Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that affects more than 10 percent of adults in the United States, only 5 to 7 percent of whom have received a diagnosis. The condition is twice as likely to occur in women than men and usually happens in people aged 45 and younger.
IBS causes abdominal discomfort, gas, and changes in the patterns of your bowel movements, as well as diarrhea or constipation. The cause of IBS is largely unknown, which hampers the development of effective treatments.
However, there seem to be common triggers for IBS, such as certain foods, stress, and hormonal changes, although these can vary from person to person.
Working out what sparks and eases your IBS can help you to manage the condition and regain control of your life. Here are five steps you can take to avoid triggers, prevent symptom flare-ups, and cope with IBS.
1. Alter your diet
Making simple changes to your diet can often provide relief from your IBS symptoms. There is no specific IBS diet as such, and what works for one person may not work for another. Diet-related changes that will work best for you will depend on your symptoms and your reaction to particular foods.
Keeping a food diary can help you to identify the foods that either improve or exacerbate your symptoms. Track the foods that you eat, the symptoms you have, and when they occur.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, foods and drinks that have been shown to worsen IBS symptoms include:
- high-fat foods
- some milk products
- alcoholic drinks
- drinks high in artificial sweeteners
- beans, cabbage, and other gas-causing foods
The International Foundation for Functional Gastrointestinal Disorders also highlight insoluble fiber, chocolate, and nuts as foods that are likely to cause problems.
Increasing your fiber intake may help to improve your symptoms of constipation caused by IBS. Foods that contain fiber include fruits, vegetables, whole grains, and beans. Adults are recommended to consume 22 to 34 grams of fiber each day.
When adding more fiber to your diet, slowly increase the amount by 2 to 3 grams per day. Adding too much fiber to your diet in one go can cause gas and bloating and make you feel even more abdominal discomfort.
Low FODMAP diet
If you experience bloating, a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet may be effective. These are all types of carbohydrates that are poorly absorbed in the small intestine. There are five groups of FODMAPs:
- fructans, including wheat, rye, onion, broccoli, and garlic
- galacto-oligosaccharides, including chickpeas, lentils, soy products, and kidney beans
- lactose, including cow's milk, ice cream, yogurt, and cottage cheese
- excess fructose, including apples, mangoes, pears, watermelon, and honey
- polyols, including nectarines, peaches, plums, cauliflower, and mushrooms
Researchers suggest that FODMAPs increase water in the small intestine, which may contribute to the loose stools and diarrhea in IBS.
What is more, FODMAPs pass into the large intestine, where billions of bacteria ferment them, resulting in gas and bloating. Reducing your FODMAP intake may improve these symptoms.
Some people have symptoms triggered by one or two FODMAPs, while others have a problem with all five. Foods should only be restricted if they contribute to your IBS symptoms.
Seeking guidance from a dietitian can help you to eliminate high FODMAP foods and then slowly reintroduce them to find a level of tolerance that is suitable for you.
2. Increase physical activity
Increasing your exercise levels may provide some relief from IBS. Exercise helps to stimulate normal contractions of your intestines and reduce stress, which relieves some IBS symptoms.
Research has shown that taking part in 20 to 30 minutes of moderate to vigorous exercise between three and five times per week significantly improved abdominal pain, stool problems, and quality of life compared with a control group.
Furthermore, being physically active regularly prevented IBS symptoms from deteriorating.
If you have not exercised for a while, it is best to build up the frequency and duration of physical activity slowly. Your goal is to reach 30 minutes of exercise five times per week - as recommended by the American Heart Association (AHA).
3. Reduce stress
Physical or psychological stressors, such as a bowel infection or a change to your job, can cause a disturbance in the complex interactions between the brain and the digestive system and therefore exacerbate symptoms of IBS.
You may find that you experience symptom relief and improved well-being by incorporating relaxation techniques into your day. Whether you have 5 minutes to spare each day or 1 hour, regular relaxation exercises will help you to feel in control of your symptoms.
Using deep relaxation techniques such as abdominal breathing, progressive muscle relaxation, and visualization is associated with many health benefits, including:
- reduced anxiety
- improved memory and concentration
- increased productivity and energy levels
- improved sleep
- decreased fatigue
- reduced muscle tension
Practicing relaxation techniques will help you to take positive steps to address your IBS symptoms and prepare you to deal with any further stress that may come your way in the future.
Meditation, getting counseling and support, taking part in regular exercise, and getting enough sleep can also help you to manage your stress levels.
4. Try IBS medications
It is not clear what causes irritable bowel syndrome, so treatments aim to relieve symptoms to allow you to live as normally as possible. If your symptoms are not alleviated by changes in your diet, lifestyle, and stress levels, your healthcare provider may suggest you try medications. These include:
- Fiber supplements. Psyllium (Metamucil) or methylcellulose (Citrucel) may help to control constipation.
- Osmotic laxatives. Milk of magnesia or polyethylene glycol may help with constipation.
- Anti-diarrheal medications. Loperamide (Imodium) may reduce diarrhea in IBS.
- Antispasmodic medications. Hyoscyamine (Levsin) and dicyclomine (Bentyl) may contribute to reducing bowel spasms.
- Antidepressant medications. Low doses of tricyclic antidepressants and selective serotonin reuptake inhibitors may help with symptoms of pain or depression.
- Antibiotics. Rifaximin (Xifaxan) could potentially help with treating small intestinal bacterial overgrowth - although more research is needed.
- Peppermint oil capsules may reduce IBS symptoms.
Medications have also been approved that have been shown to be effective in treating multiple symptoms of IBS. These include:
- Alosetron (Lotronex), which relaxes the colon and slows the movement of waste through the lower bowel to reduce diarrhea and abdominal pain.
- Lubiprostone (Amitiza), which increases fluid secretion in the small intestine to help the stool move along more easily.
- Eluxadoline (Viberzi), which reduces abdominal pain and improves the consistency of stools.
- Linaclotide (Linzess), which blocks pain signals and increases the passage of contents through the gastrointestinal tract.
Some studies suggest that probiotics might help with symptoms of IBS. However, not all probiotics have the same effect and their benefits are currently unclear.
5. Consider psychological interventions
If you are still having trouble with IBS symptoms after exploring all of the methods listed above, you might want to consider psychological therapy to help improve your symptoms.
Healthcare professionals use cognitive behavioral therapy (CBT) and psychodynamic therapy to treat IBS.
CBT focuses on your thoughts and actions, while psychodynamic therapy concentrates on what effect your emotions have on your symptoms of IBS.
Talking therapies involve stress management and relaxation techniques.
Some research has suggested that hypnotherapy improves IBS-related anxiety, depression, gastrointestinal symptoms, and quality of life.
During gut-related hypnotherapy, a therapist uses hypnosis to help you learn to relax your colon muscles and regain control of your physiological responses.
Practicing mindfulness can help you to focus your attention on sensations that are occurring in the present, instead of becoming stressed about those sensations and worrying about what they might mean.
Through mindfulness, you can develop awareness of your mind and body and relax, which may help to reduce the IBS symptoms and increase your physical and mental well-being.
There is no one-size-fits-all approach to dealing with IBS. But by trying different combinations of diet, exercise, stress management, medications, and psychological therapies, you should be on your way to reduced discomfort from the symptoms of IBS.