What Triggers IBS?
Once a person has IBS, certain factors may lead to a ‘flare-up’ of symptoms. These include:
Food. Although the connection between food allergy and IBS is not known, certain foods may worsen symptoms of IBS. Foods containing sugars called FODMAPs – fructans, oligosaccharides, disaccharides, monosaccharides and polyols – may exacerbate symptoms by increasing gas production in the intestines.
Stress. Stressful life events or long-term stress may worsen the symptoms of IBS. Stress alters the nerves and hormones that signal the ‘second brain’ in the gut, the enteric nervous system, and affects digestive processes.
Hormones. Hormones such as those involved in the menstrual cycle may trigger symptoms of IBS. This is why women have higher rates of IBS than men and may experience worse symptoms during menstruation. (16, 17, 18)
How is IBS treated?
There is no cure for IBS. Many people with mild IBS do not require treatment. For more severe IBS, many treatments available and involve changes in diet, psychological treatment, or drug treatment. These aim to relieve symptoms of IBS and are listed below:
Medications for IBS
A wide range of medications may improve symptoms of IBS. These include over-the-counter medications such as:
Fiber supplements: such as psyllium (Metamucil) to decrease constipation in constipation-predominant IBS.
Antispasmodic medication: Such as alverine citrate to reduce spasming of the colon and abdominal pain.
Probiotics: These change the bacteria in the gut to alter the speed of contents through the bowel and decrease inflammation. This may improve constipation or diarrhea.
Laxatives: These may be used in constipation-predominant IBS to improve the movement of contents through the intestines.
Stronger medications for IBS may be prescribed by your GP, including:
Antidepressants. Such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) in small doses to relieve abdominal pain in IBS. These medications may also improve symptoms of anxiety and depression.
IBS-specific medications. Such as lubiprostone and linaclotide for constipation-predominant IBS and eluxadoline for diarrhea-predominant IBS.
Antidiarrhea medications. Such as loperamide to reduce diarrhea in diarrhea-predominant IBS.
Pain medication. Such as opiates like codeine may relieve abdominal pain, and reduce symptoms of diarrhea. (19, 20)
Dietary therapy for IBS
Making changes to diet can improve symptoms since most people with IBS (90%) report symptoms worsen after eating certain foods. The low FODMAP diet eliminates foods that are not easily broken down by the gut, relieving symptoms. A dietitian will guide you to avoid high FODMAP foods such as:
Vegetables: onion, garlic, leek, broccoli, cauliflower, cabbage, peas, shallots
Fruits: apples, canned fruits, watermelon, peaches, dates, figs, pears
Dairy products: milk, ice-cream, cheeses, whey protein powder
Wheat products: bread, wheat-based breakfast cereals, biscuits, pasta
Legumes: baked beans, chickpeas, kidney beans, lentils, soy
In general, the low FODMAP diet involves 2 phases:
Elimination phase. Removing high FODMAP foods listed above from the diet.
Reintroduction phase. Slowly bringing foods back into the diet, one by one, to see if symptoms reappear. If a food does not trigger symptoms it may be kept in the diet. (21)
Psychological therapies for IBS
A GP may recommend psychological treatments if you have had IBS for a long time, or if other therapies are not working. The mind-body connection has been proposed for IBS and is gaining scientific attention. Stress often worsens IBS symptoms, and these therapies may help relieve symptoms by reducing stress and anxiety:
Gut-directed hypnotherapy. This psychological approach alters how the brain responds to signals from the gut. After hypnotic induction, the person with IBS is prompted to visualize their gut as a series of tubes with free-flowing contents, which helps restore bowel activity. Hypnotherapy has been shown equally effective to the low FODMAP diet for IBS in a 2016 trial, without requiring diet change (22), as is the gold-standard therapy for IBS. You can access gut-directed hypnotherapy at home using our program, Nerva.
Cognitive-behavioral therapy. People with IBS are taught how to challenge negative thoughts about their symptoms and adopt a more positive outlook. This helps to reduce rumination about IBS which has been shown to worsen symptoms. A range of techniques are used in this therapy such as graded exposure towards fearful stimuli, and activity scheduling. (23)
Relaxation techniques. Eastern practices such as yoga and meditation have been shown effective in reducing symptoms of IBS. These treatments are thought to act through the gut-brain connection to relieve tension and pain in the abdomen. Exercises such as diaphragmatic breathing, progressive muscle relaxation, and visualizing positive imagery, may also relieve symptoms. (24, 25)
What is the outlook for IBS?
IBS can be a very distressing condition and since the exact cause is not known there is no cure. As a chronic condition, patients often suffer from IBS for many years. However, understanding IBS and seeking appropriate treatment for your subtype can reduce the severity of symptoms.
What is science investigating?
Modern science is delving into the gut-brain connection to identify the cause of, and discover new treatments for IBS. In 2016 researchers showed hypnotherapy is comparable to the low FODMAP diet in relieving symptoms of IBS. A study from 2019 showed that hypnotherapy delivered online via Skype was almost as effective as face-to-face treatment. These represent the cutting edge in IBS research, and it is likely more psychological based therapies will be available on digital formats in the future. (22, 26)
A Word from Mindset Health
IBS is a chronic condition, and common symptoms are abdominal pain, cramping, bloating and flatulence. Diagnosis of irritable bowel syndrome is made based on abdominal pain and a change of bowel habits, either constipation or diarrhea. Risk factors are being female, young and living in a western country, being post-infectious and family history may also play a role. IBS treatment may involve medications such as anti-diarrheal, peppermint oil, antispasmodics such as dicyclomine, lubiprostone, tricyclic antidepressants. However, due to the side effects of medication, psychological therapies such as gut-directed hypnotherapy and lifestyle changes such as adopting a low FODMAP diet and keeping a food diary may be preferred. If a person experiences rapid weight loss, bloody stools or other severe symptoms, the cause may not be a functional gastrointestinal disorder but a more serious condition. In this case, blood tests, colonoscopy and further testing may diagnose Crohn's disease or ulcerative colitis. Additional treatment options may be presented to provide the best health care for these inflammatory bowel diseases (IBD) by a gastroenterologist.
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