Irritable bowel syndrome (IBS)

What is irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is a chronic disorder of the gastrointestinal tract, especially of the bowel. It is one of the most common disorders of the gastrointestinal system.

Irritable bowel syndrome (IBS) is a functional condition as the bowel does not appear damaged when it is examined, so it is still operational, but it does not function as well as it should.

IBS is not a condition that can be inherited, it is not caused by a virus or bacteria and it is generally a benign condition which does not cause malignancies.

3 types of irritable bowel syndrome (IBS)

• IBS with diarrhoea predominance (IBS-D) – in this type of IBS, there is a great deal of abdominal pain, cramping and discomfort, together with an urgency to pass loose, watery stools (at least three times a day) and there is often a feeling of not having emptied the bowel completely even after the numerous sessions in the bathroom
• IBS with constipation predominance (IBS-C) – in this type of IBS, there is a great deal of abdominal pain, cramping and discomfort, together with hard, lumpy stools and straining when trying to pass these stools, less than three bowel movements a week and a great deal of bloating or feeling full
• Alternating IBS (IBS-A) – in this type of IBS, there is a great deal of abdominal pain, cramping and discomfort and an alteration between diarrhoea and constipation (and associated symptoms)

Facts about irritable bowel syndrome (IBS)

• Irritable bowel syndrome (IBS) is a very common gastrointestinal disorder – it is the “common cold” of the digestive tract
• Around one in five people have irritable bowel syndrome, but not all have major symptoms that require treatment
• IBS can occur predominantly with normal bowel movement and either only constipation or diarrhoea
• IBS can occur predominantly with normal bowel movement and then alternate between constipation and diarrhoea
• Women are more likely to be affected by IBS than men
• Many people that do get IBS do so after experiencing a bout of gastroenteritis, an infection of the stomach
• People with gastritis also seem to be predisposed to develop IBS
• Irritable bowel syndrome is thought to affect up to 25% of all people in Western nations such as Australia, UK and the USA

Symptoms of irritable bowel syndrome (IBS)

Many other gastric disorders have the same symptoms as irritable bowel syndrome (IBS), so this disorder needs to be evaluated by a medical specialist to rule out other conditions.

Symptoms must be present for at least 3 months for a diagnosis of IBS to be made and other gastrointestinal disorders must be ruled out to confirm diagnosis.

General IBS symptoms

• Abdominal cramping and pain, especially in the lower abdomen
• Alternating constipation with diarrhoea
• Bloating
• Change in the frequency of passing stools (sometimes a lot, sometimes a little)
• Constipation
• Diarrhoea
• Feeling that the bowels are not completely empty after a bowel movement
• Gas (flatulence)
• Loose stools and increased bowel movements accompanied with stomach pain
• Passing mucous from the rectum

Other IBS symptoms

There are also some other symptoms which are associated with IBS:

• Excessive burping (belching)
• Headaches
• Heartburn
• Indigestion (dyspepsia)
• Lethargy
• Nausea
• Painful periods (menstruation)
• Reflux (GERD)
• Sensitive bladder
• Sleep problems

Health conditions associated with IBS

In addition to the above symptoms, there are some disorders which are commonly associated with IBS:

• Depression
• Fibromyalgia

Causes of irritable bowel syndrome (IBS)

It is not currently known what exactly causes irritable bowel syndrome (IBS), but there are known triggers which may increase incidence of the condition. There is much disagreement and division in the medical community about the exact cause of IBS, as some of the theories of the cause of IBS above have yet to be proven (especially the redundant colon theory).

The following are triggers which could cause symptoms and precipitate this condition:

Bowel dysfunction (disordered motility)

Some people have a bowel which is either longer or shorter than normal and this causes the muscles in the bowel to be unable to contract properly and move food through the bowel.

Diet

Some experts believe that some people have an intolerance to simple carbohydrates (high GI carbohydrates) and artificial sweeteners and so when they ingest these type of carbohydrates, they are not digested and absorbed properly in the small intestines. When they travel to the large intestines, these undigested food particles are then fermented by the intestinal bacteria, which causes a great deal of gas (flatulence), bloating and discomfort as the bacteria are not able to properly digest these food particle and perform their function properly.

Gastrointestinal infection

Studies estimate that up to around 25% of all people who have IBS, do so after they experience a bacterial or viral infection of the bowel or stomach.

