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Managing Irritable Bowel Syndrome (IBS)

Learn about the chronic functional bowel disorder characterized by abdominal pain, alternating diarrhea and constipation, and abdominal distension. Discover aggravating factors, when to refer, and management strategies including antispasmodics, bulking agents, and antidiarrheals. Get advice on diet and nutrition for IBS sufferers and explore other methods to improve symptoms such as exercise and complementary therapies.

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Managing Irritable Bowel Syndrome (IBS)

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  1. Irritable bowel syndrome (IBS) is defined as a chronic functional bowel disorder in which abdominal pain is associated with intermittent diarrhoea, sometimes alternating with constipation and a feeling of abdominal distension • The cause is unknown • It often seems to be triggered by stress, and many IBS sufferers have symptoms of anxiety and depression. • Some sufferers may have food intolerance that triggers their symptoms.

  2. Aggravating factors • Stress appears to play an important role and can precipitate and exacerbate symptoms. • Caffeine often worsens symptoms, and its stimulant effect on the bowel and irritant effect on the stomach are well known. • The sweeteners sorbitol and fructose have also been reported to aggravate IBS. • Other foods that have been implicated are milk and dairy products,chocolate, onions, garlic, chives and leeks.

  3. Whento refer • Children • Older person with no previous history of IBS • Pregnant women • Blood in stools • Unexplained weight loss • Caution in patients aged over 55 years with changed bowel habit • Symptoms/signs of bowel obstruction • Unresponsive to appropriate treatment

  4. Management • Antispasmodics • Smooth muscle relaxants alverine citrate, peppermint and mebeverine and the antimuscarinic hyoscine are used.

  5. Bulking agents • Bran, which is an insoluble fibre, is no longer recommended in IBS • Oats are more soluble than wheat bran and can be better tolerated. • Bulking agents such as ispaghula husk containing soluble fibre can help some patients.

  6. Antidiarrhoeals • Use of OTC antidiarrhoeals such as loperamide is appropriate only on an occasional, short-term basis to reduce diarrhoea or urgency of defaecation.

  7. Diet and nutrition should be assessed for people with IBS and the following general advice given: • ■ Have regular meals and take time to eat • ■ Avoid missing meals or leaving long gaps between eating • ■ Drink at least eight cups of fluid per day • ■ Restrict tea and coffee to three cups per day • ■ Reduce intake of alcohol and fizzy drinks • ■ It may be helpful to limit intake of high-fibre food • ■ Reduce intake of ‘resistant starch. • ■ Limit fresh fruit to three portions per day (a portion should be ∼80 g) • ■ People with diarrhoea should avoid sorbitol • ■ People with wind and bloating may find it helpful to eat oats.

  8. Other things that can improve IBS • Exercise • Complementary therapies.. traditional acupuncture, reflexology, aromatherapy or homoeopathy.

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