diarrhea and cramps.
Food Sensitivity: Many patients have meal-induced symptoms. Some patients
have a hypersensitive gut and meals induce gut motility (e.g. distention) that
can cause symptoms. There is also growing evidence that some food may also have
specific actions on gut motility and this could involve alterations in the
microbiome or that an individual’s microbiome might also make them more
susceptible to specific foods. However much more research is needed in this
area.
Use of antibiotics or new
medications: Antibiotics can cause an imbalance of
intestinal bacteria and other medications a change in the motility in the gut.
Stress and anxiety: These are not the cause of lBS-D but are recognized as a
common trigger of symptoms in some individuals.
Heredity: IBS-D can run in families but it is unclear how much of
this association is related to some common environment or genetics. Recent
research has identified one or more genetic defects that could be involved in a
sub-set of IBS but further studies are needed to determine whether these
defects are important. Consequently, genetic testing is not indicated.
Risks associated with IBS-D
If left untreated, IBS-D can potentially lead
to additional health complications. These include:
Diarrhea may aggravate hemorrhoids in people
who already have them.
Eliminating many foods from the diet may
result in a diet that is too limited in nutrients that could cause health
problems.
Stress and anxiety can result from the pain,
and can impact a person’s quality of life.
Tests and Treatment
Testing for Irritable Bowel Syndrome (IBS)
Often,
symptoms alone can provide doctors with the information they need to diagnose
IBS. Your doctor will perform a physical examination and take a complete
medical history that includes a careful review of your symptoms. For this
reason, it is important to be candid and specific with your doctor about the
problems you are having. A set of specific symptom criteria (referred to by
physicians as the Rome IV Criteria) has been developed to help physicians
diagnose IBS.
Rome IV Criteria
In May
2016, the Rome Foundation released the new Rome IV criteria for
diagnosing IBS. All around the world, physicians follow this organization’s
lead when diagnosing IBS.
According
to the Rome IV diagnostic criteria, IBS is characterised by recurrent abdominal pain for, on average, at least one day
per week in the last three months, associated with two or more of the following:
Symptoms related to
defecation
Symptoms associated with a
change in stool frequency
Symptoms associated with a
change in form (appearance) of stool
Treating Irritable Bowel Syndrome (IBS)
Take
comfort in knowing that IBS is an extremely common problem, and in many cases,
simple changes in your lifestyle and diet can provide symptom relief. However,
no one treatment works for everyone and treatment will depend on the types of
symptoms you have, their severity and how they affect your daily life.
Your
doctor may recommend prescription or over the counter products if your IBS
symptoms are severe and if lifestyle and dietary strategies have not helped.
Typically, medications are targeted at the dominant symptom – diarrhea,
constipation or pain.
Antispasmodic medications
may help reduce muscle spasms, abdominal pain and cramping.
Antidepressant medications,
in low doses, act on the chemical messengers in the digestive tract and can
help relieve diarrhea, pain and cramping. In higher doses, these medications
help to relieve depression and anxiety that may accompany IBS.
Antidiarrheal medications,
such as Loperamide, can help control diarrhea by reducing stool frequency and
slowing the movement of the intestines.
Laxatives speed up the
motion of stool through the intestines and may be prescribed for people who
have IBS with constipation. Laxatives are available in prescription or
over-the-counter formulations. Speak to your doctor about which one is best for
you.
Prosecretory and analgesic
agents, which increase the amount of fluid in the digestive tract as well as
reduce the sensitivity of pain nerves in the intestines. They have been shown
to soften bowel movements and make them occur more often, reduce the amount of
bloating and to decrease abdominal pain in patients with IBS.
Treating Irritable Bowel Syndrome with Constipation (IBS-C)
It is
important to find a solution that works best for you so you can find relief and
enjoy the best quality of life possible despite IBS-C. Your healthcare provider
will try to help you manage your symptoms. Recommendations generally begin with
changes to lifestyle and diet. If those changes do not bring relief,
over-the-counter (OTC) products or prescription medications may be prescribed.
