Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS)

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome, commonly known as IBS (as we will refer to it for the sake of easy reading in this article) but also occasionally referred to as irritable colon, spastic colitis, spastic colon and mucous colitis, is something many people experience. A syndrome is known as a collection of conditions or symptoms that occur simultaneously. In this case, the syndrome is a gut disorder forming a chronic condition affecting the gastrointestinal tract, mostly the large colon (intestine).

It is estimated that approximately 11% of the global population suffers from IBS, with prevalence noted in developed, westernised countries.

The majority of the global IBS demographic are women. Typically, between the ages of 16 and 40, IBS sufferers also tend to have a family history of IBS.

IBS is a very uncomfortable and painful condition, and although it is not life-threatening, it can take a major toll on your life, often forcing you to change your habits due to unpredictable bowel movements and discomfort. Pain occurs predominantly in the abdominal region (large intestine), this leads to a change in your bowel movements, with either diarrhoea or constipation being major symptoms. Your stool may also change in size and colour.

As common as the condition is, doctors are still unsure as to what the exact cause of what irritable bowel syndrome is. But it is important to note that this condition is not in any way related to inflammatory bowel disease or any other bowel conditions. It also is not able to increase your risk of gastrointestinal cancers. This is not to say it does not have an impact on your life. If the bloating, gas, diarrhoea and constipation aren’t enough to send you to your doctor, then the abdominal pain certainly may be, still, it is estimated that less than half of IBS sufferers seek medical diagnosis and attention.

In some cases, a change of diet and lifestyle are able to treat IBS, but it is advised that should you feel as though you may have the condition, you seek medical attention to help prevent the syndrome or combat it.

People experience the condition differently, and while symptoms are often the same or similar, the extent of pain experienced may vary. IBS is something that needs to be managed as it is often a long-term health issue. It does not, however, cause any problems or issues in the bowel tissue, unlike Crohn’s disease or ulcerative colitis.

The following article explores all you need to know about IBS, its symptoms, risks, complications and more. Please note that this information is not intended to serve as a medical or professional opinion, but rather a guideline. Should you seek professional advice, we advise that you speak to your doctor.

What are the symptoms of IBS?

Being a chronic condition, people with IBS complain of abdominal pain and some or all of the symptoms mentioned below for about three days of the month. However, these symptoms tend to go away once one has had a bowel movement. Alternating bouts of diarrhoea and constipation may be experienced or the sensation of having these together, that is having diarrhoea but also feeling like you have not entirely evacuated your bowl. These symptoms can be continuous or disappear only to reappear later.

The most common symptoms can include:

  • Bloating
  • Stool with mucus
  • Gas
  • Abdominal pain
  • Diarrhoea
  • Constipation

Some more severe symptoms can include:

  • Abdominal pain that continues and worsens through the night
  • Bleeding of the rectum (this should always be investigated by a doctor as it may be an indication of haemorrhoids or a more serious bowel issue).
  • Chronic diarrhoea
  • Weight loss

Symptoms between men and women tend to vary. The following depicts how the different sexes experience IBS:

IBS in men

Men are less susceptible to developing IBS. They also tend to not report their cases to their doctors, this results in a lack of concrete data.

Some doctors believe that due to men having different hormones than women, their gut is often not as sensitive to a woman’s. Another conclusion is that men simply do not like seeking help for their medical conditions unless they are life-threatening.

Lifestyle changes due to irritable bowel syndrome:

  • Men may experience a loss in their sexual desires and intimacy.
  • Men may find it difficult to work or perform daily chores due to IBS related discomfort and pain.
  • Depression is also known to me a symptom of the condition in men.

IBS in women

Doctors have found that women tend to be diagnosed with IBS during their childbearing years. These women are also more likely to report gynaecological disorders.

Common symptoms in women with IBS include:

  • Insomnia
  • Sensitivity to certain foods
  • Backache
  • Cramps
  • PMS (premenstrual syndrome)
  • Fatigue
  • Menstruation that is painful

IBS may also lead to:

Lifestyle changes

Women with IBS often have to run to the toilet frequently for bowel movements. This makes it difficult to function and perform properly at work and social events. This may also result in isolation and in turn, depression.

