Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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.