Stress

It is well known that stress has an adverse effect on the digestive system, mainly because stress causes the stress hormones to be released into the blood stream and this prevents proper digestion from occurring. Some theories link IBS with mental disorders such as anxiety and depression, because symptoms of IBS get much worse during a flare-up in the mental health conditions.

Visceral hypersensitivity

Many experts believe that some people are just more aware of their body and their bowel in particular and so may have heightened sensitivity with the workings of their bowels which may be experienced as pain.

Prevention of irritable bowel syndrome (IBS)

Non-preventable risk factors

Irritable bowel syndrome (IBS) may be unpreventable in certain circumstances:

• Disordered motility – some people have a bowel that is either smaller or larger than normal that does not contract properly to allow food to move through normally and causes some problems with the muscle contractions
• Food sensitivities and allergies – some people find allergies or sensitivities to certain foods trigger symptoms
• Gastroenteritis – in some cases, irritable bowel syndrome develops after a bout of viral or bacterial gastroenteritis and this is largely unpreventable (other than having a strong and healthy immune system that prevents deterioration of the digestive system in the first place)
• Genetics – a very small number of cases of IBS are inherited from family members due to a gene problem
• Lactose intolerance – can trigger IBS symptoms in some people
• Redundant colon – the loops of the large bowel may hang lower in some people with IBS, which may affect the bowels’ ability to contract properly and move the food through properly and this could be a factor in causing the symptoms of discomfort as well as other symptoms
• Visceral hypersensitivity – some people are just more aware of their digestive system and have a more conscious experience and awareness of pain

Preventable risk factors

There are ways to possibly prevent IBS from occuring or at least reduce severity and duration of symptoms :

• Artificial sweeteners – some recent research suggest that IBS symptoms may be triggered by artificial sweeteners (saccharin, aspartame, sorbitol), so these should be avoided when symptoms are at their worst and strictly limited at other times, to prevent worsening of symptoms
• Diet – while diet is not a currently known cause of irritable bowel syndrome, it is known that following a diet that includes mostly fresh, unprocessed and low fat foods, with plenty of soluble fibre, such as psyillium (that has been gradually added to the diet) and avoiding high fat, high GI, processed foods seems to help reduce incidence of symptoms
• Stress – while not directly causing irritable bowel syndrome in the first place, stress can aggravate it and make the symptoms much worse, so reducing stress is encouraged through some type of relaxation therapy (meditation, tai chi, yoga are all good examples)

Complications of irritable bowel syndrome (IBS)

There are no major complications of irritable bowel syndrome (IBS) as it is a functional disorder, which means it does not cause any major and problematic problems of the bowel, it just affects the functioning of the bowel.

Irritable bowel syndrome (IBS) may cause some people to skip meals (when they have pain), avoid certain foods (that are known to cause pain) and it just causes interference with daily life when symptoms are at their worst and people cannot function as well as they can normally.

Other than these, there are no serious complications with irritable bowel syndrome (IBS).

When to see a doctor about irritable bowel syndrome (IBS)

People who have any of the gastrointestinal symptoms associated with irritable bowel syndrome (IBS) should see their doctor to have a proper diagnosis to confirm whether or not they have this condition.

A doctor is the best person to diagnose this disorder and to rule out any other digestive disorder, which may present with very similar symptoms to irritable bowel syndrome (IBS).

People with existing irritable bowel syndrome (IBS) need to see their doctor if their symptoms change – if the severity of symptoms becomes worse or they experience a different set of symptoms than experienced before.

Diagnosis of irritable bowel syndrome (IBS)

Initial diagnosis of irritable bowel syndrome (IBS) includes:

• Medical history – the doctor will ask a series of questions about your symptoms (especially the duration and severity), your diet, your family medical history (if anyone else has similar symptoms or other gastrointestinal disorders)
• Physical examination – the doctor (or gastroenterologist) will examine your abdominal area for pain or discomfort, as well as examining other parts of your body if needed (your hands, eyes and mouth)

Other tests

If the initial diagnosis warrant it, the following tests can be done to further evaluate the symptoms:

• Blood test – this is ordered to test iron, haemoglobin, vitamin B12, intrinsic factor, calcium levels and other nutrients. A blood test can also determine malnourishment or even if coeliac disease is present. Sometimes the thyroid function is also requested to be tested
• Stool sample – this is ordered to determine if there is any blood in the stools or if there is a bacterial infection in the bowel present

