The management of Irritable Bowel Syndrome is often difficult and varies considerably between the patients. Here is the stepwise management of IBS
Management of Irritable Bowel Syndrome
Living with Irritable Bowel Syndrome (IBS) can present various challenges, but with the right guidance, it’s manageable. Let’s embark on a journey to understand and effectively manage IBS together.
You can also visit What is Irritable Bowel Syndrome (IBS)? on managing Irritable Bowel Syndrome (IBS)
Reassurance
The most important steps are to make a positive diagnosis and reassure the patient. Many patients are concerned that they have developed cancer, and a cycle of anxiety leading to colonic symptoms, which further heighten anxiety, can be broken by the explanation that symptoms are not due to organic disease but are the result of altered bowel motility and sensation. In patients who fail to respond to reassurance, treatment is then tailored to the predominant symptoms. Following resassurance criterias may be considered:
A) lf Diarrhea is Predominant Symptom
Nutrition Education
- Elimination diets; upto 20% may benefit from a wheat-free diet, some may respond to lactose exclusion, and excess intake of caffeine or artificial sweeteners such as sorbitol should be addressed. Milk products may be supplemented with calcium in other forms and gluten with B complex vitamins if needed.
- Avoid excess dietary intake as they can exacerbate diarrhea.
- Avoid high sugar intake, which increases osmolarity. Limit fructose, sucrose, and related carbohydrates. Dietitian-led education is necessary for the low FODMAP diet (Gibson and Shepherd, 2012).
Pharmacotherapy
- If symptoms persist despite nutritional intervention then medical management becomes necessary. Loperamide 2 to 8 mg daily is first line. Other options are codeine phosphate, cholestyramine sachet. Symptoms may improve with hydrolyzed guar gum or with probiotics that include bifidobacteria.
- lf above drugs are unhelpful (intractable IBS) then several months course of tricyclic antidepressant is sometimes beneficial.
B) If Constipation is Predominant Symptom
Nutrition Education
- Soluble fiber is beneficial for IBS (Moayyedi et al, 2014). In acute phases, a low-fber diet may be better tolerated. As treatment progresses, use adequate but no excessive fiber and ensure adequate fuid intake (30 to 35 mL/kg)
- Slowly increase dietary fber by 2 to 3 g/d to prevent discomfort and to promote soft, painless stools. Large servings of bran may aggravate IBS; assess individually.
- According to the National Institute for Health and Care Excellence (NICE) guidelines while some people with IBS may benefit from increasing their intake of soluble fibre (such as oats and barley), insoluble fibre like bran can exacerbate symptoms in some people. Therefore, it’s important to individualise dietary advice based ona patient’s symptoms.
Laxatives
- If nutritional intervention has proven unhelpful alone then laxatives as isphaghol or methycellulose can be given.
- For patients with constipation who are not responding to conventional laxatives linaclotide may be considered,
if:
- Optimal or maximum tolerated doses of previous laxatives from different classes have not helped and
- They have had constipation for at least 12 months
- According to NICE (The National Institute for Health and Care Excellence) guidelines, lactulose should be avoided in patients with irritable bowel syndrome (IBS) as it can exacerbate symptoms. Lactulose is a synthetic disaccharide that works by drawing water into the bowel, softening stools and increasing bowel movements. However, it can also cause bloating, flatulence, and abdominal discomfort, which are common symptoms of IBS.
Selective Serotonin Reuptake Inhibitors
- They can also be given for constipation predominant IBSĀ
Alternating Bowel Habits
- Pain relief by antispasmodic as Mebeverine
- Low dose tricyclic antidepressant is used in preference to selective serotonin reuptake inhibitors
Other IBS Management Options
- Psychological interventions – if symptoms do not respond to pharmacological treatments after 12 months and who develop a continuing symptom profile (refractory IBS), consider referring for cognitive behavioral therapy, hypnotherapy or psychological therapy
- Complementary and alternative medicines: ādo not encourage use of acupuncture or reflexology for the treatment of IBS
Food and Nutrition
Fermentable Oligosaccharides, Disaccharides, Monosaccha- Rides, and Polyols (FODMAPs) are poorly absorbed, short-chain carbohydrates have poor absorption, osmotic activity, and rapid fermentation. They induce prolonged hydrogen production in the intestine, influence the amount of methane produced, and cause gastrointestinal and sys-temic symptoms (Ong et al, 2010). The low FODMAP diet is now accepted as a strategy for managing symptoms of IBS.
Foods to limit on the FODMAPS DietĀ
Vegetables
- GARLIC, ONIONS, CABBAGE, PEAS & MORE
Fruits
- PLUMS, WATERMELON, APPLES, PEACHES & MORE
Fats and Dairy
- ALMONDS, PISTACIOS, ICE CREAM, LACTOSE & MORE
Starches, Cereals, and Grains
- CEREALS, PASTA, PIZZA, BREAD & MORE
Care Plan and Counseling
- IBS does not harm the intestines, does not lead to cancer, and is unrelated to inflammatory bowel disease.
- Drink six to eight glasses of water per day. Avoid carbonated beverages, chewing gum, or eating quickly which may promote gas production.
- Regular times for bowel evacuation should be planned.
- Ensure adequate food intake; patients may be afraid to eat because of potential pain
- A food diary may help to identify any food sensitivities.
- Because large meals can cause cramping and diarrhea, use smaller meals or portions eaten more often.
- Refer the patient for stress management. Patients with rapidly cycling symptoms may need further counseling and support.
- Discuss the risks and benefits of probiotic use. Multispedies probiotics are effective by altering the intestinal microbiota (Yoon et al, 2014).
- Regular exercise is important, such as walking, swimming, or yoga. Adequate sleep, meditation, hypnosis, and stress management may offer some relief.
