The symptoms of irritable bowel syndrome (IBS) can often be managed by changing your diet and lifestyle, and understanding the nature of the condition.
In some cases, medication or psychological treatments may also be helpful.
Adjusting your diet
The first step in trying to reduce your symptoms of IBS is to follow a healthy, balanced diet. Aim to:
- eat regular meals including breakfast, lunch and an evening meal (if required, small snacks can be included)
- avoid missing meals or eating late at night
- take time over your meals, making time to sit down and chew your food well
Use the Eatwell Guide to help you include foods from each food group in your daily routine.
Having enough fluid is important for overall health. It may also ease your symptoms, especially constipation. This is also particularly important when increasing the fibre in your diet or to replace fluids lost when experiencing diarrhoea.
Try to have at least 8 cups or glasses (1.5-2 litres) of fluid per day (you may need more if you have diarrhoea or are increasing your fibre intake). Good choices include water, sugar free drinks and drinks with no caffeine. Aim to reduce fizzy drinks or those that are high in caffeine.
Caffeine is most commonly found in tea, coffee, energy drinks and cola. UK guidelines state that adults should have no more than 400mg of caffeine per day and no more than 200mg per day during pregnancy. If you think caffeine may affect your symptoms, try to reduce it further or eliminate it completely.
The following tables describe the typical caffeine content in common drinks. Check product labels for accurate amounts for specific brands and varieties.
Tips to reduce your caffeine intake include:
- Reduce your intake of tea and coffee and aim to switch to decaffeinated or naturally caffeine-free varieties such as herbal teas.
- Limit cola and iron brew. Decaffeinated varieties are available, but limiting fizzy drinks generally is best.
- Energy drinks such as Red Bull, Monster and Rock Star are very high in caffeine and should be avoided.
Alcohol can make IBS symptoms worse. Aim to follow recommendations for safe alcohol intake and drink no more than 14 units per week.
If you do drink 14 units, spread this out over three or more days and have regular alcohol-free days.
Read more about alcohol guidelines.
High fat foods should be limited as part of a healthy diet. They have also been shown to aggravate some IBS symptoms, especially diarrhoea. These foods include:
- fried foods
- fast food
To improve health and potential IBS symptoms only include these foods in small amounts and infrequently. Many reduced or low-fat varieties are available for a healthier alternative.
A sweetener called sorbitol can cause diarrhoea. This is found in some sugar-free sweets, chewing gum and mints. It can also be found in ‘diabetic’ and slimming products. Check the labels and limit these products.
Processed or reheated foods contain resistant starch, which can be difficult for your body to digest. Processed foods include:
- ready meals
- potato and pasta salads
- oven chips
- part-baked breads
These starches can aggravate wind, bloating and diarrhoea symptoms. To limit these, make your own meals using fresh foods wherever possible.
People with IBS are often advised to modify the amount of fibre in their diet. Foods that contain fibre include:
- wholemeal bread
Your GP may be able to advise on what your recommended fibre intake should be.
Low FODMAP diet
If you experience persistent or frequent bloating, a special diet called the low FODMAP diet can be effective.
A low FODMAP diet should only be followed if:
- you've followed the advice above and not had symptom relief
- you've seen your GP and had other issues ruled out
- you've been referred by your GP and have the support of a trained Specialist Dietitian
A low FODMAP diet isn't suitable for everyone and must only be used following a dietetic consultation.
The low FODMAP diet is a short term intervention following a process of not eating then gradually re-introducing foods to your diet to find out which foods affect your IBS symptoms.
Probiotics are dietary supplements that product manufacturers claim can help improve digestive health. They contain so-called "friendly bacteria" that can supposedly restore the natural balance of your gut bacteria when it has been disrupted.
Some people find taking probiotics regularly helps to relieve the symptoms of IBS. However, there is little evidence to support this. It's unclear exactly how much of a benefit probiotics offer and which types are most effective.
If you want to try a probiotic product, you should take it for at least four weeks to see if your symptoms improve. You should follow the manufacturer's recommendations regarding dosage.
A number of different medications can be used to help treat IBS, including:
- antispasmodics – which help reduce abdominal (stomach) pain and cramping
- laxatives – which can help relieve constipation
- antimotility medicines – which can help relieve diarrhoea
- low-dose antidepressants – which were originally designed to treat depression, but can also help reduce stomach pain and cramping independent of any antidepressant effect
All medication should be taken following the packet or a doctor's advice.
If your IBS symptoms are still causing problems after 12 months of treatment, your GP may refer you for a type of therapy known as a psychological intervention.
There are several different types of psychological therapy. They all involve teaching you techniques to help you control your condition better. There is good evidence to suggest they may help some people with IBS.
Psychological treatments that may be offered to people with IBS include:
- psychotherapy – a type of therapy that involves talking to a trained therapist to help you to look deeper into your problems and worries
- cognitive behavioural therapy (CBT) – a type of psychotherapy that involves examining how beliefs and thoughts are linked to behaviour and feelings, and teaches ways to alter your behaviour and way of thinking to help you cope with your situation
- hypnotherapy – where hypnosis is used to change your unconscious mind's attitude towards your symptoms
The availability of psychological interventions on the NHS may vary from region to region.
Reducing your stress levels may also reduce the frequency and severity of your IBS symptoms. Some ways to help relieve stress include:
If you are particularly stressed, you may benefit from a talking therapy, such as stress counselling or cognitive behavioural therapy (CBT).