Irritable bowel syndrome Te mate kōpiro māngeongeo
Irritable bowel syndrome (IBS) is a common condition that affects your digestive system. While it can be unpleasant, it does not damage your gut. It is often a lifelong condition but symptoms can change over time. Lifestyle changes and medicine can help.
Symptoms of IBS
The most common symptoms of IBS are:
- pain or cramps in your belly
- bloating or swelling in your belly
- runny poos (diarrhoea) or hard poos (constipation), or sometimes both
- mucus in your poo
- excessive farting (too much gas in your bowel).
Symptoms often happen when you are feeling stressed, or after you have eaten certain foods. They can come and go and last for a few days or up to a few months.
Causes of IBS
We do not know exactly what causes IBS but it seems to relate to:
- your bowel being more sensitive than usual
- food passing through your digestive system too fast or too slow.
IBS is very common, affecting around 1 in 7 people. It is more common in:
- women than men
- people under the age of 50.
Diagnosing IBS
Your healthcare provider can usually diagnose IBS based on your symptoms. They may:
- examine you
- ask about your symptoms
- ask about your family history
- talk about your health and lifestyle.
Other conditions can have similar symptoms to IBS, like coeliac disease and inflammatory bowel disease. Your healthcare provider may ask you to have a blood test and provide a poo (stool) sample to rule these out.
It is possible to have both IBS and coeliac disease, or IBS and inflammatory bowel disease. But this is not common.
In some cases, your healthcare provider may refer you to have a colonoscopy or gastroscopy. This is when a specialist doctor looks inside your digestive system.
Self care for IBS
Changing how and what you eat can help to improve your IBS symptoms. Changing your lifestyle can also help — such as being more active and learning to manage your stress levels.
Eat regular meals
Eat at regular mealtimes — breakfast, lunch, and dinner. This can help to keep your bowels regular. Do not skip meals, eat late at night or just before lying down.
Always sit to eat
Sit down to eat. Avoid distractions such as the TV, phone or computer, so you can focus on eating mindfully.
Eat slowly
Make sure you chew your food well before swallowing. This is important for good digestion.
Watch your portion sizes
Eating large meals may make your symptoms worse, especially if you have runny poos, pain or bloating. Have small meals and use your hand to judge portion size.
Portion sizes — Heart Foundation
Eat a variety of healthy foods
Every day have food from the 4 food groups:
- vegetables and fruit
- grain foods
- low-fat milk and milk products
- lean meat, chicken, seafood, eggs, legumes (cooked dried beans, split peas and lentils) nuts and seeds.
Change your fibre intake
In the past, people with IBS were told to eat more fibre, which can help with constipation. But we now know that this does not help everyone with IBS. Having too much of some types of fibre, such as wheat bran, can make bloating, farting, diarrhoea and pain worse.
High-fibre foods include:
- vegetables
- fruit
- nuts
- seeds
- legumes (cooked dried beans, peas and lentils)
- wholegrain breads and cereals.
Drink plenty of fluid
Drink at least 8 cups of fluid a day. Water is best. You might need to drink more if:
- the weather is hot
- if you are doing a lot of physical activity
- you are constipated or have runny poos (diarrhoea).
Avoid foods and drinks that make your symptoms worse
It may help to keep a diary and record whether certain foods and drinks make your symptoms better or worse. You can then avoid those that make them worse.
Common foods and drinks that may make your symptoms worse include:
- fried and high-fat foods, including many takeaways, cheese, cream cheese, sour cream, cream, ice cream, thick shakes, most dips and mayonnaise, coconut cream, potato chips, hot chips, pastries, pies, sausage rolls, and chocolate
- spicy foods
- caffeinated drinks, such as coffee, tea, cola and energy drinks
- fizzy drinks and fruit juice
- alcohol
- gas-producing foods, including onions, garlic, leeks, mushrooms, cauliflower and legumes such as baked beans, kidney beans, chickpeas, and lentils
- sugar-free chewing gum and mints.
Food intolerance and special diets
If your symptoms do not get better by following the suggestions above, you may have a food intolerance. In this case it may help to try a special diet such as a low-FODMAP diet to work out what foods you are intolerant to.
