Irritable bowel syndrome is an extremely common condition, with women being affected more than men. Luckily the majority of sufferers experience only relatively mild symptoms. But for a proportion of people their IBS is much more severe, with the condition profoundly affecting every aspect of their lives.
As someone who still sees approximately 2,000 people affected by severe IBS each year, I remain convinced that education is an essential starting point in trying to manage the condition. Before trying to control your IBS you must have a firm diagnosis from your doctor to make sure nothing else is being missed.
In addition there is no “one-sizefits-all” treatment for IBS so it is more a case of trial and error to find the best treatment plan that suits you.
1. Be careful about eating too much unrefined cereal fibre
A high-fibre diet has for many years been recommended as the first-line treatment option for people with IBS. But despite often being the “healthy” choice, unrefined fibre can “irritate” the bowel and make the symptoms of IBS worse, especially if you have bloating, a loose bowel habit or both.
You may feel better if you avoid brown bread, pasta, wholewheat cereals and anything made with wholemeal and brown flour.
Rice Krispies is a good breakfast option as it is kind to the bowel and seldom causes problems.
2. Choose your fruit and vegetables carefully
Some fruit and vegetables contain a lot of carbohydrates that are not digested by our gastrointestinal system but are fermented by bacteria in the bowel. This leads to the production of gas and products that can irritate the bowel resulting in cramps, bloating and excessive wind.
These particular carbohydrates are called Fodmaps (fermentable oligo-di-monosaccharides and polyols) and it is often worth avoiding these for a while to see if that improves your symptoms.
Examples of fruit and vegetables high in Fodmaps include apples, pears, plums, cauliflower and watermelon. Those which are low include bananas, blueberries, potatoes and carrots.
There are Fodmaps apps on the internet and those from King’s College London or Monash University in Australia are particularly good.
3. If you have Diarrhoea with your IBS don’t be afraid to use medication
Try to control it with loperamide (it goes under the brand name of Imodium among others) which can be purchased over the counter. This medication is extremely safe and can be used to control an attack of diarrhoea. Some people even take it regularly if they have a persistently loose bowel habit with urgency.
Alternatively if you need to be sure that your bowels are not going to let you down in a particular situation you can take loperamide before the event, even if you don’t have diarrhoea at the time. Everybody needs a different dose to gain control so you need to work out the best dose for you by a process of trial and error.
The only side effect of loperamide, if you overdo the dose, is that you will become constipated for a while with some discomfort and bloating.
However this will soon pass if you don’t take any more of the medication.
4. Consider using laxatives on a daily basis
If you have IBS and constipation don’t be afraid of laxatives. It is a complete myth that laxatives damage the bowel in any way, even if taken long-term over many years.
The best way to use a laxative is to take the lowest effective dose on a regular, daily basis rather than larger doses intermittently which are more likely to result in an unpredictable and sometimes uncontrollable bowel habit.
Usually the best time to take a laxative is before going to bed and the most commonly used laxative in the UK is Macrogol which is available in any pharmacy. Lactulose is another popular laxative but it can cause a lot of wind and bloating and doesn’t usually suit people with IBS.
5. Avoid stress as much as possible
IBS is not caused by stress. However it can be made worse by stress and therefore it is important to try to address stress issues, although this is easier said than done. Relaxation techniques are worth exploring and moderate exercise can sometimes help.
Other lifestyle changes worth considering include avoiding irregular meals, late-night meals, large meals and irregular bedtimes. There is no doubt that sleep deprivation can make your symptoms worse and shift workers often struggle if they have IBS. Adequate fluid intake is important, but then drinking excessive amounts of water does not improve IBS and just puts a strain on the bladder which is often a bit “irritable” in IBS, even if you drink normal amounts of fluid.
Making lifestyle changes can be a challenge but the important thing to remember is that you are gradually taking control of your symptoms. l Take Control Of Your IBS by Professor Peter Whorwell (Vermilion, £12.99) is now available in all good bookshops.
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