Diagnostic tests

Once the doctor (or gastroenterologist) has reviewed the medical history and determines that further investigation is warranted, the following tests can be ordered:

• Barium meal – is often performed to rule out any other disorders of the bowel, such as ulcers and inflammatory bowel disease (IBD), ulcerations of the bowel and stomach, narrowing of the bowel and fistulas in the bowel (little pockets in the bowel). This test is not performed much in Australia any more as a CAT scan can show the same information without having to enduring the ingestion of the barium (less invasive)
• CAT scan – gives a more clearer view of the bowel and may be performed if a colonoscopy is not done (for whatever reason) and can show any major abnormalities in the bowel
• MRI – magnetic resonance imaging, can show clear pictures of the body tissues and organs, so it can show any abnormalities in the bowel and rule out other conditions
• Colonoscopy – people that have blood in their stools are often recommended to undergo a colonoscopy, which a gastroenterologist performs (a gastro specialist) and it involves having a colonoscope (small, flexible tube with a camera and light at the end) being inserted into the colon (from the anus) to get a better view of the colon (or bowel) and to take a sample of the colon (a biopsy). The colonoscopy is usually performed under light sedation and takes only about 10-15 minutes to be completed
• Gynaecological exam – many women with abdominal pain may need to undergo a gynaecological exam to rule out any gynaecological problems, if their symptoms warrant
• Ultrasound – an ultrasound can show any major abnormalities in the bowel and rule out other conditions

The further tests and investigation can rule out other conditions, especially the more serious and life threatening illnesses which can present with similar symptoms. Once other digestive disorders can be ruled out, then irritable bowel syndrome (IBS) can be diagnosed.

Conventional treatment of irritable bowel syndrome (IBS)

Since the cause of IBS is not known, conventional treatment is difficult and instead just focuses on alleviating symptoms, which is tailored for each patient’s particular symptoms. There is a slight focus on natural or complementary treatment even by conventional doctors because current drug treatments for irritable bowel syndrome (IBS) are of limited value to the patient.

Dietary modifications

Conventional medicine recommends that certain additions and limitations to the diet seem to improve symptoms in some people:

• Increase fibre – edible plant sources of fibre should be gradually incorporated into the diet to promote healthy bowel movements and prevent constipation. Soluble fibre, especially from oats and psyllium are especially recommended as they both really help the bowel to function more normally. People who have not had much fibre in their diet are recommended to add it very gradually to prevent symptoms from getting worse (and to drink lots of water and fluids)
• Increase fluid intake – drinking enough water is necessary to help hydrate the body adequately and to help with constipation symptoms especially. It is recommended to drink at least eight glasses of water every day, a little more if exercising vigorously
• Reduce foods that produce gas – certain foods such as beans and cruciferous vegetables (broccoli, cabbage, cauliflower and brussels sprouts) produce a lot of gas (flatulence) and bloating. These foods are recommended to be limited in the diet to alleviate some of the symptoms of irritable bowel syndrome (IBS)

Lifestyle modifications

Conventional medicine recommends that certain lifestyle modifications are used to help reduce severity and duration of symptoms and improve the well being overall:

• Exercise – regular exercise may reduce stress (which is often associated with aggravation of IBS symptoms) and it also helps with well-being in general
• Relax – the symptoms associated with IBS seems to get worse under periods of stress, so relaxation is a must. The gastrointestinal tract is especially susceptible to stress and strain, so any form of relaxation is recommended – yoga, meditation, tai chi, visualisation
• Stop smoking – smoking cigarettes irritates the bowel and can make IBS symptoms worse, so it is recommended to stop smoking in order to help symptoms and get better

Peppermint oil

Conventional gastroenterologists and general practitioners are are recommending peppermint oil to help alleviate symptoms of irritable bowel syndrome (IBS)), as it helps to reduce spasms in the bowel by relaxing it and assisting it in normal contractions.

The peppermint oil capsules made for IBS are coated with an enteric (protective) coating, which only dissolves and releases the peppermint oil once it enters the bowel.

Peppermint oil generally has no side effects for most people, although it can cause indigestion or allergic reactions (but these are not common side effects).

