Irritable bowel syndrome (IBS): Everything you need to know

Irritable bowel syndrome, or IBS, is the most common disorder of the gastrointestinal tract.

Symptoms may consist of recurrent abdominal pain (that often improves after a bowel movement), bloating, gas, mucous in stool, fecal urgency after eating and one or both of diarrhea and constipation. Heartburn may also accompany IBS.

IBS differs from diseases of the bowel, as it does not include structural issues, inflammation, ulcers and other physical damage.

What causes IBS?

The exact causes of IBS aren’t particularly well understood, but possible factors can include:

Change in the population of microbes that live in the gut – Bacteria and other microbes digest carbohydrates and fibre and produce gas as a byproduct. Shifts in the microbiome can change our food tolerance, gut motility, the amount of water in the stool and the amount of gas produced.

Hypersensitivity of the gut – In people with IBS, the nerves that connect the gut and brain are generally more sensitive than in those without IBS. Therefore, gas and muscular movements are often felt more strongly.

Emotional stressThe brain and gut have a direct link. Stress, anxiety and depression can have a direct impact on how our digestive tract functions. In addition, many neuroactive molecules, such as serotonin and dopamine, are produced by bacteria in the gut, so our gut health can impact our mental health, too!

Bacterial overgrowth in the small intestine – Bacteria can grow in the wrong place in some individuals. Causes include gastrointestinal motility issues, reduced acidity in the stomach or structural abnormalities of the GI tract.

How can you manage IBS?

Diet and lifestyle changes, supplements and medication can all be used to improve IBS symptoms. As symptoms of IBS are highly individualized, it is important to determine what works best for you and then create a management plan based on your unique symptoms.

Diet and lifestyle adjustments are a good starting place if you’re dealing with IBS. Take detailed notes on what you eat and the symptoms you experience, as well as the severity of your symptoms each time they occur. This information can help your healthcare team understand your IBS

Ensure you’re getting enough fibre through your diet or supplements. If you plan to increase your fibre intake, do so gradually, as it may reduce constipation for some people but can worsen gas and cramping for others depending on the source of the fibre. It’s also important to drink plenty of noncaffeinated fluids.

You may need to eliminate certain foods from your diet to reduce IBS symptoms. The support of a dietitian during an elimination trial is highly recommended. A dietitian can help you identify triggers, recommend alterations to your current diet, provide meal and snack ideas and ensure you’re still meeting your nutritional needs.

Foods to eliminate may include carbonated beverages, caffeine and foods high in FODMAPs. FODMAPs (fermentable oligo-, di-, monosaccharides and polyols) are categories of carbohydrates found in many foods, including certain grains, dairy and specific fruits and vegetables. Undigested or poorly digested carbohydrates can cause water to be drawn into the bowel resulting in loose stool or urgency. They also provide food for bacteria, which ferment the carbohydrates, producing gas as a byproduct.

Stress can also trigger IBS, in which case counselling has been shown to be a very effective treatment of symptoms. Optimal sleep and exercise can also help with symptom management.

Supplements can help with IBS symptom relief. Fibre supplements assist in absorbing water when stool is loose or can improve stool that is too hard. Probiotics may help to rebalance your microbiome and assist in improving symptoms, such as the form of stool or gas. Peppermint oil can help relax muscles in the digestive tract. Iberogast is a herbal remedy that can help with abdominal pain, bloating and nausea, as well as improve bowel motility. Finally, digestive enzymes may aid with digestion of excess FODMAPs for some individuals.

Medication, prescribed by your doctor if necessary, alleviates symptoms as well. Laxatives and IBS medications can increase fluid drawn into the digestive tract to help with constipation, anti-diarrheals can control diarrhea, tricyclic antidepressants can calm the neurons that control the intestines and help reduce pain, prokinetics can improve motility, antispasmodics can relax the smooth muscle of the GI tract and antibiotics can help reduce diarrhea for some individuals, as well as control bacterial overgrowth.

Are you suffering from IBS?

If you suffer from or suspect you may have IBS and it has not been reviewed by your healthcare team, set up an appointment with your doctor and dietitian. They can help you determine an appropriate management path and get you started toward relief.