Irritable bowel syndrome (IBS) | Mate tikotiko

Irritable bowel syndrome (IBS or mate tikotiko) is a common gut condition, with symptoms including cramping, bloating, diarrhoea and constipation. Diet and lifestyle changes can help to improve your symptoms.

On this page, you can find the following information:

Key points about IBS

  1. IBS is a chronic (ongoing) gastrointestinal (gut) condition. IBS is not the same as inflammatory bowel disease (IBD), which mainly refers to 2 long-term serious conditions, Crohn’s disease and ulcerative disease.
  2. IBS can be uncomfortable but is usually harmless. Symptoms include bouts of abdominal (tummy) discomfort and pain, bloating and changeable bowel habits from diarrhoea (runny poo) to constipation (hard poo).
  3. IBS affects 1 in 7 people and is more common in women than men, and in those aged under 50.
  4. There are simple first line dietary and lifestyle changes that can help improve your symptoms (see treatment options for IBS). This includes keeping active and working to manage stress. However, if symptoms are not relieved by first line treatment options trialling a short-term low-FODMAP diet has also been shown to help
  5. If your symptoms are ongoing despite dietary and lifestyle changes, talk to your healthcare provider about medicines to help relieve specific symptoms.

(NHS, UK, 2022)

What causes IBS?

The exact cause of IBS is still not certain. However, there is emerging evidence that changes in your gut bacteria and inflammation of your immune system may play a role in its development.

In particular, factors that contribute to IBS are thought to be:

  • sensitivity – you may have a more sensitive gut (sometimes called ‘visceral sensitivity’)
  • digestion speed – the contents of your gut may move unusually quickly or slowly (sometimes called ‘altered gut motility’)
  • bacteria – you may have an imbalance of ‘good’ and ‘bad’ bacteria in your gut (sometimes called ‘dysbiosis’)
  • leaky gut – your gut may be slightly inflamed or ‘leaky’, eg, it may have small cracks or openings that allow partially digested food, toxins and bugs to get through the gut barrier
  • infection – you may have had an infection, such as gastroenteritis, that trigged the IBS. 

What are the symptoms of IBS?

The most common symptoms of IBS are abdominal pain or discomfort, often reported as cramping, along with changes in bowel habits. 

Usually the pain or discomfort will be associated with at least 2 of the following 3 symptoms:

  • Feeling better after having a bowel movement.
  • Having bowel movements more or less often than usual.
  • Having diarrhoea or constipation as defined below:
    • diarrhoea – having loose, watery stools (poo) 3 or more times a day and feeling urgency to have a bowel movement
    • constipation – having fewer than 3 bowel movements a week. Stools can be hard, dry and small, making them difficult to pass. Some people find it painful and often have to strain to have a bowel movement.

For a diagnosis of IBS, these symptoms must occur at least 3 times a month.

Other symptoms of IBS may include:

  • feeling that a bowel movement is not completely finished
  • passing mucus – a clear liquid made by your gut that coats and protects its tissues
  • urinary incontinence (not able to control your bladder)
  • faecal incontinence (not able to control your bowel)
  • feeling bloated.

What triggers symptoms of IBS?

IBS can be triggered by diet and lifestyle, especially stress and anxiety. 

Most people with IBS notice that food triggers symptoms. Common trigger foods include:

  • dairy
  • fatty foods
  • spicy foods
  • fizzy drinks
  • caffeine
  • artificial sweeteners. 

Additionally, a group of short-chain carbohydrates called FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) are also known to trigger symptoms in some people.

When should I seek medical advice?

If you have the symptoms above, see your healthcare provider for a check-up. See them immediately if have any of the following symptoms: 

How is IBS diagnosed?

Your healthcare provider will usually make a diagnosis based on your symptoms. Because the symptoms of IBS are similar to those of more serious conditions, you may have one or more of the following tests:

What can I try if I have IBS?