Medications

Most medications recommended for irritable bowel syndrome will only just treat the symptoms of this condition and not the cause (which is not yet known). In addition, some medications are not legal in Australia as they have too many side effects, so caution is advised:

• Anti-diarrhoeals – are used to treat and control diarrhoea symptoms associated with irritable bowel syndrome (IBS) by slowing the movement of food in the bowel to form more bulkier stools. Some common ones are: Immodium, Loperamide. These medications are normally safe to take long term, except they should not be used in children, the elderly. Anti-diarrhoeal medications should definitely not be used in a bout of gastroenteritis or inflammatory bowel disease (IBD) as they can produce potentially dangerous side effects
• Anticholinergics – are basically anti-spasmodic medications as they reduce the spasms in the bowel by relaxing the bowel muscles and slowing the churning and contractions in the bowel to alleviate cramps. Common drugs are: Buscopan, Atrobel, Colofac. These drugs have minor side effects: dry mouth, constipation, sleepiness
• Anti-depressants – these medications are used to relax and calm the nerves in the bowel and only very small doses of anti-depressant medications are required for this purpose. Mostly commonly used medications are: SSRIs (selective serotonin re-uptake inhibitors) such as Paxil, Prozac, Zoloft and tricyclics such as Norpramin, Surmontil, Tofranil. Anti-depressants have side effects such as: diarrhoea, restlessness, nervousness, dry mouth, drowsiness, low blood pressure and depression
• Cholestyramine – is used for treating diarrhoea symptoms associated with IBS. It binds with the bile salts to prevent diarrhoea. It is not a common medication for diarrhoea, but is sometimes used.
• Laxatives – used for assisting with constipation symptoms and work by helping the eliminate the stools from the bowel. There are two types: (1) Osmotic laxatives, which include Movicol, Lactulose and Epsom salts, the best of which is epsom salt as it produces the least side effects; (2) Stimulant laxatives, which include senna, Ford pills and Senokot, all of which irritate the bowel after some use, so are not recommended long term
• Stool-bulking agents – this natural supplement is used for assisting with constipation symptoms and works by softening the stools and giving them bulk, to help them move through the bowel properly without getting stuck. The best ones are: Metamucil, Normafibre and Fybrogel
• Alosetron – this medication is used in women who do not relief from other IBS treatment and should only be used short-term. It is used when severe, chronic, diarrhea-predominant IBS is present
• Tegaserod – this medication seems to assist women with IBS associated with constipation; it stimulates the digestive tract to maintain movement, so decreases the risk of developing constipation. Unfortunately the effect of this medication seems to dissipate with longer-term use and it is also expensive. It is not listed on the PBS, which means it is not subsidised in Australia

Alternative / complementary treatment of irritable bowel syndrome (IBS)

Alternative treatment for IBS is recommended as a starting point, due to the very reason that the cause of IBS is not known. To get a better understanding of your IBS symptoms and to create a tailored treatment plan just for you, see a qualified naturopath.

People who are taking any type of medication (not just for IBS) need to consult their doctor before trying any herbs or other supplements as there could be a serious and adverse interaction.

Herbs

There are a number of excellent herbs which may help to provide relief for symptoms:

• Peppermint – this herb (as a tea or tincture) helps to promote proper digestion, as it relaxes the digestive tract. Peppermint oil helps to relax the muscles in the bowel and restore normal bowel contractions to relieve discomfort and pain, which reduces bloating and flatulence associated with IBS. Note: Only take peppermint oil capsules which have been specifically created for IBS, do not try making your own peppermint oil as it can severely irritate and burn the upper digestive tract. The peppermint oil capsules made for IBS are coated with an enteric (protective) coating, which only dissolves and releases the peppermint oil once it enters the bowel
• Slippery elm powder – also known as ulmus fulva, this herb has a protective effect on the whole gastrointestinal system with its mucilaginous properties. It coats the whole digestive tract and as it has similar properties to the actual mucous that coats the digestive tract normally, it helps to relax the muscles, allows the stools to pass more easily through the bowel and enables the stomach, intestines and other areas of the digestive system to heal

Vitamins

There are a number of vitamins which may help to provide relief for symptoms:

• Vitamin A – this antioxidant vitamin is important in promoting healthy mucosa in the gastrointestinal tract and so could help reduce symptoms by allowing more normal stool movement in the bowel. Vitamin A could also be deficit in people with IBS, as they may not be absorbing many of the nutrients in food, but especially the fat-soluble vitamins as the bowel is not functioning properly and not digesting fat properly (which is needed to digest the fat-soluble vitamins)
• Vitamin D – people with IBS may not be able to digest and use the fat-soluble vitamin D properly because they are not able digest fats since the intestine is not functioning properly
• Vitamin E – people with IBS may not be able to digest and use the fat-soluble vitamin E properly because they are not able digest fats since the intestine is not functioning properly
• Vitamin K – people with IBS may not be able to digest and use the fat-soluble vitamin K properly because they are not able digest fats since the intestine is not functioning properly

