Download Irritable Bowel Syndrome (IBS / Spastic Colon)

Irritable Bowel Syndrome (IBS / Spastic Colon)
Irritable bowel syndrome (IBS) is one of the most common disorders that
doctors see. The symptoms of IBS vary from person to person, and may
include diarrhoea, constipation, alternating diarrhoea and constipation,
abdominal cramping, gas, bloating and mucus in the stool. Depending on
the main symptoms, IBS can be classified as diarrhoea-predominant,
constipation-predominant or a combination of both.
The causes
The exact cause of IBS is unknown. What is clear is that people who suffer
from it are more sensitive to the type and volume of food in the intestine,
as well as to various psychosocial factors.
The walls of the intestines are lined with layers of muscle that contract
and relax as they move food from your stomach through your intestinal
tract. Normally, these muscles contract and relax in a coordinated rhythm.
But with IBS, the contractions may be stronger and last longer than
normal. Food may be forced through your intestines more quickly, causing
symptoms such as gas, bloating and diarrhoea. In other cases, the
opposite occurs and the food passage slows, with stools becoming hard
and dry, resulting in constipation.
Many people find that their symptoms worsen when they eat certain
foods, called “trigger foods”. For instance, chocolate, milk and alcohol
may be triggers that cause constipation or diarrhoea in some, while
carbonated drinks and some fruits and vegetables may lead to bloating
and discomfort in others. It is not certain why triggers affect some people
and not others, and further research into the role of food allergy or
intolerance in IBS may be helpful.
Most people with IBS find that their symptoms are worse or more
frequent during stressful events, such as a change in daily routine or
even family arguments. In addition to stress and poor dietary habits,
factors that may worsen the symptoms include an excessive use of
laxatives, antibiotics, caffeine, regular use of chewing gum; irregular
sleep and a poor fluid intake.
Because of the multiple factors that appear to be involved, managing IBS
involves education, medications, counseling, diet and stress management.
Dietary management of IBS
Eating a good quality diet is extremely important for people suffering from
IBS. It is essential to eat 3 regular meals, and snacks in between your
meals, in order to get the colon functioning correctly. In general, the best
diet is based on foods that are gentle on the digestive system and which
encourage smooth passage through the intestines. This diet will depend
on individual sensitivity, but there are some general recommendations
that apply to the majority of IBS sufferers:
Ensure an adequate dietary fibre intake
The different types of fibre, soluble and insoluble, have different effects on
the gut.
Insoluble fibre speeds food through the colon and diarrhoea-predominant
IBS sufferers should generally avoid this type of fibre. People with
constipation-predominant IBS are however often able to tolerate some
insoluble fibre without discomfort.
In general, IBS sufferers should avoid insoluble fibre, or if you do eat
them, chew them thoroughly:
Whole-wheat kernels in whole-wheat or whole grain bread
Whole grain „gritty‟ crackers
Muesli containing nuts and dried fruit
Skins of dried peas, beans and lentils and bean sprouts
Popcorn, sweetcorn and mealies
Raisins and sultanas
Nuts and crunchy peanut butter
All seeds e.g. Pumpkin, Sunflower, Sesame and poppy seeds
Tough skins and pips from fruits.
Soluble fibre tends to dissolve in water and promotes gentle regular bowel
movements. Most foods high in soluble fibre are considered safe for
people who suffer from diarrhea and constipation. Some people are
however sensitive to certain sources of soluble fibre, such as beans,
lentils, broccoli and cabbage.
Soluble fibre should be spread across the all meals and snacks day and
determining the amount that can be tolerated may require some
experimentation. Fibre should be gradually increased over a period of
weeks.
Good sources of soluble fibre include:
Ground psyllium and flax seeds
Oat and rice bran (oat bran is practical and easy to sprinkle into
most foods e.g. cereals, yoghurt, soups, stews, mashed potato etc)
Oatmeal
Pronutro (wholewheat or wheat free)
Barley
Split Peas and split lentils
Apples (peeled), pears (peeled), apricots, strawberries, bananas,
peaches
Cooked carrots, cooked spinach (without the stalks), sweet
potatoes, potatoes
Avocado
Fibre supplements may be helpful for people who don‟t get adequate
fibre from the food in their diets. However, the source of fibre differs
between products and, like foods, people react differently to them.
Because fibre can absorb water, fibre supplements should always be
taken with plenty of fluids to avoid constipation.
Increase consumption of fluids (water/ caffeine free herbal teas)
to at least 2 litres daily.
Start the day with a large glass of water as you get up in the morning and
drink water with all meals.
Exercise regularly
Exercise helps relieve depression and stress, stimulates normal
contractions of your intestines and can help you feel better about yourself.
If you've been inactive, start slowly and gradually increase the amount of
time you exercise until you are getting at least 30 minutes of moderate
intensity exercise on most days of the week.
