Irritable bowel syndrome

July 19th

Irritable bowel syndrome (IBS) affects 15 out of 100 patients older than 20 years, so what’s the best way to manage it using diet?

Presentation

Mrs S, 43, knows where every public toilet is in all the local shopping centres, petrol stations and cinemas in her area. She never knows what her bowels will do from one day to the next;

Mr F, a managing director of a busy company, likes to entertain clients at home. His wife, Mrs F, 60, worries to tears how she’ll explain her embarrassingly offensive wind at the dinner table.

These two women suffer from IBS, a common condition particularly in women in their late teens and older. It is marked by a series of symptoms that cannot be explained by other structural or biochemical reasons, and in 25% of cases is triggered by a bout of gastroenteritis.

Management

IBS can be triggered by stress and a range of emotions, so there appears to be an underlying link to the motility and sensory dysfunction of the gut with the brain.

Unfortunately, because there is no one cause, there is no one treatment shown to be effective in all cases. Management requires a longterm supportive approach while different treatments are explained and tried. These may include diet and bulking agents, probiotics, antispasmodics, alternative therapies, counselling and stress management.

Key symptoms of IBS

  • Abdominal pain or discomfort that is relieved by defaecation and passing of wind
  • Associated with a change in frequency or appearance of stools (diarrhoea to constipation)
  • Change in passage of stools from straining or urgency to incomplete evacuation
  • Passing mucus
  • Bloating, abdominal distension and offensive wind.

IBS Diet tips for patients

  • Eat 5-6 small regular meals across the day and avoid feeling full beyond comfort and overeating.
  • Relax and eat slowly, putting your knife and fork down between mouthfuls, and avoid eating on the run.
  • Drink plenty of water, especially if increasing fibre in the diet, but avoid carbonated drinks, caffeinated beverages (cola and coffee) and alcohol.
  • If you suffer from constipation, gradually increase fibre intake from a variety of different foods, aiming for 30 g of fibre a day. Some may find that the soluble fibre in fruit, vegetables, oats, psyllium and legumes is better tolerated than the insoluble fibre found in whole grains, nuts and seeds, which may worsen symptoms. For others, either may work. Take care when using unprocessed bran (no more than 1-2 tablespoons a day).
  • If you suffer from diarrhoea, try reducing intake of sugars – lactose and fructose. Lactose is found in milk, custard, ice-cream and some yoghurt) and high fructose foods including apples, pears, melons, paw paw, mango, honey, fruit juice and dried fruits.
  • Yoghurt containing good bacteria known as probiotics or a probiotic supplement may help correct bacterial overload in the gut if present.
  • Avoid high-fat foods such as fatty meats, fried foods, creamy sauces, pastries and takeaway meals if they make you feel unwell or if you need to lose abdominal fat.
  • Regular exercise may improve digestion and assist with weight management. Also try physical activity that includes stress management such as yoga and Pilates.
  • Avoid spicy foods such as chilli, onion, garlic and curries, which are common triggers for many IBS sufferers.
  • Peppermint or ginger tea may help settle the stomach and reduce wind and bloating.
  • Artificial sweeteners such as sorbitol and xylitol found in sugar-free chocolate and lollies may cause a laxative effect and excessive wind.
  • Reduce ‘windy’ vegetables such as legumes, cabbage, Brussels sprouts, cauliflower and broccoli.

Remember, food triggers for IBS are very individual, so only those foods that cause a problem should be removed from the diet – not whole food groups.

A balanced diet is still required for long-term health and disease risk reductio.

For further information on IBS, visit www.gastro.net.au, for patient support see www.ibis-australia.org.

References available at www.medicalobserver.com.au

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