IBS Toolkit for the Newly Diagnosed
If you have recently been diagnosed with Irritable Bowel Syndrome (IBS), you are likely asking yourself, what do I do now? CDHF has compiled some things to consider and learn about as you navigate your IBS diagnosis in this IBS toolkit for the newly diagnosed.
It’s important to note that there is no one-size-fits-all approach for managing IBS since every person with IBS will have their own unique experience with symptoms and triggers. We recommend working with your doctor or registered dietitian to find out what works best for you. However, there are various treatment options which can help reduce its effects so that you can live your life. We’ve outlined some evidence based strategies in our new resources below. Empowerment starts with information – so let’s get started!
Read the full toolkit for jump to the topic you are interested in:
- What is Irritable Bowel Syndrome and what are the Subtypes?
- Living with IBS (Symptoms, what causes IBS?)
- How do you manage IBS?
- Frequently Asked Questions (FAQs) on IBS
First things first – what is Irritable Bowel Syndrome (IBS)?
Irritable bowel syndrome (IBS) is considered a functional gut disorder. It involves problems with motility (movement of digested food through the intestines) and sensitivity (how the brain interprets signals from the intestinal nerves). This leads to abdominal pain, changes in bowel patterns and symptoms such as bloating, and gas.
In 2023, there is an evolving body of medical literature that describes a strong connection between the brain and the gut, and in turn the gut and the brain. The bi-directional connection and communication between the brain and the gut is the latest and most comprehensive description that explains IBS. In IBS, the brain perceives normal digestion as pain, and can then trigger changes in bowel habits.
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. It may comfort you to know that IBS is very common, so you’re not alone. In fact, Canada has one of the highest rates of IBS in the world, with an estimated 18% compared to 11% globally (Lovell et al. 2012)
CDHF recommends using the myIBS app to digitally journal your symptoms, poop, food, sleep, stress and more, to help you better understand and manage your IBS.
Subtypes of Irritable Bowel Syndrome (IBS)
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).
- IBS-U: this includes people who don’t fit into the subtypes above.
Irritable Bowel Syndrome with Constipation (IBS-C)
Naturally, the most prominent symptom of IBS-C is constipation. The changes in bowel function may include straining, infrequent stools, hard or lumpy stools, and a feeling that the bowel does not empty completely. 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. IBS-C is a distressing condition that can significantly affect the quality of life of those affected. Other symptoms may include abdominal pain and discomfort, as well as gas and bloating.
Irritable Bowel Syndrome with Diarrhea (IBS-D)
IBS-D is on the opposite end of the spectrum, with diarrhea and loose bowel movements being the primary symptom. Other symptoms include sudden urges to have bowel movements, abdominal pain and discomfort, gas, feeling unable to completely empty bowels, bloating, and passing mucus from the rectum.
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.
Irritable Bowel Syndrome with Mixed Diarrhea and Constipation (IBS-M)
IBS-M is even more complex than the other two subtypes due to the fact that it is a mix of both diarrhea and constipation as the main symptoms, in alternating bouts. As a result, the experience people have living with IBS-M can vary greatly from person to person. As with the other subtypes, additional symptoms include abdominal pain and cramping, bloating, gas, an urgent need to go to the bathroom, and a feeling that the bowels are not empty even after a bowel movement.
Living with IBS (Symptoms, What Causes IBS?)
Symptoms of IBS:
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
- Abnormal stool from
- Straining during a bowel movement
- 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.
What causes IBS?
While we don’t know exactly what causes IBS, research says that some risk factors increase their risk of developing IBS. These include:
- Family history of IBS
- Being female
- Getting a gastrointestinal virus
- Your environment
- Psychosocial factors
How do you fix IBS?
IBS is a complex condition with lots of different management strategies. What is effective for some may not work at all for others, and your doctor may have you try a few different options before finding the right treatment plan for you.
Treatment options include lifestyle and dietary changes such as stress management techniques, food intake, exercise, and improved sleep as well as physician prescribe changes such as medications, and cognitive behavioural therapy.
We review each of them briefly below.
Diet & IBS
Since they were created in 2008, The National Institute of Clinical Excellence (NICE) guidelines have been reviewed again and updated as new research emerges. Ultimately, they continue to be an excellent first line approach for patients prior to moving toward a stricter elimination, such as the low FODMAP diet. Instead of a phased dietary elimination, these guidelines focus on both diet and lifestyle factors that in general are simpler and more sustainable.