Minerals

There are a number of minerals which may help to provide relief for symptoms:

• Magnesium – the mineral magnesium is a known, natural muscle relaxant as it helps all the muscle tissues, but especially the smooth muscles relax (and smooth muscle is what is surrounding the intestine walls). This means magnesium is also useful in reducing stress on a general level in the whole body. Magnesium helps to assist by reducing spasms that happen in the colon, reducing pain, cramping, bloating and flatulence and this reduces severity and duration of symptoms
• Zinc – the important antioxidant mineral zinc promotes healing of all tissue cells and especially in the bowel which may be highly irritated and sore from all the abnormal spasms and contractions

Other nutrients

There are a number of other nutrients which may help to provide relief for symptoms:

• Carnitine – the amino acid-like substance, carnitine helps to reduce symptoms associated with IBS as it assists the mucous membranes of the intestine to heal. Studies show the effect of carnitine is greatly enhanced when combined with zinc
• Lipoic acid – the antioxidant lipoic acid, may assist in reducing severity and duration of symptoms as it helps the immune system function more effectively and boost the other antioxidants in the body so that they perform their functions more effectively
• Omega 3 fatty acids – many studies show that the omega 3 fatty acids, especially DHA/EPA have really potent anti-inflammatory properties which can provide relief of symptoms on all levels
• Probiotics – these are required to rebalance the intestinal flora, which may not be in proper balance, due to this condition. Several studies show the probiotic lactobacillus plantarum may be especially beneficial in reducing IBS symptoms by reducing the levels of intestinal bacteria that causes the bloating and flatulence
• Tryptophan – the amino acid tryptophan helps to supports the nervous system because adequate levels of this amino acid are required to make the “happy hormone” serotonin, which is important in mood regulation. Studies also show that serotonin may be especially depleted in times of stress and tryptophan may help to ensure that serotonin levels are normal, which helps the body deal better with stress and this can greatly reduce symptoms

Dietary modifications

There are a number of dietary modification strategies which may help to provide relief for symptoms (these are the same recommendations as the conventional ones):

• Increase fibre – gradually increase foods high in fibre, such as fruit, vegetables, nuts, grains, seeds, legumes. Ensure that these foods are added gradually into the diet, as a sudden intake of high fibre foods may cause a flare-up of symptoms because they put too much pressure on the digestive system which is not functioning properly. Soluble fibre, especially from oats and psyllium are especially recommended as they both really help the bowel to function more normally
• Reduce gas-forming foods – some foods can cause an excess of gas (flatulence) and bloating and can be reduced (or limited) when symptoms are severe to stop aggravation of symptoms. Foods to limit: beans, raw vegetables, fasts foods high in fat, high fat dairy, foods with high caffeine content, spicy barbeque sauce, any foods high in saturated fat

Lifestyle modifications

There are a number of lifestyle modifications which may help to provide relief for symptoms (these are the same recommendations as the conventional ones):

• Exercise – regular exercise may reduce stress (which is often associated with aggravation of IBS symptoms) and it also helps with well-being in general
• Relax – the symptoms associated with IBS seems to get worse under periods of stress, so relaxation is a must. The gastrointestinal tract is especially susceptible to stress and strain, so any form of relaxation is recommended – yoga, meditation, tai chi, visualisation
• Stop smoking – smoking cigarettes irritates the bowel and can make IBS symptoms worse, so it is recommended to stop smoking in order to help symptoms and get better

Alternative treatments

• Food sensitivities – get checked for food sensitivities and/or use an elimination diet to find any food intolerance or food allergies (especially for lactose intolerance or gluten intolerance)

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) requires some diligence in maintaining a healthy diet and some supplementation may be required to help heal the digestive system and reduce severity and duration of symptoms.