Consider probiotics
Our intestines naturally contain large amounts of bacteria, some of which
are good for us. Probiotics are “good” bacteria that help to maintain a
healthy digestive system and these can be found in foods (e.g. certain
brands of yoghurt) or in dietary supplements. The strain (type) of bacteria
used in probiotic products differ and, although probiotics are generally
considered safe, more research is needed to determine what role
probiotics play in the treatment of IBS and which strains are most
effective. Prebiotic supplementation may be necessary to ensure that the
probiotics are effective.
Take the time for bowel movements
Set aside sufficient time to allow for undisturbed visits to the toilet, and
don't ignore the urge to have a bowel movement.
Avoid problem foods
If certain foods make your signs and symptoms worse, avoid them.
Common culprits include alcohol, chocolate, caffeinated drinks such as
coffee and sodas, medications that contain caffeine, dairy products, and
sugar-free sweeteners such as sorbitol or mannitol. If gas is a problem
for you, foods that might make symptoms worse include beans,
cucumber, sweet peppers, cabbage, cauliflower , broccoli and spicy
foods. Chewing gum or drinking through a straw can cause air to be
swallowed, which can create more gas.
Avoid excessive intakes of oily or rich food
Oily take-aways, high-fat ready-made meals, pies and pastries, the fat
found on meat and chicken and excess oil used in cooking may not be well
tolerated by people with IBS as the high fat content may worsen the
symptoms.
Eat at regular times
Don't skip meals, and try to eat about the same time each day to help
regulate bowel function. If you have diarrhoea, you may find that eating
small, frequent meals makes you feel better. But if you're constipated,
eating larger amounts of high-fibre foods may help move food through
your intestines. Slow down during mealtime, chew food thoroughly and
try to avoid eating-on-the-run.
Take care with dairy products
If you're lactose intolerant, try substituting yoghurt for milk. Or use an
enzyme product, such as Lactaid, to help break down lactose. There is
also a lactose-reduced milk called EasyGest that may reduce your
symptoms. Consuming small amounts of milk products or combining
them with other foods also may help. In some cases though, you may
need to eliminate dairy foods completely. If so, be sure to get enough
protein, calcium and B vitamins from other sources.
Use anti-diarrhoeal medications and laxatives with caution
If using over-the-counter anti-diarrhoeal medications, use the lowest
dose that helps. In the long run, these medications can cause problems if
you don't use them appropriately. The same is true of laxatives. If you
have any questions about them, check with your doctor or pharmacist.
It really helps to keep a food diary for a couple of weeks, and to
document everything you eat and drink together with your symptoms.
This may help you to identify a pattern and certain trigger foods that may
be applicable to you.
Meal-planning ideas
Breakfast
A small cup of oats porridge cooked in fat free or low fat
milk (or water if you are sensitive to dairy) with added
raw oat bran and half a pawpaw with lemon
OR
A cup of bran flakes + low fat milk or yoghurt and 1
sliced small banana
OR
1 slice of brown toast with 1 poached or boiled egg with a
grilled tomato + an apple
OR
A smoothie: blend 1 cup fat free yoghurt or milk with 2
fruits and 1 Tbsp smooth peanut butter and oat bran
Snacks
A piece of fresh fruit and a small tub of low fat or fat free
fruit yoghurt
OR
4 Ryvita crackers with fat free or low fat cottage cheese
and cucumber or reduced fat hummus or peanut butter
OR
A slice of anchovy toast
OR
Milo with low fat or fat free milk
Light meal
1-2 thin slices of brown bread with tuna in brine /
skinless chicken / lean beef/ cottage cheese + salad
vegetables with ½ small avocado or 5 olives
OR
2 mini pitas filled with egg mayonnaise (2 boiled eggs
with 1 Tbsp lite mayo)
OR
A bowl of split lentil vegetable soup and grated
mozzarella cheese + 1 slice of brown toast
OR
1 tin sardines in tomato sauce on 2-4 rye crackers with a
mixed green salad and ½ small avocado
Main meal
A small baked sweet potato or a small cup of cooked
brown rice
OR
+ 1 palm sized portion of skinless chicken / lean beef /
pork fillet / fish + cooked vegetables or salad with ½
small avocado or 5 olives
OR
Stir-fried vegetables with 1 palm sized portion of beef,
pork or chicken strips with 1 Tbsp sesame oil and soya
sauce served with a small cup brown rice mixed with split
peas or spaghetti
OR
2 Pilchard fish cakes with sweet chilli sauce and 2-3
boiled baby potatoes and steamed vegetables
OR
Mushroom and tomato omelet (2 eggs) served with
roasted vegetables
OR
Optional dessert
A small piece of fruit with some low fat or fat-free
yoghurt
Note – portion sizes are estimated and are to serve only as a
guide. Contact a registered dietitian for an individualised meal
plan and portion guide.