Medications
While
lifestyle and dietary changes can play a role in helping manage mild IBS-C
symptoms, if your symptoms do not improve or even worsen, you may require
further intervention. Over the Counter (OTC) and prescription therapies are
available for treating IBS-C. OTC medications are recommended for short
term/occasional use. If you symptoms are still unresolved, you should consult
with your health care provider. With the right medication, you should find
relief and prevent IBS-C from inhibiting your everyday activities and quality
of life.
OTC therapies for IBS-C:
Osmotic laxatives: are non-stimulant
laxatives that draw water into the colon, increase bowel movements and allow
stool to pass through the colon more easily.
Bulk-forming laxatives are non-stimulants
containing fibre. Fibre brings water into the colon, softens and increases the
bulk of stool, and softens stool. Psyllium or methylcellulose are the most
common bulking laxatives used.
Stool softeners are non-stimulants,
which soften the stool by reducing surface tension and allowing intestinal
fluids to penetrate the stool to make it softer and easier to pass. Stimulant
laxatives stimulate the nerves and muscles of the intestine to trigger a bowel
movement by increasing contractions of muscles in the intestine. This helps
stool pass through the colon more quickly.
Prescription Medications for IBS-C
Some
IBS-C patients do not find relief with lifestyle and diet changes nor over the
counter medications. These individuals need safe and effective long-term
therapies. There are currently two classes of prescription medications that may
help. These are:
Prokinetic agents which stimulate
movement and contractions of the bowel. This increases the speed with which
stool travel through the digestive system, increases frequency of bowel
movements, and reduces IBS-C symptoms.
Prosecretory and analgesic
agents increase
the amount of fluid in the digestive tract as well as reduce the sensitivity of
pain nerves in the intestines. They have been shown to soften bowel movements
and make them occur more often, reduce the amount of bloating and to decrease
abdominal pain in patients with IBS-C.
Identify food triggers – Tracking foods you
eat and logging the times you experienced symptoms/distress may help reveal
connections between food and IBS-D. You should take detailed notes that should
include the types and amounts of foods eaten and the time of consumption. It’s
important to also record the time and description of distressing bowel events
or related pain and discomfort. Below are some dietary considerations which you
may want to discuss with your doctor and/or registered dietitian.
High-fat foods may worsen symptoms
of IBS-D
Dairy products – lactose free
products may be better tolerated
Avoid alcohol
A reduction of caffeine may be beneficial.
This includes caffeinated drinks, such as coffee, tea, colas and energy drinks
Sorbitol sweeteners (found in some
chewing gum) may be problematic
Drink plenty of water
Probiotic supplements such as lactobacillus
acidophilus may help alleviate IBS symptoms including abdominal pain, bloating,
and bowel movement irregularity. Ask your health care professional for more
information.
A diet low in FODMAPs (fermentable
oligo-saccharides, di-saccharides, mono-saccharides, and polyols), a group of
short-chain carbohydrates, may help relieve symptoms. The diet is used in the
short-term followed by re-introduction to assess tolerance to individual foods.
Consult your health-care professional for more information.
Eating large meals also may
trigger abdominal cramping and diarrhea. It’s best to eat smaller meals.
Fibre may be helpful in
reducing symptoms of IBS-D. If a trial of a fiber supplement such as psyllium
is used, fiber should be added gradually, because it initially may worsen
bloating and gassiness. If you have IBS-D, look for foods with more soluble
fiber, the type that takes longer to digest (such as that found in oats).
Stress is considered one of
the triggers of IBS symptoms. Here are some healthy habits that may also help
reduce IBS symptoms.
Exercise may improve and could
reduce stress.
Get enough rest. This allows your body
to maintain basic function, repair and manage stress.
Use relaxation techniques: deep breathing,
visualization, Yoga.
Consult a professional trained
in Cognitive Behavioral Therapy or Gut Directed Hypnotherapy.
Medications for IBS-D
While
lifestyle and dietary changes can play a role in helping manage mild IBS-D
symptoms, if your symptoms do not improve, you may require further
intervention. Over the Counter (OTC) and prescription therapies are available
for treating IBS-D.
OTC
medications are recommended for short term/occasional use. If your symptoms are
still unresolved, you should consult with your health care provider. With the
right medication, you may find relief and prevent IBS-D from inhibiting your
everyday activities and quality of life.