There is no cure for IBS, but there are treatments that can make a big difference. Talk to your healthcare provider about what might be best for you. 

The following approaches help a lot of people to manage their symptoms.

Keep a food, mood and symptom diary

Keep a diary of your symptoms and what you have changed (food or lifestyle). It will help you to see when you are feeling better and when you are feeling worse. Take note of how you felt as well, as feelings like stress and anxiety can affect your symptoms.

Eat mindfully and regularly

  • The gut loves regularity so eating meals at regular times throughout the day (and not skipping meals!) will help your digestion. This may mean 3 main meals or 3 smaller meals with snacks in between. Intermittent fasting is not useful for people with IBS as skipping meals can slow down your digestion.
  • Make sure you chew your food and eat slowly to support your digestion.
  • Eat to your level of hunger. Often we eat out of habit, so before eating, ask yourself how hungry you are. If you’re not very hungry, have a smaller meal or snack. Stop eating when you are full or comfortable. This will also help you eat more regular meals.

Choose nourishing foods

Eat a variety of foods from the 4 food groups. Learn more about the 4 food groups and healthy eating. 

Food swaps for specific symptoms

Certain foods are known to make symptoms worse.

For diarrhoea:

  • Replace fluids by drinking 8-10 cups of water per day.
  • Limit aggravating foods such as fatty foods, spicy foods, caffeine and alcohol.
  • Have a break from artificial sweeteners, usually found in chewing gums and sugar free drinks.
  • Slightly reduce insoluble fibre intake and slowly eat more soluble fibre. Learn more about fibre.
  • Trial a dairy free diet for two weeks. Try lactose free milk, soy, oat or almond milk. Hard cheeses like Edam and tasty have no lactose, so you can still eat these. After two weeks, if it makes no difference, re-introduce dairy back in.

For constipation:

  • Try to slowly increase your fibre intake with whole gains, fruits, vegetables, legumes, nuts & seeds. Learn more about fibre.
  • Try green kiwifruit (1-2 per day) or prunes (1-4 per day).
  • Drink at least 8 glasses of fluid each day
  • Try whole or ground linseed: start with 1 teaspoon per day and increase every few days to a maximum of 3 teaspoons. Make sure you have 50mls of fluid with each teaspoon of ground linseed.
  • Try Psyllium husk, which is available on prescription from your healthcare provider. Start slow increasing from 10g to 30g over 2–4 doses throughout the day, trial for 3 months.

For reflux/indigestion:

  • Eat small, frequent meals.
  • Sit upright after eating; reclining or lying down will make reflux worse. Avoid eating within 1–2 hours of sleep.
  • Avoid fizzy drinks, alcohol and caffeine.
  • Reduce spicy foods and fatty foods.

Drink plenty – but choose wisely

  • Try to have at least 8 cups (250ml) of water a day.
  • Caffeine can irritate your gut. Try not to have more than 3 caffeine drinks (tea, coffee, cola) each day. Reducing your coffee intake may improve your symptoms.
  • Fizzy drinks may make bloating or reflux worse. Try not to have fizzy drinks.
  • Alcohol irritates and speeds up the gut, so try a period of reduced alcohol.

Managing Stress

Researchers have also found that reducing your stress can help to ease your symptoms. Read more about stress and how to manage it. 

Physical activity

There is evidence that being more active can help reduce your IBS symptoms. This may be because it helps digested food move through your gut, reducing gas and bloating. Read more about the benefits of physical activity.  

Cognitive Behavioural Therapy (CBT)

Because of the connection between the brain and the gut (the gut-brain axis), talking therapy such as CBT, has been found to be helpful in managing IBS symptoms.

Gut Directed Hypnotherapy

There is strong evidence to suggest that gut-directed hypnotherapy improves symptoms in people with IBS by 70-80%, which is as equally effective as the low FODMAP diet and there are no restrictive diets to follow. There are clinics that offer this in person, however a lower cost option are apps such as Nerva, a 6 week programme developed by a gastroenterologist at Monash University.

