What is IBS?
IBS stands for irritable bowel syndrome. This is when a group of gut symptoms are present in the absence of other medical conditions. Studies have found that IBS has a big impact on quality of life (1).
It is thought that 17% of people in the UK, and 9 – 23% of the population worldwide suffer with IBS (2 – 3). This has been found to be almost twice as common in women as compared with men (2).
The exact cause of IBS isn’t clear, but scientists think this may be related to changes in: the immune system, the movement of muscles in our gut, changes in gut bacteria, changes in the gut wall or a more sensitive connection between the gut and the brain. This can present in very different ways between individuals, but it is often diagnosed following a bout of gastroenteritis (an infection in the gut) and tends to be impacted by diet and stress levels (2).
Common Symptoms of IBS:
- Abdominal pain
- Stomach cramps
- Diarrhoea and/or constipation
- A feeling that you urgently need to poo
⚠ You should see your doctor urgently if you get symptoms such as: blood in your poo, needing to poo frequently overnight, unintentional weight loss, fever, ongoing diarrhoea and/or vomiting – especially if you have a family history of bowel cancer, coeliac disease or inflammatory bowel disease.
How is it Diagnosed?
IBS is diagnosed by a doctor who considers: your symptoms, medical history, family history and medical test results (4).
⚠ Before assuming that you have IBS it is important that your doctor rules out other medical conditions including coeliac disease, inflammatory bowel disease, bowel cancer and gastroenteritis.
A diagnosis of IBS will be made by your doctor by using a set of criteria based on your symptoms. To get the most out of your appointment with your GP, take a 2 week food, mood and symptom diary with you. We’ve designed one for you here. This also helps you get to know your body a little bit better too. There are 4 different types of IBS:
- IBS with predominant constipation (IBS – C)
- IBS with predominant diarrhoea (IBS – D)
- IBS with mixed bowel habits (IBS – M)
- IBS unclassified (IBS – U)
If you are diagnosed with IBS, make sure you know what type you have by asking your GP.
⚠ As part of your GP’s investigations, you may be tested for coeliac disease. If you are getting a blood test to check for coeliac disease, make sure that you continue to include at least 3g of gluten in your diet for 6-8 weeks before this test (this works out as 2 slices of bread or a portion of pasta per day) (5)
There are lots of things you can do to manage the symptoms of IBS, from both a dietary and lifestyle perfective.
- Eating regular meals and aim to give yourself 12 hours break from food overnight.
- Chewing your food well (aim for 20 times a mouthful!)
- Depending on the type of IBS you have, altering your fibre intake
- Avoiding common dietary triggers for you
- Work on ways to reduce stress, from mindfulness, yoga, meditation or just getting out in nature without distraction.
- Exercise (not too much, not too little)
- Probiotics can be helpful for some people: the advice is to take one type of probiotic daily for at least four weeks to see if they improve your symptoms. If not, you can then try another brand. See here for more information on probiotics.
- Input from a psychologist for stress management can be helpful for some people.
- There is some evidence that gut-directed hypnotherapy can lead to significant reductions in IBS symptoms (7).
It is often helpful to keep a diary of what you eat and when you get symptoms of IBS (YOU GET YOUR FOOD DIARY HERE!). A registered dietitian can guide you through this process and help you to identify triggers in your diet. See here for more information about first-line dietary advice for IBS.
The Low FODMAP diet
IBS symptoms may be managed with diet is called the low FODMAP diet, which has been found to provide significant relief from IBS symptoms (6). However, the jury is still out on whether the low-FODMAP diet is superior to other diets in managing IBS symptoms in the long run. As with everything, it is very personal and may not work for all with IBS. The low-FODMAP diet was designed to be followed for a short period of time and long term use may negatively affect your gut in the long run (8).
FODMAPs are specific types of carbohydrates in your diet which are poorly digested and often linked with worsening symptoms of IBS.
FODMAP stands for:
- Fermentable (processed in the gut to ferment undigested carbohydrate, which produces gas)
- Oligosaccharides (fructans and galactooligosaccharides, – from wheat, rye, onions, garlic, legumes and pulses)
- Disaccharides (lactose – present in most dairy products, including milk, soft cheeses and yogurt)
- Monosaccharides (fructose – mostly in honey, apples and high fructose corn syrup)
- Polyols (sorbitol and mannitol – present in some fruit and veg and used as artificial sweeteners)
FODMAPs are avoided for 4-6 weeks, then each FODMAP is reintroduced one at a time so you can find out which FODMAPs trigger your symptoms, and in what amounts. Therefore, it usually takes at least 3 appointments and a few months to complete this process. See here for more information about the low FODMAP diet.
⚠ The low FODMAP diet isn’t suitable for everyone, it should not be followed without support from a trained Dietitian, the full diet is only supposed to be followed for a maximum of 6 weeks.
Where to Find Support
- Speak to your GP if you suspect that you might have IBS
- See a dietitian – your GP can refer you to a Dietitian or you can find a private practice dietitian (preferably one who has experience working with IBS and is trained in the low FODMAP diet)
- The IBS Network – this charity supports those who suffer with IBS by providing information and running support groups. You can also purchase a the Can’t Wait Card and Radar Key from this website.
⚠ If you are interested in trying the low FODMAP diet, be sure to book an appointment with a dietitian who has training and experience with this diet.
- Agarwal & Spiegel (2011) “The effect of irritable bowel syndrome on health-related quality of life and health care expenditures” Gastroenterol Clin North Am. 40(1):11-9.
- Khanbhai & Singh Sura (2013) “Irritable Bowel Syndrome for Primary Care Physicians”. BJMP 2013;6(1):a608.
- Saha (2014) “Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine” World J Gastroenterol. 20(22): 6759–6773.
- Lacey & Patel (2017) “Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome”. J Clin Med. 6(11): 99.
- Leffler et al. (2013) “Kinetics of the histological, serological and symptomatic responses to gluten challenge in adults with coeliac disease” Gut. 62(7): p. 996-1004.
- Halmos et al. (2014) “A diet low in FODMAPs reduces symptoms of irritable bowel syndrome” Gastroenterology. 146(1): p. 67-75 e5.
- Peter et al. (2016) “Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome” Aliment Pharmacol Ther. 44(5): p. 447-59.
- Altobelli et al. (2017) “Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis” Nutrients. 9(9): 940.