OTC therapies for IBS-D
Peppermint oil ( For this therapy to work, the l-Menthol needs to reach the small intestine. CDHF Recommends you ask you doctor about IBgard with its SST® (Site Specific Targeting) technology which delivers microspheres of peppermint oil quickly and reliably in the small intestine. Click here to get your free coupon.
Probiotic
Fibre
Alpha galactosidase enzymes (e.g. Beano), simethicone, although efficacy with many products is not proven.
Prescription Drugs for IBS-D
IBS-D
patients suffer from a multitude of symptoms including abdominal pain,
bloating, and diarrhea. The commonly used prescription drugs only address a
single symptom rather than the constellation of symptoms observed in IBS-D
patients. Recent advancements in the treatment of IBS have produced newer
medications that not only treat the multiple symptoms but have been
specifically studied and approved for use by Health Canada in IBS-D patients.
Physicians
may now prescribe one or a combination of drugs that:
reduce abdominal pain by
blocking the pain signals to the brain
relax the muscles in the
gut to reduce diarrhea and the urgent, uncontrollable need to use the washroom
(urgency)
reduce both abdominal and
bowel symptoms including pain, bloating, urgency and diarrhea Your doctor can
determine if a combination or a single treatment is right for you.
What is the cause of excessive flatulence and burping?
This is a common problem! We all pass gas and or experience burping but for some people, these symptoms can be really bothersome. It is important to recognize that everyone has gas in the digestive tract. When there is some gas and fluid in the intestines, movements (contractions) of the intestines to propel the contents onwards may cause rumblings.
There two major causes of excessive gas:
First, subconscious swallowing of air can result in excessive burping. Eating slowly, avoiding gum chewing and smoking, rectifying problems that lead to phlegm accumulation in the back of the throat (such as postnasal drip), and correcting a habit of clearing the throat and swallowing can help minimize air swallowing. Belching often induces instinctive reflex swallowing with further gas accumulation so you need to make a conscious effort not to swallow after each belch.
And second, gas can form as a result of the breakdown of certain dietary items, especially carbohydrates, by bacteria normally present in the large intestine. Foods that cause gas include beans, broccoli, cabbage, fruit drinks, carbonated drinks, and dairy products. Beano (obtainable over-the-counter) may help to reduce gas formation when you have a lot of vegetables and fruits at any meal.
There is no one answer or diagnosis that applies to all people. I suggest that you contact your family doctor and discuss your symptoms and the tests he or she might want to do.
How common is IBS?
IBS is very common. In fact, Canada has one of the highest rates of IBS in the world, estimated 18% vs. 11% globally (Lovell et al. 2012).
What are the most common symptoms?
A: Abdominal Pain, irregular bowl patterns that result in constipation, diarrhea, or alternating periods of both.
A: No. IBS is a chronic (long term), but manageable condition. Over time, the symptoms of IBS typically do not get worse, and with an effective treatment plan, as many as one-third of IBS patients may eventually become symptom-free.
Are there any complications of IBS?
While IBS can cause pain and stress, it does not cause any permanent damage to the bowel or lead to cancer or any other major illness.
Is there an IBS Diet?
A: One of the most common diets recommended by healthcare professionals to alleviate IBS symptoms is the FODMAP diet. Fermentable carbohydrates (also known as FODMAPs), are small carbohydrate (sugar) molecules found in everyday foods that may be poorly absorbed in the small intestine of some people. FODMAPs are fermented (digested) by intestinal bacteria, which can lead to symptoms of abdominal pain, excess gas, constipation and/or diarrhea. Following a low-FODMAP diet may help to reduce gastrointestinal symptoms in 75% of IBS patients.
Learn more about the FODMAP diet here. Check out the other diets here.
Will probiotics help my IBS?
A: If other dietary strategies have not been successful in relieving your symptoms, a trial of a probiotic (in the dose recommended) may be helpful. However, Probiotics are not medicine! They are available to purchase as capsules, tablets or powders, and can also be found in some fortified yogurts and fermented milk products. However, not all probiotics are the same. It is important to choose a product that is proven to be safe and offers benefits for the specific symptoms you want to relieve. Speak to your doctor or pharmacist about which probiotic may be right for YOU.
Are there other ways to manage IBS?