Should I be taking a probiotic?

Probiotics are live, beneficial bacteria found in fermented foods like yoghurt, kefir and tempeh or in pill form. The evidence to support the use of probiotics in IBS is inconclusive, there is some evidence behind certain strains so it’s best to speak to a dietitian. 

Probiotics may be beneficial for some people, but in others they may increase wind and bloating. 

If you want to trial a probiotic, it’s recommended you start slowly and try for a minimum of 4 weeks. If you don’t notice a change, or have an increase in your symptoms, stop taking them.

If you have tried all of the above tips and your symptoms don’t improve, it is recommended that you see a dietitian to follow a short-term low-FODMAP diet followed by a reintroduction phase.

What is the Low-FODMAP diet?

Research suggests that 3 in 4 people with IBS get symptom relief, usually within 1–4 weeks, from following a low-FODMAP diet. These positive effects can continue long term. It’s best if you can see a dietitian experienced in this diet to help support you make the changes needed. 

FODMAPs are either poorly absorbed in your small intestine or are not digestible.

Because they are poorly absorbed, they reach the end of your digestive system (the large intestine or colon), where most of your gut bacteria live. Here, your gut bacteria ferment them, producing gas. This leads to bloating and flatulence.  

FODMAPS also have an osmotic effect, which means they draw water into your colon (bowel). This can cause cramping and more bloating. 

Depending on your digestive system, the combination of producing gas and drawing water in can lead to inconsistent or excessive bowel movements, diarrhoea or constipation, and tummy pain.

This process is likely to be made worse by stress and lack of physical activity. 

Read more about the low-FODMAP diet and common foods containing FODMAPs. There is also an app developed by Monash University to help you follow this diet. It is important that after a period of 4–6 weeks of a low FODMAP diet you start to reintroduce foods that contain FODMAPs so that you don’t have a lifetime of restricted eating and can enjoy a variety of foods. 

It is strongly recommended that you get support from a dietitian throughout this process, as it is important to follow the diet correctly and to ensure you are still getting a balanced diet.

Are medicines used to treat IBS?

Medications are sometimes recommended to help treat IBS symptoms. Some examples include:

  • laxatives for relief of constipation
  • anti-diarrheal medications to relieve chronic diarrhoea
  • anti-spasmodic medications to assist in relieving abdominal pain and cramps
  • antidepressant medication to help with pain.

Read more about medicines for IBS.

Learn more

IBS Central Monash University, Australia
IBS resources Monash University, Australia
A Little Bit Yummy FODMAP made easy (paid membership)

References

  1. Irritable bowel syndrome in adults – not just a gut feeling BPAC, NZ, 2014
  2. Irritable bowel syndrome Crohn’s & Colitis, NZ
  3. Low FODMAP diet efficacy in IBS patients – what is the evidence and what else do we need to know? NZ Medical Journal, 2016
  4. Johannesson E, Ringström G, Abrahamsson H, Sadik R. Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects World J Gastroenterol. 2015 Jan 14; 21(2): 600–608.
  5. Qin H-Y, Cheng C-W, Dong Tang X-D, Bian Z-X. impact of psychological stress on irritable bowel syndrome World J Gastroenterol. 2014 Oct 21; 20(39): 14126–14131.
  6. Kinsinger SW. Cognitive-behavioral therapy for patients with irritable bowel syndrome: current insights Psychol Res Behav Manag. 2017; 10: 231–237.
  7. How effective is gut-directed hypnotherapy in people with IBS? Monash University, Australia
Credits: Health Navigator Editorial Team . Reviewed By: Dr Derek JY Luo, MBChB (Otago) FRACP, Consultant Gastroenterologist; Gabrielle Orr & Amanda Buhaets, NZ Registered Dietitians, Auckland Last reviewed: 08 Nov 2022