Self care strategies

The following are the strategies most recommended to achieve this:

• Antioxidants – there are a number of antioxidant supplements that are especially recommended for helping reduce symptoms and increase healing capacity (carnitine and lipoic acid)
• Avoid alcohol – it may be necessary to stop drinking any alcohol while the intestines and the rest of the digestive system are in the process of healing and this is because acohol is known to irritate the intestines
• Avoid artificial additives – any type of artificial colour, flavour or preservative is potentially a trigger to worsen IBS symptoms. Read food nutrition labels and avoid foods which have any numbers in the ingredient list, as these will invariably be some type of artificial additive
• Avoid artificial sweeteners – these can trigger severe diarhoea symptoms so should be avoided. Always read food labels and avoid foods that are labelled “diet” or “no sugar”, as this invariably means they contain some type of artifical sweetener, such as: sorbitol, asparatame, saccharin (but there are others)
• Avoid carbonated drinks – any type of carbonated drinks should be completely avoided as they create further gas and bloating in the intestines, as well as causing abdominal pain
• Avoid coffee – it is advisable to avoid coffee as it can cause abdominal cramping and diarrhoea in many people with IBS
• Avoid fried foods – foods that are really high in fat (butter, margarine and other high fat spreads) and any fried foods should also be avoided as they cause more pressure on the digestive system because fats are quite slow to digest and can cause an aggravation of symptoms
• Avoid refined sugar – there is some evidence to suggest that a diet high in refined sugar can have a detrimental effect on intestinal bacteria and cause gas buildup to occur in the intestines. Foods high in sugar are those which are processed and should be avoided as much as possible
• Avoid cigarette smoke – people who smoke have to give up. This is just another reason to help with the decision to stop smoking. Cigarette smoke causes a number of problems with digestion and should be avoided. People who do not smoke should avoid exposure to second hand smoke from people who smoke around them
• Digestive and pancreatic enzymes – the digestive and pancreatic enzymes are released by the digestive to help digest foods that are eaten so that their nutrients can be absorbed through the bloodstream. Digestions starts mainly in the stomach and ends in the small intestine. The digestive and pancreatic enzymes help to increase the amount of food digested by reducing the load on the digestive system and this reduces the amount of undigested foods that may escape into the bloodstream and cause the immune system to resonde with an allergic reaction
• Essential fatty acids – the essential fatty acids, especially the omega 3 (DHA/EPA) and omega 6 (GLA) are vital for a properly functioning gastrointestinal system as they reduce inflammation that may be associated with this digestive disorder and this reduces severity and duration of symptoms. The best way to get adequate levels of the essential fatty acids is to eat 3-4 servings of oily fish each week and ensure it is deep ocean, wild fish (not farmed). The fish with the highest levels of omega-3 fatty acids are: mackerel, salmon, sardines, trout, tuna. People who cannot eat fish should try a supplement with balanced levels of each of the essential fatty acids and ensure it has been tested for mercury
• Exercise regularly – physical activity is a must for anyone with a digestive disorder as it helps to increase blood and lymphatic circulation. This helps to eliminate any toxins or unwanted substances more quickly out of the body. Exercise also increases the endorphins released and reduces stress
• Fibre – increasing the amount of fibre in the diet is vital for ensuring healthy digestion. The best types of soluble fibres is psyllium, which helps the intestinal flora digest food properly. The best ways to add psyillium or slippery elm to the diet are in: smoothies, milkshakes, sauces, yoghurt, breakfast cereal, muesli, dips. Suggested dosage is up to 2-3 teaspoons per day, but add it gradually if fibre hasnt been an integral part of the diet previously, start with 1/2 teaspoon for a few days and add another 1/2 teaspoon every 4 days until at the 2-3 teaspoons a day level
• Food intolerances or sensitivities – these can be confirmed (if not known) through either an elimination diet or a blood test. An elimination diet involves removal of all the suspected allergens (such as dairy, gluten) as well as all processed foods and associated food additives and then re-introducing these foods, one at a time to determine if they have an adverse effect on digestion, or any other part of the body
• Limit red meat intake – red meat is most often a trigger for IBS symptoms and that is because it takes a long time to digest and absorb meat through the digestive system, which can put a big strain on all parts of digeston and trigger symptoms of IBS
• Organic – another strategy to reduce the stress on the gastrointestinal system is to avoid foods which are not grown organically (without the use of pesticides and other chemicals and antibiotics). This helps the digestive system because it does not have to also try to detoxify the chemicals in the food in addition to trying to digest foods normally (which is not occuring in this condition). Not only this, but studies show that organic food has higher levels of all their nutrients than food not grown organically
• Peppermint oil – this oil is highly recommended by doctors and gastroenterologists to reduce the spasms in the intestines which cause the pain and also cause the improper digestion of foods
• Probiotics – the “good” bacteria may be in short supply in the digestive system which could be contributing to the symptoms. Acidophilus and other probiotic bacteria are required to help re-populate the intestines with “good” bacteria, which help to properly digest foods and reduce the amount of undigested food that escapes the gut. People who are not lactose intolerant should also include yoghurt that has live cultures
• Reduce stress and relax – prolonged and unrelenting stress is not good for healthy digestion. While stress is not known to cause leaky gut syndrome, it certainly can make symptoms worse because it causes the parasympathetic nervous system to remain in stress mode, which means digestion and absorption is not effective as the nerve that controls it prevents it from happening properly. Learn stress reduction techniques to help reduce this trigger for IBS symptoms
• Slippery elm – the herb slippery elm is necessary for intestinal health as it is required to heal the intestinal mucosa by providing a mucilaginous layer over the intestinal wall, which reduces the stress on the intestines and helps to heal the intestines more quickly
• Smaller meals – eat smaller meals to help reduce the load on the digestive system, which is not working properly and cannot handle larger meals, which can cause worsening of symptoms when the stomach and intestines struggles to handle the large amount of food eaten. Aim to have around 6 smaller meals each day
• Supplements – certain supplements may be required to help in the healing process by reducing the load on the intestines and reduce symptoms. The fat-soluble vitamins may especially be required because this digestive disorder causes a problem with fat digestion, magnesium to help relax the strong muscles that surround the intestines and tryptophan to help induce a more relaxed state of mind by increasing amount of the mood enhancer serotonin