A: There are medications approved in Canada for IBS (over the counter or prescription) that can help your symptoms as well. Peppermint Oilis a relatively new treatment option out there has recently been confirmed in a clinical trial. Peppermint can relax muscle, eases hypersensitivity in the bowels, and modulates pain in IBS.
IBgard is a new clinically tested capsule filled with tiny beads of peppermint oil, using a technology called SST (Site Specific Targeting). It is the only product of its kind on the market that has gone through a clinical trial. It has been proven to be effective and safe in relieving symptoms in patients with moderate to severe IBS-M and IBS-D.
This product is easily attainable and available over the counter. Patients tested saw relief in symptoms over the course of 24 hours and continued relief over a 3-4 week period. You can read the full clinical study here, or, if you’re interested in giving IBgard a try, you can also fill out a survey to get a free trial sample here.
How is IBS different than IBD?
A: Although both illnesses can be seriously debilitating, there are several primary differences between Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS). IBD is an autoimmune disorder that causes swelling and ulcerations (sores) in the bowel. IBS involves problems with motility (how the bowel moves contents through our intestines) and sensitivity (how the brain interprets sensations in the bowel). Symptoms of IBS may wax and wane and possibly disappear altogether whereas IBD is a chronic condition.
Understanding the FODMAP Diet
In this handy printable resource, CDHF covers the basics of the FODMAP diet.
FODMAPs are a group of small carbohydrate (sugar) molecules found in everyday foods. Carbohydrates are made up of carbon, hydrogen, and oxygen and provide an important source of energy for the body. FODMAP carbohydrates that may be poorly absorbed in the small intestine of some people.
FODMAPs move through the digestive tract to the large intestine (colon), where they can draw water into the colon and are rapidly fermented (digested) by naturally-occurring gut bacteria. The fermentation of FODMAPs produces gas and other by-products. It is estimated that 50% of people with IBS may benefit from a low FODMAPs diet, however, the quality of scientific evidence is very low. Of these people, there is a possible benefit for overall symptoms such as abdominal pain, cramping, bloating, excess gas, constipation and/or diarrhea.
Download and print this resource to help you understand the FODMAP diet. Complete with easy to reference cheat sheets of common low FODMAP food options, as well as a list of foods to avoid, this resource is a great opportunity for those who are new to the diet to learn the basics.
This guide is meant to explain the basics only, and CDHF encourages any IBS patients who are thinking about attempting this elimination diet for themselves to do so under the guidance of a registered dietitian.
Understanding IBS-D Webinar
https://www.youtube.com/watch?v=Xioy3qi5G7U
IBS affects between 10 and 15 percent of people in the developed world, about one-third of whom have IBS with diarrhea as the primary symptom, commonly referred to IBS-D. In this empowering session, Dr. Steve Vanner reviewed the basics of IBS-D and answered the many questions of attendees.
Living Positively with IBS Animation
https://www.youtube.com/watch?v=T1dmbtesTjo
If you are one of the 5 million Canadians living with IBS, you know all about its not-so-pleasant symptoms. Understanding the syndrome is the first step to feeling better. There are proactive strategies you can take to relieve symptoms. Watch our IBS animation to learn about proactive strategies and treatment options that can help you get back to living your life, your way.
IBS, IBD & Mental Health Webinar
https://www.youtube.com/watch?v=RbeytaBjqi0
Did you know people living with GI disorders have higher rates of anxiety and depression compared to the general population and vice versa? These observations are summarized in a theory known as the “gut-brain axis”. IMAGINE’s lead investigator, Dr. Paul Moayyedi talks about this ground-breaking research, and how you can get involved in the studies taking place across Canada.
CDHF Talks: IBS and the Gut Microbiome
We are very excited to announce our new #CDHFTalks with Dr. Turbide, gastroenterologist at the University of Calgary – on a digestive condition that you may be familiar with - Irritable Bowel Syndrome, or IBS for short. IBS is a chronic pain disorder, that is very common within the Canadian Population.
In this series of videos, Dr. Turbide goes over all things IBS – what it is, the different types of IBS, if your microbiome can be a cause of your IBS, and tips on managing IBS. He also talks about all of the treatment options available - whether that be prescription medications, over-the-counter medications, or psycho-social interventions.
This is one you definitely don’t want to miss so have a watch here.
Watch the full version or skip to each section to find the answers you are looking for.