Varied symptoms according to the menstrual cycle Women with IBS tend to report that their symptoms are often varied according to the stages of their menstrual cycle. On the 14th day of their cycle (which often lines up with ovulation in a woman with regular periods), they tend to feel bloated and constipated. In the week before their menstrual cycle, they often have large amounts of abdominal pain as well as diarrhoea.

Difficulties in romantic relationships

Women tend to experience a loss of sexual desire if they have IBS. This is often due to them feeling pain or discomfort during sexual intercourse.

Endometriosis

This condition occurs when the tissue that is typically found in the inner lining of the uterus grows outside it. This often results in fertility issues or infertility in women. Research has shown that women who suffer from this condition are more susceptible to experiencing IBS symptoms.

Pregnancy

Symptoms of nausea, heartburn, constipation, and bowel movements are increased when women are pregnant. Researchers are trying to establish what the link between pregnancy and IBS is, seeing as many of the symptoms seem to overlap. Some doctors believe that these symptoms are the result of the force of pressure from the foetus pressing on the mother’s internal organs, but this is yet to be proven.

When to see a doctor

Less than one in five people with IBS seek out medical attention. It is vital to consult with your doctor should you find the symptoms of IBS to be chronic (persistent). Sometimes these symptoms, if experienced more severely, can be the result of colon cancer (not linked to IBS). Hence the importance of seeking medical attention to rule this out.

If cancer or more serious conditions have been ruled out, IBS is often the diagnosis. Your doctor may be able to lessen the pain you are experiencing and possibly prevent chronic diarrhoea and other more severe issues that can develop from IBS.  

What are the different types of IBS?

Being a chronic condition, the symptoms of IBS tend to flare up intermittently. The Rome Foundation, an organisation that defines, researches and classifies functional conditions and gastrointestinal disorders such as IBS, has managed to divide the condition into four different subtypes. These are defined by the consistency of the stool during an IBS flare-up.

If you are able to determine the subtype of IBS that you have, it will make it easier for your doctor to pinpoint what the possible triggers are for you and this will help him/her to prescribe effective medication. In addition to medication, you will also be able to:

  • Enforce dietary changes needed by detecting which foods are creating an IBS reaction.
  • Avoid situations that invoke stress as this may cause your gut to react negatively.
  • Take prescribed medication to aid in diarrhoea and laxatives for constipation.

The following are the four subtypes of IBS that have been identified:

  • Constipation with IBS I known as IBS – C (the ‘C’ stands for constipation).
  • The same thinking is applied for diarrhoea with IBS, which is known as IBS – D.
  • When people have a pattern of diarrhoea and constipation that is alternating, this is known as IBS – M (mixed IBS).
  • If someone does not fit into this pattern, they are often diagnosed with IBS – U, this is unsubtyped IBS.

The types are further explained as follows:

IBS - C: Constipation with IBS

This type of IBS often results in painful and hard stools over 25% of the period of the IBS flare-up. It is also possible for people to experience watery stools and diarrhoea for 25% or less of the time. However, the identifying factor is the predominant constipation.

Your doctor is likely to conduct imaging tests in order to detect rule out any anatomical abnormalities (abnormal structures that are in an odd location or have an inconsistent or strange shape) in the gut.

You will be advised to include more fibre in your diet as well as whole grains in order to help your stools to soften and allow them to pass with ease.   If necessary, a bulking agent may be prescribed to aid this process.

Your symptoms may include:
  • Dry, small and hard stools associated with constipation.
  • Pain in your abdominal region, this often includes sharp stabbing sensations and cramping.
  • Constantly feeling like you need to go to the toilet.
  • Feeling bloated and gassy, particularly after certain foods.
  • Mucus in your stool.
  • Internal haemorrhoids may result due to having to strain during a bowel movement and this may result in anal bleeding when you go to the toilet.

Your doctor is likely to provide you with laxatives to help relieve your constipation, he/she may prescribe something with more strength than over-the-counter drugs such as Lubiprostone (Amitiza) – this helps to treat chronic constipation.

IBS – C can be a very uncomfortable condition. If you feel as though you may have it, do not try to diagnose yourself. Rather make an appointment to see your doctor. The symptoms of IBS are very similar to symptoms of other conditions, it is dangerous to confuse them and misdiagnose yourself. Many women experiencing this tend to think they are having their periods and write off the condition. Always seek professional advice when you are unsure or you feel as though your symptoms may be more serious.

