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The symptoms of irritable bowel syndrome (IBS) can often be managed by changing your diet and lifestyle, and understanding the nature of the condition.
In some cases, medication or psychological treatments may also be helpful.
Changing your diet will play an important part in controlling your symptoms of IBS. However, there is no "one size fits all" diet for people with the condition. The diet that works best for you will depend on your symptoms and how you react to different foods.
It may be helpful to keep a food diary and record whether certain foods make your symptoms better or worse. You can then avoid foods that trigger your symptoms. However, it's important to remember that these foods will not necessarily need to be avoided for life.
People with IBS are often advised to modify the amount of fibre in their diet. There are two main types of fibre: soluble fibre (which dissolves in water) and insoluble fibre (which doesn't dissolve in water).
Foods that contain soluble fibre include:
Foods that contain insoluble fibre include:
If you have diarrhoea, you may find it helps to cut down on the insoluble fibre you eat. It may also help to avoid the skin, pith and pips from fruit and vegetables.
If you have constipation, increasing the amount of soluble fibre in your diet and the amount of water you drink can help.
Your GP may be able to advise on what your recommended fibre intake should be.
If you experience persistent or frequent bloating, a special diet called the low FODMAP diet can be effective.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are types of carbohydrates that aren’t easily broken down and absorbed by the gut. This means they start to ferment in the gut relatively quickly, and the gases released during this process can lead to bloating.
A low FODMAP diet essentially involves restricting your intake of various foods that are high in FODMAPs, such as some fruits and vegetables, animal milk, wheat products and beans.
If you want to try the low FODMAP diet, it’s best to do so under the guidance of a professional dietitian, who can ensure your diet is still healthy and balanced. You can ask your GP or specialist to refer you.
You can read more about the low FODMAP diet on the Kings College London website.
Your IBS symptoms may also improve by:
Many people find that exercise helps to relieve the symptoms of IBS. Your GP can advise you on the type of exercise that is suitable for you.
Aim to do a minimum of 150 minutes of moderate-intensity aerobic activity, such as cycling or fast walking, every week.
The exercise should be strenuous enough to increase your heart and breathing rates.
Reducing your stress levels may also reduce the frequency and severity of your IBS symptoms. Some ways to help relieve stress include:
Read more about how to manage stress.
Probiotics are dietary supplements that product manufacturers claim can help improve digestive health. They contain so-called "friendly bacteria" that can supposedly restore the natural balance of your gut bacteria when it has been disrupted.
Some people find taking probiotics regularly helps to relieve the symptoms of IBS. However, there is a little evidence to support this, and it is unclear exactly how much of a benefit probiotics offer and which types are most effective.
If you want to try a probiotic product, you should take it for at least four weeks to see if your symptoms improve, and you should follow the manufacturer's recommendations regarding dosage.
A number of different medications can be used to help treat IBS, including:
These medications are discussed in more detail below.
Antispasmodics such as Buscopan work by helping to relax the muscles in your digestive system. Examples of antispasmodic medicines include mebeverine and therapeutic peppermint oil.
Side effects associated with antispasmodics are rare. However, people taking peppermint oil may have occasional heartburn and irritation on the skin around their bottom.
Bulk-forming laxatives are usually recommended for people with IBS-related constipation. They make your stools softer, which means they are easier to pass.
It's important to drink plenty of fluids while using a bulk-forming laxative. This will help prevent the laxative from causing an obstruction in your digestive system.
Start on a low dose and then, if necessary, increase it every few days until one or two soft stools are produced every one or two days. Do not take a bulk-forming laxative just before you go to bed.
Side effects associated with taking laxatives can include bloating and wind. However, if you increase your dose gradually, you should have few, if any, side effects.
The antimotility medicine loperamide is usually recommended for IBS-related diarrhoea.
Loperamide works by slowing contractions of muscles in the bowel, which slows down the speed at which food passes through your digestive system. This allows more time for your stools to harden and solidify.
Side effects of loperamide can include stomach cramps and bloating, dizziness, drowsiness and rashes.
TCAs, such as amitriptyline, are usually recommended when antispasmodic medicines have not been able to control the symptoms of pain and cramping. They work by preventing signals being sent to and from the nerves in your digestive system.
However, TCAs will only start to provide relief after three to four weeks, as your body gets used to the medication.
Side effects of TCAs can include a dry mouth, constipation, blurred vision and drowsiness. These side effects should improve within a few days of starting the medication. Tell your GP if the side effects become a problem – they may prescribe another type of antidepressant.
Common side effects of SSRIs include blurred vision, dizziness and diarrhoea or constipation.
If your IBS symptoms are still causing problems after 12 months of treatment, your GP may refer you for a type of therapy known as a psychological intervention.
There are several different types of psychological therapy. They all involve teaching you techniques to help you control your condition better, and there is good evidence to suggest they may help some people with IBS.
Psychological treatments that may be offered to people with IBS include:
The availability of psychological interventions on the NHS may vary from region to region.
Some people claim therapies such as acupuncture and reflexology can help people with IBS. However, there is no medical evidence to suggest their effectiveness, and they are not recommended.