Irritable bowel syndrome
Irritable bowel syndrome (IBS) is a chronic condition that affects the digestive system. It is quite common and can begin in childhood, adolescence or adulthood. It affects most commonly women.
IBS is characterized by recurrent abdominal pain occurring on average at least once a week, associated with two or more of the following:
- Pain related to stool evacuation
- Change in the frequency of stool
- Change in the form (appearance) of stool
Causes and triggers
We don't know exactly what causes IBS, but experts believe that a combination of several factors, such as genetics, gut bacteria, the nervous system, and stress, likely play a role in the development of this digestive disorder.
It may be the result of abnormal contractions of the colon and intestines (which can result in severe cramping) or even food sensitivities or allergies. Some theories suggest that an infection of the intestines, such as the traveller's diarrhea, may trigger IBS. Research is still ongoing for a better understanding of the causes of this syndrome.
Treatment
As IBS is a chronic condition, there is no cure. It's important to learn to recognize IBS symptoms and what seems to trigger them in order to manage symptoms and optimize treatment. Symptoms may also be alleviated by taking medication or making dietary or lifestyle changes. Most medications target the patient's primary symptom (diarrhea, constipation, or pain).
Dietary approach
Although food does not cause IBS, it can have an effect on its symptoms. Certain eating habits can help ease IBS-related discomfort or pain, including:
- Eating slowly and chewing food well
- Avoiding behaviours that could increase the ingestion of air (e.g., drinking soft drinks, chewing gum, talking while eating, eating quickly)
- Avoiding large meals or those that are high in fat
- Eating smaller portions
- Avoiding eating late at night
- Cooking vegetables before eating
- Staying hydrated (drinking between 1.5 and 3 L per day), especially if constipation is an issue
- Avoiding alcohol and caffeine
- Increasing soluble fiber intake (e.g., psyllium, oat, bran)
- Avoiding foods containing artificial sweeteners such as mannitol, sorbitol, and xylitol, as they may cause gas, bloating, or diarrhea
- Talking to your health care provider about taking probiotics, as some types may help relieve IBS symptoms
People with IBS are often less tolerant of certain food groups (e.g., legumes). These foods are designated by the acronym FODMAP: Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. If you have IBS, you may benefit from a personalized low-FODMAP diet.
These foods are designated by the acronym FODMAP:
- Fermentable
- Oligosaccharides (e.g., fructans and galactans)
- Disaccharides (e.g., lactose)
- Monosaccharides (e.g., fructose)
- And
- Polyols (e.g., sorbitol and mannitol)
If you have IBS, you may benefit from a personalized low-FODMAP diet.
If you decide to try a low-FODMAP diet, it is important to use suitable alternatives that are nutritious, and to make sure that you are maintaining a healthy, well-balanced diet.
It should also be noted that some FODMAP-containing foods that aren't usually well tolerated in large quantities may be tolerated if eaten in smaller quantities.
Consult an experienced nutritionist if you are interested in trying this approach.
| Not well tolerated | Well tolerated | |
|---|---|---|
| Vegetables | Garlic, artichoke, asparagus, beet, broccoli, cabbage, cauliflower, shallot, onion, leek, pea | Eggplant, carrot, pumpkin, celery, cucumber, squash, endive, green bean, lettuce, bok choy, spring onion (green only), parsnip, sweet pepper, potato, tomato |
| Fruits | Apricot, avocado, cherry, dried fruit, mango, watermelon, nectarine, peach, pear, apple, plum | Citrus fruit (orange, grapefruit, lemon, mandarin), ripe banana, blueberry, strawberry, raspberry, passionfruit, kiwi, honeydew melon, grape |
| Protein sources | Certain marinated or processed meats, legumes, cashew nuts, pistachio, dairy products (milk, yogurt, fresh and soft cheeses like ricotta or cottage) | Lactose-free dairy products, certain cheeses (brie, camembert, feta), seafood, pumpkin seeds, walnuts, macadamia nuts, eggs, tempeh, firm tofu, meat, poultry |
| Grains | Wheat or barley (in large quantities), inulin, corn, rye | Oats, spelt, gluten-free products, quinoa, rice |
| Sweeteners | Fructose, mannitol, honey, corn syrup, sorbitol, xylitol | Aspartame, maple syrup, table sugar |
| Miscellaneous | Mushrooms |
Psychological approach
Other conditions, such as anxiety, depression, headaches, and sleep disturbances are more common in individuals who have IBS. The following measures could be of some benefit:
- Exercise
- Get enough sleep
- Learn to better manage stress
- Consider gut-directed psychotherapy
Pharmacological approach
If these measures are not enough to adequately manage your IBS, your health care provider may suggest the use of probiotics or oil of peppermint, or may prescribe medication to help relieve some of your symptoms.
When should I see a healthcare professional?
- If there is blood in your stool
- If you have fever
- If you experience significant weight loss
- If you feel tired and are unusually pale
- If you have persistent diarrhea or chronic constipation
For more information:
Related services
- Nutrition consultation - Initial meeting
- Nutrition consultation (Follow-up meeting)