IBS - D: Diarrhoea with IBS

With this type of IBS, people experience loose, watery stools associated with diarrhoea for more than 25% of their IBS flare-up. Constipation is not typically experienced with this type of IBS.

Your doctor will probably suggest that you eat smaller meals more frequently, as well as avoid certain foods that may trigger the diarrhoea. Spicy foods, dairy and artificial sweeteners should be avoided.  

Your symptoms may include:
  • Abdominal pain
  • Bloating
  • Suddenly needing to go the toilet
  • Having no bowel control
  • Gas
  • Loose, watery stools

Stress and other psychological traumas are often triggers for diarrhoea. Wheat, dairy, red wine and caffeine have also been known to trigger it. IBS – D can be a very embarrassing and uncomfortable condition. Your doctor will most likely prescribe antidiarrheal medications (mentioned later in this article). However, we will also discuss certain lifestyle factors that can be taken into consideration and changed in order to prevent or lessen the symptoms of IBS – D.

IBS - M: Mixed type IBS

A few people with IBS do not definitively experience one of the above-mentioned types. If a sufferer experiences alternating bouts of constipation and diarrhoea, they will fall into this category. This means diarrhoea and constipation are experienced during the same flare-up. In this case, triggers will need to be identified in order to balance treatments. Dietary changes, avoiding stressful situations, and being prescribed anti-diarrheal medications as well as laxatives will help ease the symptoms of abdominal pain, gas and bloating, as well as diarrhoea and constipation. 

Unsubtyped IBS

This type of IBS is known to include the following symptoms:

  • Gas
  • Cramping
  • Bloating
  • Mucus in the stool
  • Abdominal pain and discomfort

What makes this type of IBS different is that people who fall into this category are not likely to experience irregularities in their stool.

What are the causes of IBS?

As mentioned, doctors are still uncertain as to what the exact cause of IBS is. Granted food allergies and stressful situations are known to trigger the symptoms of IBS, however, the root cause of the condition is still unknown. It is estimated that at least 10 to 15% of people experience IBS in their lifetime.

The following issues that result in a flare-up of IBS have been identified, however, triggers often vary depending on the person:

Gastrointestinal motor issues

As the colon is compromised, digestion may slow down causing constipation or increase causing diarrhoea.

Mental health issues

Stress is often a factor that aggravates certain physical issues - IBS being one of them. Depression and panic attacks also seem to be linked to IBS. It is still unknown as to whether mental health issues have a direct link to physical ailments or just exacerbate them. 

Brain to gut signal issues

The messages relayed to the intestines from the brain can sometimes not be received correctly, this causes the intestines to not work properly when digesting food.

Genetics

It is also a plausible theory that IBS is genetic and can run in the family. This can be due to genetics or similarly experienced environmental factors – this is still unclear though.

Hypersensitivity

Cramping and bloating may be extremely painful for someone with a low pain threshold. Therefore, someone who does not handle pain very well may experience symptoms more frequently than others who might not recognise them as much.

Bacterial gastroenteritis

If you have a bacterial infection in your intestines, this is known to lead to the symptoms of IBS.

Bacterial changes in the small intestine

If the bacteria vital for the digestive processes in the small intestine changes, this has known to result in symptoms of gas (flatulence) as well as diarrhoea.

Hormones

Women are known to have more severe IBS symptoms when they are having their period. This had led some doctors to believe that there may be a link between the hormones responsible for reproduction and problems in the bowel. This is evidence-supported as women tend to experience fewer symptoms of IBS when they have gone through menopause.

Food sensitivity

Certain foods are some of the most well-known triggers for IBS. People often find that after eating a specific food, the symptoms of IBS tend to flare up again.  

Problem foods can include:

  • Alcohol
  • Coffee
  • Dairy
  • Fatty foods
  • Carbohydrates
  • Spicy foods

The theory is that the intestines struggle to absorb specific components of the above foods. This results in bloating, abdominal pain, diarrhoea, constipation and more.

What are the risk factors for IBS?