Diet and Nutrition Recommendations
The NICE guidelines recommend limiting components in foods that can be irritating to the gut, leading to changes in digestion. This means potentially limiting intake of the following types of foods/drinks:
- Caffeine – particularly in those with IBS-D (but can potentially help with motility in those with constipation)
- Carbonated drinks
- High fat foods
- Sorbitol and other sugar alcohols
Although this provides an excellent start point, individuals can have very different tolerance levels to these common triggers. Use the philosophy “cut back, not cut out” when attempting to change your diet with IBS. A full restriction of these food items may not be required. Instead, consider keeping a food journal and monitoring how you feel after intake of caffeine, fat, carbonated drinks, alcohol, etc.
In addition to the food items to limit, there are some other nutrition basics that can improve IBS symptoms. For instance, how much fluid you should drink each day – for most, it’s recommended to have at least 8 cups of water or other non-caffeinated drinks.
Fibre is also an important consideration. Not only should you consider how much to consume, but also which types are best for specific GI symptoms. In particular, with IBS, we generally try to limit insoluble fibre and increase foods high in soluble fibre, such as oats or psyllium husk. However, these recommendations can vary depending on the person. It’s best to review your fibre intake with a dietitian before making changes.
Lastly, a core ‘dietary basic’ that can really make a difference with IBS is how we eat – specifically slowing down, chewing our food, and eating regular meals and snacks. It’s best to avoid missing meals or having long gaps between eating times. Setting aside time to eat without distraction and noticing how your body feels can greatly reduce IBS symptoms.
The Low FODMAP Diet for IBS
At this time, the most well-recognized diet to support IBS is the low FODMAP diet. This is an elimination-style diet. The goal is to reduce intake of specific types of fermentable carbohydrates found in a variety of foods. The low FODMAP diet is implemented in 3 phases – the elimination phase, reintroduction phase, and maintenance phase.
While a restrictive diet like this may not be for everyone, many people do feel better. Studies estimate that about 50-75% of people with IBS may benefit from a low FODMAP diet. It has been shown to help with improvement in symptoms such as cramping, bloating, gas, constipation, abdominal pain, and diarrhea.1
It is important to be assessed by a doctor or gastroenterologist to first rule out other possible diagnoses such as celiac disease or inflammatory bowel disease. Learn more about the low FODMAP diet, and other diet options for IBS.
Stress Management for IBS
Stress is a major risk factor for IBS. Individuals with IBS may frequently report symptom flares during periods of higher stress. Common examples of life stressors include periods of transitions (death of loved ones, loss of employment, new employment, retirement), financial insecurity, illness of loved ones, aging of parents. Even positive life events such as birth of a new child and a new promotion may result in positive stress otherwise referred to as eustress. Stress can impact the structure and function of the brain; it can also result in the liberation of stress hormones, and other chemicals liberated through the nervous system to affect how the gut functions. Stress can alter the movement (motility) in the intestine by either speeding up the bowel transit or slowing it down, physically affect the contractions and movement of your gastrointestinal system, sometimes causing pain and other bowel symptoms such as diarrhea, constipation or both.
Quite a lot can be involved in a full stress management plan, and everything should be tailored to individual needs. Many stress management techniques can be added quite simply to your day-to-day life. Some include:
Even just 5-10 minutes of deep breathing per day can help you cope with stress. Taking a moment to focus on your breathing can help keep your mind from wandering to external stressful events or internal emotions. There are hundreds of breath practices that can positively impact the vagus nerve and its function. Belly breathing, alternate nostril breathing and breath watching practices are three popular breathing practices that can be readily learned through a beginner class for yoga, or even online through meditation and breathing applications. The LyfeMD application (www.lyfemd.com) is one such application that is available to use at no cost if you have IBS and live in Canada. Concentrating on your breathing and listening to your body helps you focus on doing something positive for your well-being.
Our minds are fascinating things. But oftentimes our minds wander – causing us to overthink and ruminate on situations that cause us stress. Mindfulness practices are those that help us to focus on being fully present in the moment we are currently in. Whenwe are truly focused on being present we are consciously not allowing our minds to wander to stressful situations and emotions.
