Irritable bowel syndrome (IBS) is a common, chronic gastrointestinal disorder affecting 10–20% of the population. It is typically characterised by recurrent abdominal pain and bowel dysfunction, significantly impairing quality of life. Although there is no definitive cure for IBS, symptoms can be effectively managed through an appropriate diet and lifestyle changes. In this guide, we set out in detail the principles of the IBS diet and prevention strategies that can help alleviate symptoms and make everyday life easier.
The specialists at the Endomedix Gastroenterology Centre are committed to providing their patients with the most up-to-date and personalised treatment options. Once a diagnosis has been made, appropriate treatment and dietary advice are key to successful management.
What is irritable bowel syndrome (IBS)?
Irritable bowel syndrome (IBS) is a functional bowel disorder, which means that there is no detectable organic abnormality, such as inflammation or a tumour, underlying the symptoms. IBS can be described as a disorder of the gut-brain axis, where communication between the gut and the nervous system is not functioning properly.
The main symptoms of IBS
IBS is diagnosed on the basis of the Rome IV criteria, according to which the patient must have experienced recurrent abdominal pain on at least one day per week over the past three months, accompanied by at least two of the following:
- The pain is related to bowel movements.
- The pain is associated with a change in the frequency of bowel movements.
- The pain is accompanied by a change in the consistency and shape of the stools.
Types of IBS
IBS is classified into four main types based on the predominant bowel movement disturbance:
- IBS-C (constipation): More than 25% of stools are hard and pellet-like (Bristol Stool Scale types 1–2), and fewer than 25% are loose or watery (Bristol Stool Scale types 6–7).
- IBS-D (diarrhoea-predominant): More than 25% of stools are loose or watery (Bristol Stool Scale types 6–7), and fewer than 25% are hard (Bristol Stool Scale types 1–2).
- IBS-M (mixed type): More than 25% of bowel movements are hard and more than 25% are loose.
- IBS-U (unclassifiable): The symptoms meet the criteria for IBS but do not fall into any of the previous three categories.
Possible underlying causes and risk factors
The exact cause of IBS is unknown, but a number of factors may contribute to its development:
- Genetic and epigenetic changes: A pattern of familial clustering can be observed.
- Previous infections: It may develop following certain gastrointestinal infections (post-infectious IBS).
- Stress and psychological factors: Chronic stress, anxiety and depression can exacerbate symptoms.
- Negative experiences in early life: Traumatic events may also contribute to the development of the condition.
- An imbalance in the gut flora: Small intestinal bacterial overgrowth (SIBO) is also common in IBS.
Dietary strategies for managing IBS
Diet plays a key role in managing the symptoms of IBS. The aim is to develop a diet that alleviates symptoms without causing nutritional deficiencies. The specialists and dietitians at the Endomedix Gastroenterology Centre can help you put together a personalised diet plan.
The role of fibres
Fibre may play a dual role in IBS. It is important to distinguish between soluble and insoluble fibre.
- Soluble fibre: When dissolved in water, it forms a gel-like substance which helps to normalise stool consistency. It effectively alleviates the general symptoms of IBS and abdominal pain. It is recommended to start by consuming them in low doses (3–4 g per day) and then gradually increase the amount to avoid bloating. Good sources include oats, barley, psyllium (plantain husk), apples, carrots and citrus fruits.
- Insoluble fibre: This does not dissolve in water and increases the bulk of the stool. These should be avoided as they can exacerbate symptoms, particularly pain and bloating. Examples include wheat bran, wholemeal products and nut shells.
Low-FODMAP diet
FODMAP is an acronym standing for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These are short-chain carbohydrates that are poorly absorbed in the small intestine and are rapidly fermented by bacteria in the large intestine, leading to gas, bloating, abdominal pain and diarrhoea.
