Irritable bowel syndrome (IBS) is a common long-term condition, affecting around 12 million people in the UK. Typically causing abdominal pain and altered bowel movements, its symptoms vary between individuals, and can range from mild to severe. The condition can have a profound effect on everyday life.
Unfortunately, the precise causes are unknown, meaning there are no targeted medications capable of addressing what has gone awry. Although your doctor may prescribe certain drugs (for example, antidiarrhoeal or anti-constipation medicines), no single IBS drug will work for everybody. For people living with IBS, self-care strategies are essential.
Focus on food
In many cases, diet makes all the difference. Since the precise triggers are so individual, it may be helpful to work out your own pattern by keeping a food and symptom diary.
"In terms of diet, the basics are that people should be having regular meals, and they should try to avoid excess caffeine, alcohol and fizzy drinks," says Dr Simon Smale, a consultant gastroenterologist and medical adviser at The IBS Network. "If you’re doing all those things and your bowels are still a problem, it's worth considering specific exclusion diets such as the low-FODMAP diet, avoiding lactose or avoiding wheat."
The low-FODMAP diet has attracted particular attention in IBS circles. According to a growing body of evidence, FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) can contribute to IBS symptoms in those susceptible. Through cutting out certain hard-to-digest carbohydrates, many IBS sufferers will experience symptom relief.
"A low-FODMAP diet is meant to help people with IBS figure out whether certain sugars and fibres in their diets are symptom triggers," explains Patsy Catsos, a registered dietician and author of The IBS Elimination Diet and Cookbook. "The learning happens during the systematic process of eliminating high-FODMAP foods, then reintroducing them. The low-FODMAP phase is ideally temporary."
As she explains, high-FODMAP foods (which include the likes of onions, beans and milk) do not themselves cause IBS. People with resilient guts can eat these foods without problems, and can easily handle the extra gas and fluids that build up in their intestines.
"We know that IBS sufferers react differently to these foods, and we can often successfully manage symptoms by lowering the FODMAP content of the diet," she says. "But intolerance to FODMAPs is not universal among IBS sufferers. There can be other types of dietary triggers, such as fat intolerance, or food allergies. And often it just isn’t about the food."
Another significant contributor to IBS is stress, whether chronic or acute. Although the relationship isn't entirely clear, many IBS sufferers also live with psychological conditions such as generalised anxiety disorder.
"Stress and anxiety are important triggers for GI symptoms and recent studies suggest that behavioral therapies, like cognitive behavioural therapy or hypnosis, or yoga, offer similar benefits to the low-FODMAP diet in IBS patients," says Dr William Chey, a professor of GI and Nutrition Sciences at the University of Michigan.
"It's very helpful to make sure there are things you can do to manage your stress. Sometimes we find referring people to a psychologist can help," adds Smale.
While diet and stress are the most obvious places to begin, some IBS sufferers find relief through alternative therapies and herbal remedies. Peppermint oil, for instance, has been shown to alleviate IBS symptoms.
It's also important to take regular exercise. As well as improving overall well-being, exercise can speed up intestinal transit and alleviate constipation. (If you're more prone to diarrhoea, it may be wise to stick to gentler forms of exercise during flare-ups.)
One helpful tip when you're on the go would be to keep your Radar NKS Key handy. This can be purchased from Disability Rights UK and the IBS Network, and gives you access to more than 9,000 accessible toilets for the disabled around the UK.
Finally, a number of studies have shown that probiotic supplements can help treat IBS through balancing out your intestinal flora. However, this is not a one-size-fits-all solution, and you may find you need a little trial and error before finding the right one.
As Chey explains: "It is likely that different probiotics will work better or worse in individuals who have differences in their microbiomes and genetics."
Really, it falls to every individual - together with their medical practitioner - to find a self-management plan that's right for them. While this may involve a process of trial and error, the good news is that most IBS sufferers learn their triggers, driving an improvement in their condition over time.
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