Mindfulness might sound easy, but it can be tough as we need to train our brains to focus only on the present. The good news is that mindfulness practice is free and available to all of us. Being mindful can be as simple as sitting in a comfortable chair, closing your eyes and focusing on your breathing. But you can also practice mindfulness while doing physical activities like yoga and tai chi, or while following guided or non-guided meditation. Anything that helps us to focus on the present rather than letting our mind unconsciously wander to the past or future allows is to enjoy the gift of the present moment.
Choose the mindfulness technique, or techniques, that work best for you that fit into your lifestyle. Remember that mindfulness takes practice, and its normal to find your mind wandering back to stressful thoughts even while practicing mindfulness. When you notice your mind drifting to other thoughts, try to consciously return your thoughts to your breathing and focus on being present in the moment. Try the mindfulness practices in the LyfeMD application for IBS.
Increased Exercise for IBS
There is strong evidence to suggest that increasing low-to-moderate exercise can decrease the severity of symptoms in people with IBS.
The most important aspect is not necessarily the intensity of the exercise, but the consistency. Try adding an exercise that you enjoy and that you can be consistent with. Try to aim for 20-30 minutes 3 times per week and increase the number of days you exercise as your body adjusts to the increased movement. Jumping into a new activity too quickly may increase risk of injury and can also be difficult to commit to with busy lifestyles.
Try adding low intensity exercises on a regular basis to help reduce IBS symptoms. Some exercise options are:
- Low impact aerobics
- Resistance training
To help keep your exercise consistent try to set aside time in your day-to-day routine for exercise. Also, it can help to encourage friends or family members to exercise with you.
Before starting an increased exercise plan it is recommended that you speak with your health care provider to understand any associated risks you may have by increasing your exercise levels. If you have physical limitations that impact your ability to do certain types of exercise, work with a trainer or physiotherapist who can tailor a plan to your needs.
While increasing your exercise be sure to keep track of your exercise and the symptoms you experience daily in the app. This will help you understand the impact that the increased exercise is having on your symptom management.
Many studies have been conducted to understand the relationship between increased low-to-moderate exercise and reduced symptoms of IBS. While researchers are still researching the relationship between exercise and IBS, it is believed to be likely related to the following factors:
- Stress relief: exercise has a positive effect on stress levels.
- Better sleep: increasing your physical activity can improve your sleep.
- Improve gas release: physical activity may improve your body’s ability to get rid of gas which could help alleviate symptoms of bloating and abdominal pain.
- Promote bowel movements: exercise can also promote bowel movements by increasing the action of the smooth muscles in the gut, which can help symptoms.
- Overall well-being: people who exercise regularly are more likely to have healthier overall habits. Healthier habits could help minimize IBS symptoms.
While increasing exercise can work wonders in reducing IBS symptoms, it can take some time before you may notice the benefits. Don’t think of this as a short-term habit change but rather the first step towards a long-term plan to move more. It will also vary greatly from person to person, depending on the severity of their IBS, how active they were prior to starting to increase exercise, how consistently they exercise, and other factors.
The most important thing is just to be consistent and make exercise a part of your daily routine.
Safely increasing physical activity may be one of the best things you can do for your health. Not only can it help with your IBS symptoms, but it may also reduce your risk of chronic disease, improve your balance and coordination, reduce stress, and help you maintain a healthy weight.
Sleep is so important for overall health and wellbeing in all people, but especially in those with IBS. Getting a quality sleep on a regular basis can help improve your IBS symptoms.
A concerning aspect of sleep and IBS is that IBS symptoms can often be the cause of sleep disturbances, such as struggling to fall asleep due to abdominal pain. This can turn into a vicious cycle of poor sleep which in turn leads to worsening IBS symptoms. In fact, sleep disturbances are one of the most common non-intestinal complaints of people with IBS.
It’s important to discuss your sleep problems with your healthcare provider to ensure that there are no other underlying concerns causing poor sleep.
Practicing good sleep hygiene is an important part of this treatment plan to improve your overall quality of sleep. Read through and practice the recommendations in the Tips for Healthy Sleep section.
Also, while on this treatment plan be sure to record your sleep times and quality measures daily as well as your IBS symptoms. Over time you may be able to see a relationship between your sleep quality and duration to your IBS symptoms.
It has been shown that quality sleep can improve the symptoms of IBS, but unfortunately, the symptoms of IBS often cause a poor sleep! In fact, 30-70% of people with IBS report having problems sleeping.
