Irritable Bowel Syndrome (IBS). First line advice.

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What is this information about?

This information is about irritable bowel syndrome (IBS). It explains things that you can try to do to make your IBS symptoms better. If they work, this means you may not have to take medicines for your IBS. Advice about things that you can try first to make a condition better is called ‘first-line advice’.  

This information includes:

• the symptoms of IBS 
• first line advice for all types of IBS 
• how you can deal with symptoms of IBS such as: 
  • constipation  
  • diarrhoea  
  • wind and bloating

Why have I been given this information?

You have been given this information because you have symptoms of IBS. IBS symptoms can be uncomfortable and painful.  Following the advice in this information can help to make your symptoms better. It may also mean that you do not have to take medicine for your IBS.

What is IBS?

IBS is a condition that affects your digestive system (the parts of your body that help you to break down your food and get nutrition from it such as your stomach and gut (bowel)). Around 1 to 4 people out of every 20 get IBS. Symptoms can come and go over time. They may last for days, weeks or months at a time and can be mild or more severe. 

The usual symptoms of IBS include:

• wind (burping or farting), feeling bloated (feeling like your tummy (stomach) is full and tight because it has wind trapped in it). You may get both of these. 
• diarrhoea (runny or watery poo) or constipation (you poo less often and your poo may also be larger or smaller than usual and dry, hard or lumpy). You may get diarrhoea and constipation at different times.  
• pain low down in your tummy (abdomen). This may get better after you have had a poo. As well as having pain, how often you have a poo, how easy it is for you to poo or what your poo looks like might change. 
• feeling the need to have another poo even when you have just been to the toilet.  
• feeling that you cannot wait to go for a poo (feeling of urgency) 
• feeling that your symptoms are worse after eating

There is no one cause of IBS. The things that cause people’s symptoms to start are different from person to person. They can include:

• the foods that they eat 
• their eating habits such as what they eat and how and when they eat it 
• feeling stressed

What things can I try that might help my symptoms of IBS whatever type of IBS I have?

Trying these things may help you to get symptoms less often or less badly:

• follow a regular meal pattern. Eat at the same times each day. 
• sit down and relax when you are eating 
• chew your food well 
• do not eat late at night 
• avoid fried and processed foods and foods that are high in fat 
• Drink plenty of fluids (not drinks that have caffeine in them) spread through the day 
• do regular exercise

What foods and drinks can I have that will help me to eat well and avoid the symptoms of IBS?

Fibre

Fibre has many health benefits. Try to include itd as part of a balanced diet. The amount of fibre and the type of fibre in your diet can have an impact on your bowel and your IBS. 

Fibre is found in:

• fruit 
• vegetables 
• pulses (beans, lentils and peas) 
• wholemeal and wholegrain products (bread, rice, pasta).

Dietary fibre is not digested or taken in by your body. It moves through the bowel and is then digested by the bacteria that live there or it comes out of your body in your poo.

There are two types of fibre, soluble and insoluble.

• Soluble fibre works by soaking up water like a sponge during digestion. It forms a sticky gel. This gel slows the digestion of foods which may make you feel fuller for longer. 

Good sources of this type of fibre include: 

• oats 
• pulses (beans, peas and lentils)
• linseeds 
• fruits 
• vegetables

How can soluble fibre help?

Soluble fibre:

• may help manage diarrhoea as it soaks up water in your intestines 
• can help to make constipation better by drawing water in to soften your poo as it goes through your intestines 
• increases the amount of healthy bacteria in your bowel. This is because the bacteria use fibre for energy.

• Insoluble fibre 

This type of fibre does not dissolve in water and cannot be digested by your body.  It makes your poos more bulky. This means they pass through your bowel more quickly.   

Foods rich in this type of fibre include:

• wholegrain and wholemeal cereals, bread, rice and pasta 
• seeds and nuts 
• fruits 
• vegetables

How can insoluble fibre help?