A lot of people are likely to experience occasional symptoms of IBS, however, your chances of developing the condition are greatly increased if:

  • You have any kind of mental issues such as depression, anxiety, personality disorders or have a history of abuse. For many women, domestic abuse is a risk factor too as negative emotions often elicit a gut response.
  • You have a family member who has had IBS. This may be related to your family genes or the shared environmental factors of your family.
  • You are under the age of 45 as these are the most prominent years of the condition.
  • You are a female, as IBS is seen in more women than men.

What are the complications for IBS?

Constipation and diarrhoea are both symptoms of IBS and are known to aggravate haemorrhoids. If you are also avoiding certain foods, then you may not be getting enough of the right nutrition that your body needs. This is known to lead to malnutrition.

It is important to be aware that the most significant complication associated with IBS is that your lifestyle is probably going to take a turn for the worst. Your life will significantly change as you may have to avoid certain activities such as outdoor excursions (as you may need to have a bathroom always near), seeing family and friends due to feeling uncomfortable from the pain or experiencing diarrhoea and constipation.

You may also feel uncomfortable in your body due to bloating and face a loss of confidence. This can result in depression, which is often a serious condition if not diagnosed, treated and dealt with.

How is IBS diagnosed?

In order to diagnose IBS, your doctor will need to know your medical history as well as your family’s and also assess you through a physical examination.

The following explains the diagnosis process in detail:

Criteria needed to make an accurate diagnosis

Due to the fact that there are no accurate physical symptoms of IBS that allow for a definite diagnosis (diarrhoea, constipation and abdominal discomfort can often be standalone conditions or associated with other diseases), the diagnosis often involves the process of ruling out other conditions.

To aid in this process, doctors and researchers have created a method that consists of two steps or rather, two sets of criteria in order to diagnose IBS and other gastrointestinal disorders, known as functional gastrointestinal conditions in which the bowel does not function normally.

These criteria are both based on the symptoms the patient is experiencing, after all other conditions have been ruled out. The criteria are as follows:

  • Manning criteria – This set of criteria focuses on the pain and experience of bowel movements that are incomplete, changes in the consistency of the stool, having a stool with mucus in it, as well as the pain that is relieved through defecation. The more of these symptoms that are present, the higher the likelihood of the diagnosis being IBS.
  • Rome criteria – This set of criteria determines specific symptoms and signs that must be present before the diagnosis of IBS is possible. The important signs are discomfort or abdominal pain that lasts for a minimum of three days of the month, experienced over the most recent three months. This must be associated with at least two of the following:
    • Improvement of discomfort or pain through defecation
    • Inconsistency of stool

Your doctor will assess how well you fit with the above criteria and will also look into any other signs or symptoms that may lean towards a more severe condition. There are a few red flag symptoms and signs that may require additional testing to be conducted.

These red flags are:

  • Weight loss
  • Bleeding of the rectum or blood in the stool.
  • Fever
  • Experiencing abdominal pain that does not subside through a bowel movement or if it occurs at night.
  • Chronic diarrhoea, especially if it keeps you awake at night.
  • Anaemia that is linked to an iron deficiency.

If however, you fit the criteria for IBS (being the Manning and Rome criteria mentioned above), then your doctor may recommend that you begin a treatment course without the need for more tests. If you do not respond to the suggested treatment, your doctor will then conduct additional testing.

Additional tests

These often include a number of tests such as stool studies to examine the stool for infection or possible issues of the ability of the intestine to absorb nutrients from your food, this is known as malabsorption. Additional tests may involve undergoing several tests to rule out any other causes resulting in your symptoms. These usually involve laboratory tests - which typically include routine tests to monitor your health for conditions and diseases and determine treatment, and imaging tests – these let doctors take a look inside your body through monitoring and examining the forms of energy patterns created by the body tissues that create an image for doctors to examine (e.g. an X-ray).

These are explained accordingly:

Lab tests:

