The symptoms of irritable bowel syndrome (IBS) can often be reduced by changing your diet and lifestyle, and understanding the nature of the condition.
In some cases, medication or psychological treatments may also be helpful.
Changing your diet will play an important part in controlling your symptoms of IBS. However, there is no "one size fits all" diet for people with IBS. The diet that will work best for you will depend on your symptoms and how you react to different foods.
It may be helpful to keep a food diary and record whether certain foods make your symptoms better or worse. You can then avoid foods that trigger your symptoms. But it is important to remember these foods do not need to be avoided for life.
People with IBS are often advised to modify the amount of fibre in their diet. There are two main types of fibre:
- soluble fibre – which the body can digest
- insoluble fibre – which the body cannot digest
Foods that contain soluble fibre include:
- fruit, such as bananas and apples
- root vegetables, such as carrots and potatoes
- golden linseeds
Foods that contain insoluble fibre include:
- wholegrain bread
- nuts and seeds (except golden linseeds)
If you have IBS with diarrhoea, you may find it helps to cut down on the insoluble fibre you eat. It may also help to avoid the skin, pith and pips from fruit and vegetables.
If you have IBS with constipation, increasing the amount of soluble fibre in your diet and the amount of water you drink can help.
Your GP will be able to advise you what your recommended fibre intake should be.
The National Institute for Health and Clinical Excellence (NICE) provides more detailed advice about IBS and diet (PDF, 39kb).
Your IBS symptoms may improve by following the advice below:
- have regular meals and take your time when eating
- avoid missing meals or leaving long gaps between eating
- drink at least eight cups of fluid a day, particularly water and other non-caffeinated drinks such as herbal tea
- restrict your tea and coffee intake to a maximum of three cups a day
- lower the amount of alcohol and fizzy drinks you drink
- reduce your intake of resistant starch, starch that resists digestion in the small intestine and reaches the large intestine intact – it is often found in processed or re-cooked foods
- limit fresh fruit to three portions a day – a suitable portion would be half a grapefruit or an apple
- if you have diarrhoea, avoid sorbitol, an artificial sweetener found in sugar-free sweets, including chewing gum and drinks, and in some diabetic and slimming products
- if you have wind and bloating, consider stopping all cereals for six weeks or increasing your intake of linseeds (up to one tablespoon a day)
Avoid exclusion diets (where you do not eat a certain food groups, such as dairy products or red meat) unless you are being supervised by a professional dietitian.
Most people find exercise helps relieve the symptoms of IBS. Your GP will be able to advise you about the type of exercise that is suitable for you.
Aim to do a minimum of 30 minutes vigorous exercise a day, at least three times a week. The exercise should be strenuous enough to increase your heart and breathing rates. Brisk walking and walking uphill are both examples of vigorous exercise.
Read more about the benefits of exercise and the different types of fitness activities you can try.
Probiotics are dietary supplements that product manufacturers claim can help improve digestive health. They contain so-called "friendly bacteria" that supposedly destroy "bad bacteria", helping to keep your gut and digestive system healthy.
Some people find taking probiotics regularly helps relieve the symptoms of IBS. However, there is no scientific evidence to prove that probiotics work and have beneficial health effects.
If you decide to try probiotics, make sure you follow the manufacturer's instructions and recommendations regarding dosage.
Reducing the amount of stress in your life may help lower the frequency and severity of your IBS symptoms. Some ways to help relieve stress include:
- relaxation techniques, such as meditation or breathing exercises
- physical activities, such as yoga, pilates or tai chi (where deep breathing and relaxation is combined with slow and gentle movements)
- regular exercise, such as walking, running or swimming
If you are particularly stressed, you may benefit from a talking therapy, such as stress counselling or cognitive behavioural therapy (CBT).
Read more about how to manage stress.
A number of different medications are used to help treat IBS, including:
- antispasmodic medicines (antispasmodics) – which help reduce abdominal pain and cramping
- laxatives – used to treat the symptoms of constipation
- antimotility medicines – used to treat the symptoms of diarrhoea
- antidepressants – originally designed to treat depression, but can also help reduce abdominal pain and cramping
These medications are discussed in more detail below.
Antispasmodics work by helping relax the muscles in your digestive system. Examples of antispasmodic medicines include mebeverine and therapeutic peppermint oil.
Side effects associated with antispasmodics are rare. However, people taking peppermint oil may have occasional heartburn and irritation on the skin around their anus (bottom).
Antispasmodics are not recommended for pregnant women.
Bulk-forming laxatives are usually recommended for people with IBS-related constipation. They make your stools denser and softer, which means they are easier to pass.
It is important you drink plenty of fluids while using a bulk-forming laxative. This will help prevent the laxative from causing an obstruction in your digestive system.
Start on a low dose and then, if necessary, increase it every few days until one or two soft stools are produced every one or two days. Do not take a bulk-forming laxative just before you go to bed.
Side effects associated with taking laxatives can include bloating and wind. However, if you increase your dose gradually, you should have few, if any, side effects.
The antimotility medicine loperamide is usually recommended for IBS-related diarrhoea.
Loperamide works by slowing contractions of muscles in the bowel, which slows down the speed at which food passes through your digestive system. This allows more time for your stools to harden and solidify.
Side effects of loperamide include:
- abdominal cramps and bloating
- skin rashes
Loperamide is not recommended for pregnant women.
Two types of antidepressants are used to treat IBS – tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).
TCAs are usually recommended when antispasmodic medicines have not been able to control the symptoms of pain and cramping. They work by relaxing the muscles in your digestive system.
However, TCAs will only provide relief after three to four weeks, as your body starts to get used to the medication. They should be taken consistently.
Possible side effects of TCAs include:
- dry mouth
- blurred vision
These side effects should improve within a few days of starting the medication. Tell your GP if the side effects become a problem – they may prescribe another type of antidepressant.
Amitriptyline is the most widely used TCA.
Selective serotonin reuptake inhibitors (SSRIs) are an alternative antidepressant. Examples of SSRIs that are used to treat IBS include:
Common side effects of SSRIs include blurred vision, diarrhoea or constipation and dizziness.
Read more about selective serotonin reuptake inhibitors (SSRIs).
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 work by teaching you techniques to help you control your condition better. The availability of psychological interventions on the NHS may vary from region to region.
Hypnotherapy has been shown to help some people with IBS reduce their symptoms of pain and discomfort.
Hypnosis is used to change your unconscious mind's attitude towards your symptoms.
You can have hypnotherapy as an outpatient in some NHS hospital pain clinics, or you can learn self-hypnosis techniques to do at home.
Psychodynamic interpersonal therapy (PIT)
Psychodynamic interpersonal therapy (PIT) is a type of talking treatment that has had some success in helping people with IBS.
It is a form of psychotherapy based on the principle that your unconscious thoughts, beliefs and attitudes can influence how you think, act and feel.
Your therapist will help you to explore how your past might have unconsciously affected you. They will also help you to confront unhelpful beliefs, attitudes and behaviours in order to try to change them.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is another type of talking treatment that can help with IBS.
CBT is based on the principle that the way you feel depends partly on the way you think.
Studies have shown that if you train yourself to react differently to IBS by using relaxation techniques and staying positive, you should see a decrease in your pain levels.
CBT may also help you to cope better with stress, anxiety and depression.
Some people claim therapies such as acupuncture and reflexology can help people with IBS. However, there is no medical evidence to suggest they are effective and they are not recommended.