Insoluble fibre: 

• helps you to have a healthy digestive system 
• can help to prevent constipation as it speeds up how quickly poo moves through your bowel

• Linseeds (golden or brown) can help reduce constipation, wind, and bloating.  It may take some time before you notice that they are working, and it can take up to six months to get the full benefit. 
  • Try 1 tablespoon of linseeds per day
  • Use whole, ground or milled linseeds (linseed meal).
  • Take with a drink. Use 150ml of fluid for every tablespoon of linseeds 
  • Mix into yoghurt, breakfast cereal, soup or salad
• Probiotics are ‘good’ bacteria that live in the gut. Including probiotic products in your diet can improve the balance of good bacteria.  This may help to relieve gut symptoms including: 
  • constipation, wind and bloating 
  • diarrhoea caused by antibiotics. Start taking probiotics at the start of the course to prevent diarrhoea 
  • gastroenteritis (stomach upsets)

If you decide to try them:

• try one brand at a time. Look for products containing Bifidobacterium or Lactobacillus 
• take daily for one month 
• If they do not relieve symptoms try another brand. Different brands contain different types of probiotic.

Can stress affect my gut health and my IBS?

Yes. Your gut can be affected by mood and stress. Making lifestyle changes and dealing with stress can help relieve gut symptoms more than dietary changes in some people. 

Speak with your GP or dietitian about local services that can help you to manage your mood and stress such as:

• stress management 
• ‘Time to Talk’

You can find further information about managing stress on the NHS website www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/stress/

How can I manage some of the main symptoms of IBS?

Constipation

There are many reasons why you might get constipation. One of the main reasons is not drinking enough fluids. This can lead to you having hard, bulky poos that make it difficult to have a poo. 

To help relieve constipation: 

• drink plenty of fluid. Have at least 8 cups of decaffeinated fluids per day 
• slowly Increase the amount of fibre you have in your diet. If you increase it too quickly it can make your symptoms worse.
• avoid eating wheat bran 
• try linseeds
• try probiotics

Diarrhoea

There are many reasons why you might get diarrhoea. You can make changes to your diet that help to slow the movement of food through your gut. This can reduce the symptoms of diarrhoea.

Try to:

• avoid fizzy drinks 
• reduce the amount of caffeine you have. Aim for no more than 3 cups a day of caffeinated drinks. 
• have less than two units of alcohol a day and at least two alcohol free days per week 
• limit the amount of fibre you get from foods such as wholemeal cereals, breads and pasta. Try white varieties instead. 
• limit the amount of fruit you have to 3 portions per day. Do not have more than 1 portion (30g) a day of dried fruits and fruit juice (200ml)
• avoid sorbitol, mannitol and xylitol. These are artificial sweeteners found in sugar-free sweets, drinks and chewing gum.  
• reduce the amount of high fat foods that you eat. This includes foods such as fast food, sausages, chips, cakes, cream, butter and battered foods.  
• try taking probiotics if you have diarrhoea that starts after you have had a course of antibiotics or gastroenteritis (tummy upset). 
• replace any fluid that you have lost because of your diarrhoea to prevent dehydration. Drink at least 8 cups of decaffeinated fluid per day.

Wind and bloating

Sometimes too much gas builds up in your bowel when you digest your food. Making changes to your diet can help to make the symptoms of wind and bloating better. Limit the amount of fruit you have to 3 portions per day. Do not have more than 1 portion (30g) a day of dried fruits and fruit juice (200ml).

• Limit how many foods you have that produce lots of gas when you digest them. For example, beans and pulses. 
• Include 2 to 3 portions of vegetables a day. 
• Try adding oats and linseeds to your diet. 
• Avoid sorbitol, mannitol and xylitol. These are artificial sweeteners found in sugar-free sweets, drinks and chewing gum. 
• Try a lactose free diet for 2 to 4 weeks. 
• Try taking probiotics.

Reflux

Reflux (food and acid coming back up your food-pipe from your stomach) can also be a common problem in people living with IBS. You may be able to reduce your symptoms of reflux by:

• having small frequent meals 
• sitting upright during a meal and for 30 minutes afterwards 
• trying to relax when you are eating 
• chewing your food well  
• not having anything to eat or drink for 2 to 3 hours before you go to bed 
• avoiding fatty or fried foods 
• limiting how much alcohol you drink. Try not to drink on an empty stomach.

Who can I contact if I would like further information or support after I have read this information?