  • Blood tests – IBS symptoms are similar to those of celiac disease which is a food sensitivity to rye, barley and wheat. Blood tests are conducted in order to rule this disorder out. It is vital to note that if children have IBS, their chances of developing celiac disease is far greater than children who do not have IBS. An upper endoscopy is often performed should your doctor suspect your diagnosis is celiac disease. This procedure is done to obtain a biopsy (wherein tissue is removed in order to examine the body for disease) from the small intestine.
  • Tests for lactose intolerance – The enzyme that is needed in order to digest and absorb the sugar found in dairy products is known as lactase. If this enzyme is not produced by your body, you may experience problems similar to those that are caused by IBS. These include gas, diarrhoea and abdominal pain. To determine if lactose intolerance is the cause of the above symptoms, a breath test may be conducted by your doctor, he/she may also recommend that you remove all dairy products from your diet for a few weeks in order to find out if you are experiencing a lactose intolerance or possibly IBS. If the symptoms go away after avoiding dairy products, the diagnosis is lactose intolerance, otherwise, further testing is done to possibly diagnose IBS.
  • Breath tests – A breath test is performed in order to look for bacterial overgrowth. This is done by asking the patient to swallow a pill containing urea that is marked with a rare carbon isotope.  After half an hour or so the patient will exhale into a collection card for a few minutes, which will then be tested for the presence of H.Pylori bacteria. Bacterial overgrowth occurs when this bacteria infects the colon moves up and grows in the small intestine, this leads to the sufferer being bloated, experiencing abdominal pain or discomfort and diarrhoea. This tends to be a common condition in those have undergone bowel surgery, have a disease that results in the digestion process slowing down or those suffering from diabetes.

    There are 3 types of breath tests:
    • Hydrogen breath test (HBT) - Measures both the methane and hydrogen production of the digestive system. It does this in order to evaluate if there is a malabsorption of carbohydrates (dietary sugars). Secondly, the test determines if there is bacterial overgrowth in the small intestine that may be causing the abdominal pain. 
    • Bile acid breath test - The bile acids in the liver help digest the fats, also known as lipids found in the small intestine. If bacterial overgrowth is present, this process is affected. This kind of breath test makes use of a bile salt that has a radioactive tracer attached in order to assess if there is a bile salt dysfunction present. 
    • Xylose breath test - This is a highly specific and extremely sensitive test that tests the bacterial overgrowth in the small intestine. 
  • Stool tests – The stool is often examined for parasites and bacteria if you are experiencing diarrhoea.

Imaging tests:

  • Radiography (X-ray) – X-rays, which are digital images produced through beams that are absorbed by different bodily tissue, are often used to obtain an image of the colon in order to detect any issues or areas of concern.
  • Lower gastrointestinal (GI) series – This is a test where your doctor fills the large intestine through the rectum with barium (a liquid) that makes it easier to detect any issues in the human colon (large intestine) in an X-ray.
  • CT (computerised tomography) scan – These scans create X-ray images of the internal organs that are cross-sectional (taken from different angles). When CT scans are conducted of the pelvis and abdomen, this helps your doctor to rule out any other conditions that may be the cause of the symptoms experienced, particularly if abdominal pain is one of them.
  • Colonoscopy – If you are suffering from chronic (ongoing) abdominal pain or are over the age of 50 and experience symptoms that may be the result of a severe condition, your doctor is likely to perform a colonoscopy which is a diagnostic test that uses a small, flexible tube inserted via the anus in order to examine the entire length of the colon and its lining. This procedure is able to find ulcers, bleeding, tumours and more.

Colonoscopy

  • Flexible sigmoidoscopy – This procedure allows for your doctor to take a closer look at your sigmoid (lower colon) and rectum. The lighted, flexible tube-like instrument, known as a sigmoidoscope is inserted into the rectum in a gentle fashion and then passed into the lower colon.

What is the treatment for IBS?

Due to the cause of IBS being unknown, treatment, therefore, focuses on relieving the symptoms in order to improve your lifestyle and ensure that your daily life can still be functional. In the majority of cases, the symptoms can be controlled through coping with stress and making the right changes in your lifestyle and diet. It is advised that you avoid the foods that tend to trigger symptoms of IBS, stick to a healthy exercise regime, drink the recommend amount of water (about two litres / half a gallon) a day and getting enough sleep (seven to eight hours a night).

Depending on the severity of your symptoms, treatment may need to include more than lifestyle changes, you may also be given certain medications.

