Firstly, Irritable bowel syndrome (IBS) is a chronic, relapsing, and often lifelong disorder of the lower gastrointestinal tract, with no discernible structural or biochemical cause. IBS typically manifests with abdominal pain, an associated change in stool form and/ or frequency.
The exact cause and precipitating factors of IBS are variable and unique with elements of non-modifiable risk factors such as genetic factors, but it is clear that diet and lifestyle play a key role in symptom frequency and severity. This is solidified by up to 90% of people report that food triggers symptoms with psychosocial elements such as associated stress, anxiety and/or depression also directly impact IBS control. Therefore, we can target these aspects to significantly impact IBS management, with this in mind below are the top tips/ pieces of advice you can provide your patients with;
Food vs Symptom Diary
Knowing what you eat and your bodies reaction can help narrow down and highlight the food that trigger your IBS
Stress management
Stress management works by influencing the physiological functioning of the gastrointestinal tract via the brain-gut axis, and may affect the person's pain experience, symptom behaviour, expectations of treatment, and clinical outcome.
Stress management is a buzz phrase that is thrown around a lot in the social space of late, with many hints, tips and advices to better manage your stress response. I will not address all the ways and pathways you can undertake to destress but the value to IBS control could be the lifestyle alteration your patients need.
Confirm and target predominant factors/ symptoms
By highlighting the predominant symptoms, we can hone in on them in a more isolated manner;
o Diarrhoea/ bloating = A reduced intake of insoluble fibre, such as wholemeal or high-fibre flour and breads, cereals high in bran, and whole grains such as brown rice.
o Constipation – trail soluble fibre supplements (for example ispaghula) or foods high in soluble fibre (for example oats and linseed). By gradually increasing fibre intake we are able to minimize flatulence and bloating
- Lifestyle management and advice
o The general and holistic benefits of regular physical activity are well known and documented. In terms of IBS specific benefits, regular physical activity is theorised to reduce intestinal gas retention, improve gas transit time, reduce abdominal distention, and reduce colonic transit times in people with constipation. In addition, regular exercise may reduce stress and affect visceral hyperalgesia through central pathways, and encourage weight loss if the person is overweight or obese.
o Alcohol can induce or worsen IBS symptoms by affecting gastrointestinal motility, absorption, and intestinal permeability.
o Caffeine increases gastric acid secretion and colonic motor activity.
o Fatty foods affect small intestinal motility and stimulate the gastrocolic reflex, which may lead to spontaneous bowel movements in people with IBS.
In conclusion it is clear that due the IBS vast variability between patients its management should be individualised to the person's symptoms and psychosocial situation, and may include offering drug treatment and behavioural interventions, if symptoms persist despite initial dietary and lifestyle advice as stated above.
References
McKenzie, Y.A., Bowyer, R.K. and Leach, H. et al (2016) British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). Journal of Human Nutrition and Dietetics. 29(5), 549-575.
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