People with IBS were more likely to report poor sleep, and woke more frequently during the night.
Sleep apnea is a sleep disorder that affects roughly 20% of the population. Common symptoms of sleep apnea are snoring, temporary episodes of not breathing during sleep, and waking with a dry mouth. Research has found that people with sleep apnea are more likely to have IBS than those without sleep apnea.
Determine your sleep needs:
We’ve all heard that we should get 8 hours of sleep per night, but this is an average and may not be a perfect fit for you. Some people may need more sleep than others, and our needs actually change as we grow older. Generally, the younger we are the more sleep we need. From infants who need 12-16 hours of sleep a day all the way to adults who need between 7-9 hours of sleep.
When we don’t get enough sleep, we accumulate sleep debt that we usually need to ‘pay off’. This may involve extra sleep by napping, going to bed early, or sleeping in to catch up.
To determine how much sleep you personally need follow these steps:
- Set aside a week or two that you can focus on your sleep and not allow disruptions or changes to your sleep schedule.
- Select a typical bedtime and stick with it each night.
- Allow yourself to sleep as long as you want, awakening without an alarm clock in the morning.
- After a few days, you will have paid off your sleep debt, and you will begin to approach the average amount of sleep that you need.
- Once you have determined your perfect sleep duration try to set a bedtime each night that will allow you to get the proper duration of sleep while still waking in time to start your day.
Getting a more successful sleep will likely have a fairly immediate effect on reducing IBS symptoms. Plus, improved sleep will have the benefit of improving your overall performance, mood, and well-being.
Follow the tips for healthy sleep to uncover exactly the perfect amount of sleep you need each night, reduce any existing sleep debt, and try to treat yourself to a great night’s sleep each night.
The more consistent your sleep schedule, the more benefits you should see. As with most treatment options, consistency is key.
Cognitive Behavioural Therapy for IBS
Research shows Cognitive Behavioural Therapy (CBT) to be effective in improving bowel symptoms, psychological distress, and quality of life in people with IBS. CBT as a treatment is based on a shorter-term and collaborative model. A course of treatment is approximately between 12-15 sessions, but this is dependent on the treatment goals you and your therapist agree to.
CBT is based on the relationship between our cognitions (thoughts), behaviours and emotions. Unhelpful thoughts negatively impact how we feel and these difficult feelings impact how we behave, and the feedback loop continues from there. Unfortunately, we can’t directly control our emotions. If you have ever received the advice “Just don’t worry about it!” then you know the difficulty of trying to just turn off a feeling. We do have control over our thoughts and behaviours. Clients work with their therapist to learn to become aware of ineffective thought and behaviour patterns, and learn strategies that help modify these in order to positively influence their emotional state.
Medications & IBS
The contributing factors to the development of IBS are quite complex and include alterations in the bottom up signalling pathways from the gut to the brain. In addition, top down signaling pathways from the brain to the gut are intimately involved in the development of IBS. Given the onset of IBS is attributed to a myriad of factors, there is no one medication that is universally effective for all people with IBS. Therefore, many IBS medical therapies are frequently directed toward the management of symptoms, rather than the root cause of the problem, because the root cause may vary among IBS patients. Medications are likely to have a modest effect, but when used together with diet and behavioural therapies, the effectiveness may be substantially greater.
Types of prescription medication for IBS
There are a few different types of medication. These include:
- Anti-spasmodics to helpdecrease the spasming of muscles in the intestinal tract
- Anti-depressants to help
- Neurotransmitter-active compounds are another option. Neurotransmitters pass information from various parts of the body, including the gut, to the brain and vice versa. By damping down the transmission of nerve impulses, neurotransmitter-active compounds affect the contraction of intestinal muscles, which is useful in treating diarrhea.
- Chloride channel activators can be used to treat IBS-related constipation. The activation of chloride channels in the intestine stimulates the flow of intestinal fluids, which can help move food through.
- The balance of bacteria in the gut may be altered in IBS. A minimally absorbed gastrointestinal targeted or selective antibiotic can be used to treat diarrhea predominant IBS, and acts to influence the gut bacterial imbalances (dysbiosis) and help the gut microbiome. Use of this type of antibiotic does not mean you have an active infection. Selective antibiotics such as this may not only be effective but are associated with fewer side effects as they do not have action outside of the gut.