The treatment for IBS can be explained as follows: 

Medication:

  • Anti-diarrheal – There are a number of over-the-counter medication that can be used to treat diarrhoea. These include Loperamide (marketed as Imodium) – a well-known treatment for diarrhoea. Other medications that can be beneficial are known as bile acid binders, these include Prevalite, Colestid and Welchol. Please note that these often lead to being bloated – which can be very uncomfortable for most people.
  • Fibre supplements – Psyllium or methylcellulose is a great fibre supplement which aids in the relief of constipation. When fibre is obtained through food, this may result in bloating whereas when it is obtained through supplements, it often results in far less bloating. If fibre supplements are not a strong enough treatment to improve bowel movements, you may be prescribed osmotic laxatives. These include polyethylene glycol or milk of magnesia.
  • Antidepressants – If you are experiencing severe amounts of pain which can lead to depression (amongst other things), your doctor is likely to prescribe a SSRI (selective serotonin reuptake inhibitor) or a tricyclic antidepressant. These are known to aid in relieving the symptoms of depression and also inhibit the neuron activity that has control over the intestines.
    • If you experience abdominal pain and diarrhoea and do not develop depression, your doctor might recommend a lower dosage of tricyclic antidepressants. These include Pamelor (nortriptyline), Elaval or Trepiline (amitriptyline) or Tofranil (imipramine). However, the side effects can include constipation and drowsiness, amongst others. Prozac or Sarafem (SSRIs) are often helpful if you experience depression as well as constipation and pain.
  • Antispasmodic and anticholinergic medications – Levsin (hyoscyamine) and Bentyl (dicyclomine) are medications that aid in relieving the symptoms of bowel spasms that are painful. They can also be used for those with flare-ups of diarrhoea, however, they are known to worsen symptoms of constipation and often lead to a number of other symptoms, such as experiencing a difficulty when urinating. If you have glaucoma, these medications should be administered with caution.
  • Counselling – This may be beneficial if you are stressed or depressed, which are known to make your symptoms worse.
  • Antibiotics – The overgrowth of bacteria is often treated with antibiotics. Your doctor may suggest that you supplement these with probiotics to help preserve the ‘good’ intestinal flora.

IBS specific medication

There are two medications that have been approved for IBS specifically:

  • Lubiprostone (Amitiza) – This works through increasing your secretion of fluid in the small intestine in order to aid in the passing of stools. This has been approved for women over the age of 18 that are suffering from IBS -C (IBS and constipation). The effectiveness and result in men has not yet been proven. The common side effects of this drug include diarrhoea, nausea and abdominal pain. It is normally prescribed to women who have severe constipation with IBS when other treatments have had no effect.
  • Alosetron (Lotronex) – This was created to aid in relaxing the colon in order to slow down the lower bowel movement of waste. This can only be prescribed for those with severe diarrhoea. Like Lubiprostone, it is only approved for use in women and should only be prescribed when all other options have been exhausted.

There are also a number of dietary changes that can be made over and above medications. These include the following:

  • Cutting out gluten – If you experience symptoms of diarrhoea with IBS, by stopping eating rye, wheat and barley (gluten foods), research has shown that symptoms can significantly improve.
  • Cutting out fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) – This may sound made up, however, these are foods that invoke a reaction or sensitivity to certain types of carbohydrates such as lactose, fructans, and fructose – these are what are known as FODMAPs. These are typically found in certain vegetables, grains, dairy products and fruits. People do not normally react to every kind of FODMAP food. But symptom relief is often found through lowering your intake of these foods and then slowing reintroducing them.
  • Cutting out foods with high-gas content – If you find that you are often bloated and seem to pass a large amount of gas, then your doctor may recommend that you eliminate fizzy drinks, and some vegetables such as cauliflower, cabbage and broccoli, as well as raw fruits.

What are the home remedies for IBS?

In the majority of IBS cases, lifestyle and dietary changes are known to provide significant relief. These improvements are not always immediate but are often long-term solutions, whereas medication can often be temporary.

These changes include:

  • Fibre experimentation – If you have IBS, fibre is known to be a blessing that is often mixed. It can help in the relief of constipation, however, it often makes bloating, cramping and gas worse. It is advised that slowly increasing your fibre intake over a certain number of weeks can help your body to react in a more comfortable way. Bean, vegetables, fruit and whole grains are known as high-fibre foods. It may be best to speak to a dietician for guidance in doing this in a healthy manner.
    If you take fibre supplements, try to drink plenty of water in order to reduce constipation, bloating and gas.
  • Avoid trigger foods – If you know of certain foods that tend to worsen your symptoms of IBS, it is best to avoid them completely. These are known to include:
    • Chocolate
    • Alcohol
    • Caffeine
    • Fizzy drinks
    • Dairy
    • Non-nutritive sweeteners

If gas is one of your symptoms, try to avoid foods that make this worse. We mentioned them above, but for the sake of easy reading, these are:

  • Beans
  • Broccoli
  • Cabbage
  • Cauliflower

It is also good to note that chewing gum and drinking liquids through a straw can result in swallowing air, which leads to bloating.

