Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) affects at least 10 to 15% of adults.  This is usually due to foods eaten, stress, anxiety, some drugs, and even hormones.  People with irritable bowel syndrome may experience some or all of the following:

• diarrhea
• constipation
• gassiness
• cramps
• bloating
• nausea

Dealing with Irritable Bowel Syndrome

Dietary and lifestyle changes such as healthy eating, managing stress, and regular exercise can help to control symptoms.  Try the following to help you manage yours.

Healthy eating

• Eat a variety of foods from all four food groups in Canada's Food Guide to Healthy Eating. This includes choices from Grain Products, Vegetables and Fruit, Milk Products and Meat/Alternatives.
• Eat 3 small regular meals and 2 to 3 snacks per day.  Follow this pattern daily.
• Choose foods higher in fibre. Aim for 25-30 grams/day.
• Limit spicy and high-fat foods.
• Limit alcohol and caffeine.
• Eat in a relaxed, quiet environment.
• Eat slowly and chew your food well.
• Avoid eating "on the run" or while watching T.V. so you can pay attention to how much, and how fast you eat.
• Avoid eating late at night so your food has time to digest.

Stress management
Bowel symptoms may worsen during periods of stress or emotional upset.  Relaxation and stress management techniques often help relieve anxiety and reduce symptoms associated with IBS.

Regular exercise
Exercise is important for good health and may help alleviate stress and symptoms of discomfort.

Several factors can cause or worsen a "flare-up" (attack) of diarrhea or constipation.  Use the tips below to help you manage your symptoms.

Managing diarrhea

Certain foods and drinks may cause diarrhea.  Here are some tips to help prevent or to help control diarrhea if it occurs:

Limit high fat and deep fried foods
These can cause the bowel to contract soon after eating.

Limit foods and beverages that contain caffeine 
Caffeine may worsen diarrhea and may cause cramping.

Limit alcohol consumption
Alcohol may increase spasms in some people.

Monitor fructose tolerance
Higher amounts of fructose may bother some people.  Fructose is a natural sugar found mostly in fruit drinks, fruit juices and honey.  It is also found in fresh and dried fruits, processed foods(pre-packaged and canned) and soft drinks.  Smaller amounts of these foods may be better tolerated.
 
Monitor artificial sweeteners
Some artificial sweeteners such as sorbitol may also worsen symptoms. Sorbitol is found in sugar-free drinks, candy and gum. 

Choose soluble fibre
Foods higher in soluble fibre, such as oat bran, oatmeal, barley, rice, applesauce, bananas, pears and potatoes may help lessen diarrhea by thickening the stool.

Choose less irritating foods
When you have diarrhea, try the following foods as they may not upset your bowel as much as others. 

• Foods rich in protein such as chicken, fish, eggs, cheese, and smooth peanut butter.
• Lower fibre foods such as white bread, pasta, melba toast and muffins without nuts and seeds.  Plain cereals such as Cheerios TM , Special K TM, Rice Krispies TM, Cream of Wheat TM and oatmeal are also good choices.
• Cooked or canned fruits such as apple, fruit cocktail, apricots and peaches and vegetables such as carrots, green/yellow beans, potatoes, mushrooms, zucchini and beets.

Replenish fluids
There is a risk of dehydration with diarrhea due to the loss of water through the stool.  Drink at least 8 glasses (2 L) of non-caffeinated fluid each day when your bowel movements are loose, watery and frequent.

Supplementation
Consider taking a calcium supplement if your intake of dairy foods is low.  Check with your doctor, dietitian or pharmacist for advice on supplements.

Managing constipation

Increase your fibre and fluid intake 
High fibre foods will help hold water in the stools and increase stool size.  An increased fluid intake is needed to keep the stool soft.

Increase fibre slowly
Too much fibre too quickly can cause cramping, bloating and gas.  Your body will adjust to the increase in a few days.

Good high fibre choices include:

• Whole grain cereals and breads like All Bran TM, Red River TM, Bran Buds with psyllium and multigrain breads and bran muffins.  Choose cereals with more than 4 grams of dietary fibre per serving.
• A wide variety of vegetables and fruit, including dried fruit such as prunes, dates, raisins.
• Legumes, such as dried peas, beans and lentils.
• Taking psyllium, a natural fiber, with water may help. It is sold as Metamucil® or Prodiem®

Laxatives
Use laxatives only if the doctor suggests them.  Try making diet and lifestyle changes first. 

Fluid
To prevent constipation, drink at least 8 cups (2 L) of fluid per day.

Stay active
Exercise helps to promote regularity and has many other health benefits.  Find an activity you enjoy and go for it!

Preventing gas/bloating

Meal time
The amount of food you eat, how often you eat, and the types of foods you eat can all contribute to gas and bloating.  Smaller, regular meals in a relaxed environment may help to lessen symptoms.  Limiting gas-forming foods can also be helpful.

Gas forming foods
Reduce your intake of spicy and fried foods.  Carbonated beverages like pop and beer, and vegetables such as onions, beans, brussel sprouts, turnips, peppers, radishes, broccoli and cabbage can also cause discomfort for some people. 

Not everyone will react the same to these foods.  Keep a diary of the foods that bother you most.

Avoid swallowing air 
Avoid chewing food quickly, talking while eating, using a straw with drinks, and drinking from bottles.  Sipping on very hot or cold beverages and chewing gum or sucking on candies can also increase the amount of air swallowed.

Over-the-counter products
Products like Gas-X® or Beano® may help to relieve gas. 

Lactose Intolerance?

Milk and milk products contain important vitamins and minerals like calcium and vitamin D, which help to build strong bones.

Some people may experience a temporary intolerance to lactose.  Lactose is the sugar found naturally in Milk & Milk Products.  Symptoms may include gas, cramping, bloating and diarrhea shortly after drinking milk or eating milk products.  You do NOT have to avoid milk & milk products.  Here are some tips to help you enjoy them:

• Spread your milk products out during the day.
• Take smaller amounts of milk products with meals and snacks.
• Add lactase (an enzyme that helps digest lactose) available as Lactaid  pills or drops.
• Try Lactaid milk.
• Soy or rice milk is naturally lactose free.  Choose products fortified with calcium and vitamin D.

*Your doctor can diagnose a true long-term lactose intolerance.

Find a solution… keep a food diary

Keep a record of what you eat and when you experience symptoms.  This may help you identify foods that make your symptoms worse.

On your food record, include the date, time, what you ate, how much, general anxiety or stress level, and  symptoms of diarrhea, constipation, bloating, cramps, and nausea.  Be sure to write down if the symptoms are mild or severe.

When to contact your doctor

If your bowel habits change or your symptoms worsen, call your doctor.  Anemia, bleeding, weight loss, fever, or continuous or severe diarrhea are not symptoms of IBS and a doctor should be called immediately.

For more information

For health advice and information 24 hours a day, seven days a week, call Capital Health Link at 408-LINK (5465) or, outside the local Edmonton calling area, call toll-free 1-866-408-LINK.

Disclaimer
Reviewed by Alberta clinical experts. Brought to you by HealthLink Alberta. Copyright.
This material is designed for information purposes only. It should not be used in place of medical advice, instruction and/or treatment. For more health advice call Capital Health Link at 780-408-LINK (5465) 24 hours a day, seven days a week. In Alberta, call Toll-free: 1-866-408-LINK (5465)