Types of non-prescription medications and/or supplements for IBS
There are a few different types of non-prescription medications that are available for the treatment of IBS:
- Fibre supplements – these have been very well studied, and are effective for all IBS sub-types. Various fibre supplements have been studied, with variable support. However, psyllium fibre supplements are easily available, reasonably well tolerated and effective to treat both diarrhea and constipation. When starting a fibre supplement, it is important to start at a low dose, even half of what is recommended on the product label, and then increase the dose gradually over time to the recommended dose. In a sub-group of patients, fibre supplements may not be well tolerated, and if this is the case, it may be related to the types of bacteria in the gut, and their inability to metabolize fibre. If fibre is not tolerated, it can be discontinued and another treatment option pursued.
- Peppermint Oil – there is a growing body of evidence for the effectiveness of peppermint oil in IBS treatment. Several studies have demonstrated effect for peppermint oil for overall IBS symptoms, and specifically for abdominal pain and quality of life. It is thought to work by decreasing gut related spasms and therefore decrease cramps. However, some studies have demonstrated that peppermint oil, while effective, may not be any more effective than a placebo treatment. Consult with your doctor to determine the best time in your disease course for peppermint oil trial.
- Probiotics – several clinical studies have been completed with various probiotics, different doses and for varying durations. Overall there appears to be a positive signal for the benefit of probiotics compared to placebo, but it is very difficult to make conclusive recommendations as to the most effective probiotic. Probiotics containing Bifidobacteria, and Lactobacillus are among the most promising agents. Talk to your doctor, or registered dietitian about the right probiotic for you.
- Laxatives – When constipation does not respond to dietary changes, laxatives may be used as first line treatment options. Non-stimulant laxatives that work by drawing water in the bowel are the well tolerated and effective. Talk to your doctor about the best option for you.
When starting any new medication, it is important to stay in communication with your doctor the entire time. Be sure to inform your doctor of any side effects you may experience, even if they are minor.
Be sure to follow the dosage advice accurately and consistently and consult with your doctor or pharmacist if you have any questions. Learn more about medications and supplements for IBS.
Dysbiosis and IBS
Whether triggered by infection or some other factor, a disrupted gut microbiota is a key factor in IBS. Dysbiosis is shorthand for a gut microbiota that looks different compared to that of healthy individuals—and this difference can pertain to the names of the microbes present, or the functions they are able to provide. Nearly always, the dysbiotic gut community is less diverse.
What complicates the picture is that there is no single configuration of dysbiosis. Everyone with IBS may have a slightly different version of a disrupted gut microbiota. But what all types of dysbiosis have in common is that the gut microbiota is not able to keep the immune system in check, increasing the likelihood that an individual will experience gastrointestinal symptoms.
Dysbiosis isn’t the only factor in IBS: genes, patterns of gut motility and sensation, brain-gut communication, and response to stress all contribute to the emergence of symptoms. But possibly dysbiosis is what locks the immune system into a dysfunctional pattern that keeps the symptoms from going away.
Dealing with Dysbiosis
Can dysbiosis in IBS be fixed? While lasting changes to the gut microbiota are very difficult to achieve, studies show that interventions targeting the gut microbial community in different ways can successfully reduce symptoms. These interventions are not as simple as reducing ‘bad’ microbes and increasing ‘good’ microbes, but instead they put pressure on the microbial ecosystem in different ways to restore the functions it’s supposed to provide.
Frequently Asked Questions
How is IBS different then 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.
Can IBS kill you?
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?
A: 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.
What is the relationship between the gut microbiome and IBS?
A: When the trillions of bacteria that live in your intestines are disrupted (the gut microbiome), this appears to contribute to symptoms of IBS, potentially disrupting how our immune system reacts to food, how we digest food, how our gut and brain communicate, and so much more. While the research is in its infancy, scientists have found that therapeutics or diet targeting the gut microbiome may be a way to manage IBS in the future.
Looking for more information on treatment options for IBS? Check out more resources:
CDHF’s myIBS App
MyIBS is our FREE and easy-to-use tracking app for Irritable Bowel Syndrome (IBS). Journal your symptoms, poop, food, sleep, stress and more with this flexible tool that helps you better understand and manage your IBS. Download it today on the App Store, or on Google Play!
LyfeMD empowers people to take control of their wellness through an easy-to-use application. The LyfeMD app provides personalized health coaching to those with chronic digestive and inflammatory diseases. Learn more about the LyfeMD App today!