 High-fibre foods

  • Stick to regular eating times – Do not skip any meals and try to eat at the same time each day as this helps in regulating the function of your bowels. When experiencing diarrhoea, frequent and small meals may help. However, in the case of constipation, eating high-fibre foods and having meals in larger amounts helps in moving the food through the intestines with ease.
  • Avoid or limit dairy products - In some more severe cases, dairy products may need to be cut out completely. If this is the case, then you may need to take vitamin B, calcium and protein supplements. However, in less severe cases, it can help to substitute milk or cream for yoghurt, eating dairy with other foods at the same time or taking an enzyme supplement to aid in the digestion and breakdown of lactose.
  • Drink enough fluid – Water is the best fluid for your body. Avoid caffeinated beverages and alcohol as these stimulate the intestines and often make diarrhoea even worse. Fizzy drinks also create more gas.
  • Adopt a healthy exercise regime – If you are experiencing stress or depression, exercise aids in stimulating the contraction of the intestines and through the release of endorphins, helping you to feel better. If you have any medical issues, it is best to consult with your doctor and a personal trainer or biokineticist beforehand.
  • Be cautious when taking laxatives and anti-diarrheal medication – Try to use the lowest recommended dosage when taking over-the-counter medication or sticking to the prescribed dose when taking prescription medication. If you have any questions about these, it is best to speak to your doctor or pharmacist.

Can IBS be prevented?

Digestive issues can and often are experienced by those who have anxiety or depression, as well as stress. However, those with IBS who are also under a large amount of stress, tend to experience more severe cases of abdominal pain, diarrhoea and constipation. It is advised that you find avenues in which to deal with your stress and possibly ease your symptoms of IBS.

These are listed accordingly:

  • Counselling – Psychiatrists or psychologists are able to equip you with coping techniques and teach you how to respond to certain events that cause stress (stressors) and how you can change your reaction to them.
  • Relaxation techniques and exercises – In these progressive techniques, you begin by tightening your muscles one at a time. Starting at your feet, you tighten their muscles, concentrating on the muscles and then slowly releasing them and the tension stored in the tense muscles. Then move up to your calves, hamstrings, and continue moving up the body, taking on one muscles group at a time and then slowly releasing the tension and you release the muscle. By doing this daily, even when sitting at your desk, your body will start to relax more and more in stressful situations.
  • Biofeedback – This a technique that helps reduce the tension in the muscles and slow down your heart rate through the help and feedback of a specialised machine. After which, you will be taught how to create these positive changes on your own. The technique basically teaches you how to control the reactions of your body through monitoring involuntary reactions of your body and training you to control them. The idea here is to help you to enter into a relaxed state of mind in order to deal with stress more effectively.
  • Deep breathing techniques – Breathing from your diaphragm can help invoke a sense of calmness and bring more oxygen into your lungs. The majority of people tend to breathe from the chest, but breathing from your diaphragm is most beneficial, resulting in the separation of the muscles of your chest from the abdomen. This means that when inhaling, you must expand your belly and when you exhale, your belly will automatically contract. This aids in relaxing the muscles in your abdomen which can result in your bowel activity normalising.
  • Mindfulness – This is a technique which often involves meditation and enables you to focus on being present in the moment and helps you to let go of distractions or worries.
  • Other stress-releasing techniques – Try setting aside at least 20 minutes a day to yourself. Whether you spend it going for a walk, lying in a bath or just lying down, try to focus your energy on yourself, your goals and relaxing.

What is the outlook for IBS?

IBS is known to be a very painful condition and does not have a cure as yet due to the exact cause being unknown. It is best to immediately consult with your doctor if you have rectal bleeding, progressive abdominal pain or drastic weight loss due to IBS.

If you are able to understand what IBS is and the subtype you may have, this will greatly help you and your doctor to find a reliable and effective plan of treatment in order to relieve and manage your IBS symptoms.

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