A dietitian can help you to work out if you have a food intolerance. Ask your healthcare provider to refer you to a dietitian.
Being active can help to:
- relieve stress
- keep your bowels regular
- reduce other IBS symptoms.
It can also help you to feel better about yourself.
Aim for at least 30 minutes of moderate physical activity most days. Be active in as many ways as possible — move more and sit less.
It may be best for you to stick to moderate exercise only. Intense, long duration forms of exercise such as long distance running or cycling may make IBS symptoms worse in some people.
Reducing stress can help many people to ease their IBS symptoms. Getting enough sleep and being physically active can help to reduce stress. Relaxation techniques such as calming breathing, yoga, tai chi or muscle relaxation exercises may also help.
Talking therapy such as cognitive behavioural therapy (CBT) has been found to help many people ease their IBS symptoms.
Cognitive behavioural therapy (CBT) — Healthify
There is strong evidence to suggest that gut-directed hypnotherapy improves symptoms in many people with IBS. There are clinics that offer this therapy in person.
You can also buy a gut-directed hypnotherapy app such as Nerva. This is a 6-week programme developed by Monash University.
Treatment for IBS
There is no cure for IBS. You may be able to manage your symptoms by changing how and what you eat, and making some lifestyle changes. You may also need to take some medicines or supplements.
Medicines and supplements
Antispasmodics help to relax the muscles in your digestive system. They include medicines such as mebeverine, hyoscine butylbromide and peppermint oil capsules.
These medicines can help to reduce stomach pain, cramps, bloating and wind.
You can only get mebeverine on prescription from your healthcare provider.
You can get hyoscine butylbromide on prescription from your healthcare provider, or after talking to a pharmacist.
You can buy peppermint oil capsules over the counter at your pharmacy and at some supermarkets. Do not take peppermint oil if you have heartburn, as it can make this worse.
Hyoscine butylbromide — My Medicines
A fibre supplement can help if you do not get enough fibre in your diet and you are constipated. It will make your poo denser and softer, which makes it easier to pass. But some fibre supplements can make bloating and gas worse for some people. This can usually be avoided by starting on a small dose and increasing it gradually.
Fibre supplements are also called bulk-forming laxatives or bulking agents. They include:
- Konsyl-D
- Metamucil
- Benefiber.
You can get fibre supplements on prescription or you can buy them over the counter at the pharmacy. You can also buy some fibre supplements at the supermarket.
Follow your healthcare provider's advice on how to take a fibre supplement, or follow the directions on the label. Make sure you drink at least 8 cups of fluid a day. This helps to stop the fibre supplement causing a blockage in your bowels. It may take 2 to 3 days before the fibre supplement helps your bowels to move.
If the fibre supplement does not help your constipation, you may need a different type of laxative. Ask your healthcare provider, pharmacist or dietitian what is best for you.
Anti-diarrhoea medicines such as loperamide work by slowing down how quickly poo moves through your bowel. They can also make your poo less watery.
Some antidepressants, such as amitriptyline and nortriptyline, can also help reduce IBS symptoms when taken at a low dose. They are not used if you have constipation as they can make this worse for some people.
Probiotics
Probiotics are 'good' bacteria that normally live in your gut. They are also in fermented foods such as yoghurt, kombucha and some dietary supplements.
There is some research that suggests taking probiotics may improve IBS symptoms. But we do not know by how much and exactly which types are most effective. Some probiotic supplements and fermented foods can also contain ingredients such as FODMAPs (a group of carbohydrates), which can make your IBS worse.
If you want to try probiotics, you should take one for at least 4 weeks to see if you get better. You can buy probiotics at your pharmacy and at most supermarkets. Follow the directions on the label.
Other supplements
Iberogast is a herbal solution that helps ease IBS symptoms in some people. You can buy it at your pharmacy. Follow the directions on the label. You should not take Iberogast if you are pregnant, breastfeeding or have liver disease.
Some people find some other foods and supplements such as aloe vera juice and curcumin help with their IBS. There is no good evidence these treatments work.