Irritable Bowel Syndrome (IBS): Diet, Medication and Alternative Therapies

In India Irritable Bowel Syndrome (IBS) is known to affect about 15% of the population and usually occurs in the ages of 15-50. It is characterised by intermittent episodes of pain or cramps and changes in bowel patterns.  Symptoms may range in intensity. At times you may experience severe pain that may cause you to take a day off from work while at other times the pain may not be as bad.   There is no one way of determining whether a person has IBS based only on their symptoms. This is because the symptoms of IBS overlap with many other conditions. 

What are the First Signs of IBS?

The symptoms of IBS vary from person to person but usually include:

• abdominal pain, bloating and cramps that disappear after passing stools
• frequent gas
• bouts of diarrhea or constipation or both
• sticky substance or mucus in the stool
• change in the appearance of the stools or frequency in passing stools

IBS can be ‘diarrhea-predominant’ or ‘constipation-predominant’. Women either experience symptoms when they are menstruating or their symptoms may worsen at this time. The symptoms may be less in post menopausal women. People may observe that their symptoms tend to increase during periods of high stress.   

Diagnosing IBS: Sanjana Kapur’s story

Sanjana Kapur, 35, used to get stomach aches for days together. The pain seemed to worsen around her menstrual cycles and subsided when she passed stool.  When the pain lasted for a few months, she sought help from Dr. Kartikeya Kohli, Associate Consultant at Sitaram Bhartia Institute of Science and Research.   She informed him that the pain dissipated when she took over-the-counter medicines like meftal spas during her cycles.  Upon being asked about fever or rectal bleeding, she told the doctor that she did not face either symptom. She highlighted that she experienced pain and had noticed an intolerance to meat. She also mentioned repeated occurrences of diarrhea.  “On the basis of her symptoms, medical history and a physical examination, we recommended a stool test,” says Dr. Kartikeya.  This was followed by a course of an antibiotic for amoeba and giardia and deworming treatment. In a follow up visit a few weeks later, she told the doctor that her symptoms persisted.  “When we saw no improvement in Sanjana’s condition, we realized she needed specialised care from a gastroenterologist.” Sanjana was then referred to Dr. Nivedita Pandey, Consultant Gastroenterologist at Sitaram Bhartia.  The doctor patiently listened as Sanjana narrated her concerns. She reviewed  Sanjana’s history and prescriptions and decided to perform a per rectal examination and proctoscopy.   Sanjana was recommended a few more investigations such as a flexible sigmoidoscopy and colonoscopy.  As it turned out, all her tests came negative. Through these tests, the gastroenterologist ruled out infections, ulcerative colitis and Crohn’s disease.  Sanjana was eventually diagnosed with Irritable Bowel Syndrome. “Irritable Bowel Syndrome is a clinical diagnosis, meaning that we have to understand your medical history, how you have responded to any treatment and run some tests to exclude other conditions before determining IBS, “ explained Dr. Nivedita.   Sanjana was curious to know what factors are responsible for the condition.

What Causes IBS?

The exact cause of IBS is not known. Multiple studies indicate different explanations such as:

• Severe infection of the gastrointestinal tract which may lead to IBS
• Abnormal and strong contractions of the colon and intestine leading to cramping pain
• Stress and anxiety that affect the intestines
• Allergies or sensitivities to food since intolerance to certain foods is common among people with IBS

Now that she knew she had IBS, she wanted to know how best to deal with it. 

How Do You Treat IBS?

“IBS is a condition for which you need regular care. As you learn to recognize factors that may affect your symptoms, you should talk to us so we can modify your treatment plan if required, ” says Dr. Nivedita.  Remember to make note of your bowel movements, especially if you feel a particular food or drink altered them in any way. Since not everyone experiences the same symptoms, the lifestyle modifications needed may differ from person to person. 

Diet Modifications

Speak to your doctor before excluding any foods from your meals.  “Without proper guidance, you could end up doing more harm than good.” When planning her diet, Sanjana was encouraged to follow a vegetarian diet keeping in mind her intolerance to meat. She was also advised to be cautious about specific foods.

Foods to avoid with IBS

Dairy products: People with IBS may be sensitive to lactose, which is majorly present in milk and ice cream. Speak to your doctor to know whether you should refrain from consuming dairy products.  Gluten based foods: You could eliminate gluten from your diet as some people have shown improvement in their symptoms even in the absence of celiac disease.  Gas-causing foods: If you experience a lot of gas or bloating, you may be advised to exclude cabbage, cauliflower, broccoli, alcohol, caffeine or raw fruit from your diet.

Foods to Eat as part of an IBS Diet

Fibre-rich foods such as cooked carrots and potatoes with skins, pulses, kidney beans, white or whole wheat bread and raw vegetables like cucumber, lettuce, tomato, spinach should be included in your diet. You should also eat  apples with skin, banana, almond and peanuts as snacks between meals and drink orange or apple juice, as these contain a lot of fibre.  These foods help soften the stools and reduce constipation but may also be helpful for people with diarrhea.  Some people also find they can comfortably consume foods made of rice or soy and bread or eggs. Probiotics: The benefits of probiotics or foods containing ‘good’ bacteria are still being studied. However, there may not be any side effects of consuming foods such as curd/dahi, lassi and chaas which contain probiotics.

Medication 

You will be advised medication if lifestyle changes have had no effect on your symptoms.  For people with IBS who experience constipation most of the time, laxatives and fibre supplements may be prescribed.  For those with recurrent diarrhea, anti-diarrheal medications may be advised.  Sometimes you may also be recommended other pain medicines, antispasmodics or antidepressants even if you do not have depression. Antidepressants contain tricyclic agents that reduce pain in people with IBS.

Alternative Therapies

Some of the other ways to heal IBS naturally include techniques to reduce stress and pain through: Counseling may help people with IBS who have several worries around their meals or abdominal pain. In sessions with a therapist, you will be guided to respond to stressful situations, recognize negative thoughts so that you can alter these in a way that reduces your anxiety.    Relaxation exercises which involve tensing each of your muscles, holding them in certain positions for a few minutes and then releasing those positions. When practiced daily, these can benefit in lowering stress levels.    Mindfulness Based Stress Reduction (MBSR)Therapy: Studies show that MBSR has resulted in an improvement in the quality of life and severity of symptoms of people who underwent the therapy. This therapy helps people accept and understand problems and their emotions instead of suppressing them, through mediation sessions and group trainings. You can avail a mindfulness course online or watch videos to practice it. When you are able to process thoughts and events without judgement, you’re able to let go of stressors that may be weighing you down.  Biofeedback which is a procedure in which electrical sensors are placed on your body. These sensors record information that is displayed through a computer. When you have access to this information about your body functions, you are able to make changes and exercise control over bowel movements and ease your symptoms. Biofeedback is not widely available in India. Sanjana understood the importance of keeping track of her symptoms and a close eye on the foods she ate. She had never heard of some of the stress relieving techniques that the gastroenterologist recommended but they seemed worth trying out because of the pain and discomfort she suffered. 

Conclusion

“When guided on making necessary changes, most people are able to successfully adapt to a new lifestyle and become more in control of their symptoms,” finishes Dr. Nivedita. More Resources

• Persistent Stomach Pain Bothering You? Get Yourself Checked for Inflammatory Bowel Disease!
• Stomach Pain in Kids: Don’t Dismiss Recurrent Stomach Aches!
• Gastric Pain: Antacids Not Working? Here’s Why!
• Diarrhea: When Are Loose Motions Worrisome?