Caring for someone with irritable bowel syndrome (IBS)

Partner

The best way to help a partner with irritable bowel syndrome (IBS) is to be supportive and sympathetic, but also the following can be helpful too:

• Avoiding smoking inside – people with irritable bowel syndrome (IBS) need to be away from any cigarette smoke, as it can exacerbate their symptoms
• Eating smaller meals – help your partner to eat smaller meals by joining them in eating smaller meals, as this helps support your partner a great deal. Cooking and eating smaller meals is one way to help reduce the load on the digestive system by reducing the amount of food that needs to be digested and absorbed
• Encourage a healthy diet – a healthy diet is one which has adequate amounts of fresh fruit and vegetables, wholegrains, legumes, protein and healthy fats and has little or no processed foods. Try to avoid buying and eating processed foods at home as this will help to prevent your partner from indulging too (and subsequently having digestive problems)
• Encourage exercise – going for walks (or joining a gym together) with your partner is a great way to bond. Exercise helps to improve circulation, reduces stress and encourages better health overall

Friends

People who have a friend who has irritable bowel syndrome (IBS) can support their friend by the following:

• Dinner parties – if you invite your friend to a dinner party, try to ensure there is food that they can eat. The best way to do this is to ask what foods are off limits for them and ensure to let them know beforehand which foods they should avoid
• Discourage alcohol – if your friend has IBS, they should be limiting alcohol intake as it can cause a worsening of symptoms, so try to make your social meetings ones that are alcohol free

Parents

Parents of a child who has irritable bowel syndrome (IBS) can support their child by:

• Avoid smoking inside – people with irritable bowel syndrome (IBS) need to be away from any cigarette smoke, as it can exacerbate their symptoms
• Cooking smaller meals – this is one way to help reduce the load on the childs digestive system by reducing the amount of food that needs to be digested and absorbed
• Fibre – it is important to include some soluble fibre in the child’s diet, slowly and a little at a time (to prevent worsening of symptoms) to help with symptoms. Studies show that a diet high in plant fibre is associated with lower incidence of IBD. Some good sources of fibre are: psyllium (this can be added to cereals and smoothies, but ensure to have adequate amounts of water to enable it to flow through the digestive system properly), vegetables, legumes and cereals
• Probiotics – introduce some probiotics to the child’s diet, preferably in powder form as it can be more easily assimilated into other foods, but the tablets can also be taken if this is not successful
• Slippery elm – find creative ways to add slippery elm to foods (smoothies, breakfast cereal, muesli) in the childs diet. Slippery elm is one of the herbs most beneficial for any type of digestive disorder, but especially one in which there is irritation and damage to the intestinal wall and the intestinal mucosa

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Last reviewed and updated: 6 May 2025