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Routine, Routine, Routine…
We all generally function better when we have a set routine and your bowels are no different – especially when you have IBS.
It’s important to eat your meals at approximately the same time each day – this includes weekends!
Slowing down is also important. Many of us have busy schedules and often meal times are rushed. This tends to cause more stress on the bowel and aggravates IBS symptoms. Take enough time with meals, chew properly and don’t rush.

Drinking
Maintaining good hydration levels is important with IBS – ensure you are drinking at least 2 litres per day of mainly water (unless you have any other medical condition which requires you to restrict your fluid intake).
In patients that are constipated the fluid works with fibre in the diet to help relieve constipation. In individuals who have diarrhoea predominant IBS the fluid intake is important in recouping the fluid loss through loose motions.
Caffeine should be limited to no more than 2-3 cups of tea / coffee per day. This is due to caffeine stimulating bowel movements which can worsen symptoms. Furthermore, alcohol and carbonated drinks should also be minimised as both can worsen symptoms of diarrhoea. Low sugar drinks and those with added sweetener should also be avoided as they contain sorbitol which can lead to bloating and diarrhoea.

Probiotics
Probiotics are now readily available and can come in the form of capsules, drinks and yoghurts. They help to replace the “bad” bacteria in our bowels with “good” bacteria. Some studies have shown an improvement in IBS symptoms (abdominal pain and bloating) when using probiotics, however they do not seem to work for everyone.
The consensus is to try a particular probiotic for at least 4 weeks to assess response.

Not all fibre is equal
We are often told that having fibre is an important aspect of our diet but in patients with IBS it can exacerbate symptoms.
There are two main types of fibre – soluble and insoluble.
In patients with diarrhoea predominant IBS it is advisable to reduce insoluble fibre. This type of fibre does not easily dissolve in water and is found in whole-wheat bread, brown rice, and cereals. It adds more bulk to the stools which can make bloating and diarrhoea symptoms worse.
Soluble fibre is found in oats, barley, fruit and vegetables. It dissolves in water and forms a soft gel which can help aid the passage of stool. Increasing soluble fibre can help relieve symptoms in patients with constipation predominant IBS.

What are FODMAPs?
FODMAP stands for fermentable oligo-saccharides, di-saccharides, mono-saccharides and polyols.
These are essentially carbohydrates that are not well digested and enter the large bowel. Once there they draw in water in the large bowel and are fermented by gut bacteria leading to production of excess gases. This in turn can cause bloating and abdominal pain.
Having a low FODMAP diet has been shown to improve IBS symptoms in up to 80 % of patients. Examples of foods that are high in FODMAPs are numerous, including apples, pears, sweeteners, milk, cheese and cabbage. It is important to attempt a low FODMAP diet in conjunction with your doctor and a dietician.

For more information or a comprehensive consultation with a bespoke management plan please contact us at the GP Clinic London.

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Do I have IBS?
IBS symptoms include the following:
Bloating
Abdominal pain
Diarrhoea
Constipation
Urgency to open bowels
Feeling of incomplete bowel emptying

The symptoms need to be present for at least 6 months in order to positively diagnose IBS. Stress and anxiety can trigger the symptoms or make them worse. Typically, the bloating and abdominal pain is worse after eating and better after opening the bowels. The bowel habits may be altered in different ways, some patients have diarrhoea, others constipation and some with a mixed / alternating pattern.

Other Causes
Seeing a doctor is important if you feel you may have IBS – the symptoms are non-specific and other conditions can cause similar symptoms.
It is important for a clinician to take a thorough history and examination to rule out inflammatory bowel disease (ulcerative colitis and Crohn’s) and coeliac disease. Other less frequently encountered conditions also need to be excluded depending on risk factors, age and symptoms. For instance, bowel cancer may present with a change in bowel habit and ovarian cancer can present with symptoms of bloating.
Blood tests are usually recommended as a first line investigation, but other tests may be required such as stool tests, abdominal / pelvis ultrasound and colonoscopy.
It is only if these tests come back as negative that a diagnosis of IBS can be made.

Red flags
If you have any of the following symptoms it is worth seeing a doctor as soon as possible to rule out any other causes. Sometimes these symptoms can be associated with potentially sinister conditions:
Blood in the stools
Weight loss
New onset symptoms after the age of 40

What Treatment is available?
It is important to tackle IBS symptoms with a holistic approach. We know that stress is linked closely with IBS symptoms so this is an important area to focus on. Exercise and relaxation practices such as yoga and meditation can be hugely beneficial. There is also some evidence that acupuncture can help. In some cases, psychological therapies like CBT (cognitive behavioural therapy) and hypnotherapy have been shown to be effective.
Diet is an important aspect of IBS management. Ensuring you eat meals at approximately the same time each day and at regular intervals can help with symptoms. Also maintaining good hydration throughout the day and cutting down on tea, coffee and alcohol can help.
Specific dietary changes can also result in improved symptoms – this includes changing the type of fibre that you consume and low FODMAP diets – see article “5 dietary changes for IBS patients” for more information.
There are different types of medication that can help:
For abdominal pain and bloating – antispasmodic medications that relax the bowel (such as hyoscine and mebeverine) can be helpful. Also peppermint oil capsules can significantly reduce bloating.
In patients with diarrhoea predominant symptoms the use of loperamide can settle loose stools. Bulk-forming laxatives can be used in constipation predominant IBS.
Second line treatments include the use of antidepressant medications (both tricyclic antidepressants and selective serotonin reuptake inhibitors) – they are used in lower starting doses than those used for depression. These medications require monitoring and follow up and can often result in a significant reduction in symptoms.

For more information or a comprehensive consultation and a bespoke management plan please contact us at the GP Clinic London.

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