The low-FODMAP diet is one of the most effective second-line treatments for alleviating the symptoms of IBS. The diet consists of two main phases:
- Elimination phase (6–8 weeks): Removing all high-FODMAP foods from the diet. These include, for example, wheat, onions, garlic, dairy products, pulses, lentils, and certain fruits (e.g. apples, pears, mangoes) and vegetables.
- Reintroduction phase: Once symptoms have subsided, foods belonging to each FODMAP group are gradually reintroduced, one at a time, to identify which ones cause symptoms and what quantities can be tolerated.
It is important that the low-FODMAP diet is followed under the supervision of a healthcare professional, such as a dietitian, as an overly restrictive diet can lead to nutrient deficiencies.
Other dietary considerations
- Gluten-free diet: There is no clear evidence to suggest that a gluten-free diet is generally recommended for IBS, unless the patient also has coeliac disease or gluten sensitivity.
- Probiotics: Certain probiotics may be effective in alleviating general symptoms and abdominal pain. As there is no single strain or preparation that can be universally recommended for everyone, it is advisable to consult a doctor or dietitian. Probiotics should be taken as a course of treatment (for a maximum of 12 weeks), and if symptoms do not improve, you should stop taking them.
- Peppermint oil: When taken in capsule form, it can be effective in relieving abdominal pain and cramps.
Lifestyle advice and prevention
As well as diet, lifestyle is also key to managing the symptoms of IBS.
- Regular exercise: Physical activity has been shown to have a beneficial effect on digestion, particularly in cases of constipation-predominant IBS. Regular walking or light exercise can help stimulate bowel movements and reduce stress.
- Stress management: As chronic stress can exacerbate symptoms, it is important to learn effective stress management techniques. Mindfulness, cognitive-behavioural therapy, relaxation training and hypnotherapy can all be used successfully.
- Adequate sleep: Restful sleep is essential for a healthy digestive system. Try to establish a regular sleep routine.
- Keeping a food diary: This can help you identify the foods and situations that trigger or exacerbate your symptoms.
Medication treatment options
When dietary and lifestyle changes do not bring about sufficient improvement, medication may also be required. Treatment is always targeted at the predominant symptoms.
- Antispasmodics: They effectively relieve abdominal pain and cramps.
- Anti-diarrhoea medicines (e.g. loperamide): These can be used in cases of IBS with diarrhoea.
- Laxatives (e.g. polyethylene glycol): These may help with constipation-predominant IBS.
- Antidepressants: At low doses, tricyclic antidepressants may be effective in relieving abdominal pain, particularly in cases involving diarrhoea.
- Antibiotics (e.g. rifaximin): These may be useful in IBS with diarrhoea, particularly if SIBO is the underlying cause.
- New-generation medicines (e.g. eluxadoline, lubiproston): These have been specifically developed to treat the symptoms of IBS.
When should you see a doctor?
Although IBS is a chronic but benign condition, it is important that the diagnosis is made by a specialist. Consult a gastroenterologist if your symptoms persist. A medical examination is particularly important if you experience so-called „alarm” symptoms, such as:
- Significant, unintentional weight loss
- Blood in the stool
- Symptoms that occur at night and wake you from sleep
- Iron deficiency anaemia
- A family history of inflammatory bowel disease or bowel cancer
The Endomedix Gastroenterology Centre offers modern diagnostic procedures and experienced specialists to rule out other, more serious conditions and confirm a diagnosis of IBS.
Summary
Irritable bowel syndrome is a complex condition that requires a personalised approach to treatment. Once a correct diagnosis has been made, a combination of an appropriate diet, regular exercise and stress management can significantly improve quality of life. Adjusting fibre intake, trying a low-FODMAP diet and taking probiotics can all be effective strategies.
Please remember that you don’t have to cope with your symptoms on your own. The team of experts at the Endomedix Gastroenterology Centre is on hand to help you with diagnosis and to draw up the most effective treatment plan, so that you can regain the health of your digestive system and peace of mind in your daily life.
