Information for patients

DMI ref: 9446-09.indd(RP)

A Self-help Guide for People with Irritable Bowel Syndrome

Department of Colorectal Surgery Tel: 01473 712233

Issue 1: January 2010 The Ipswich Hospital NHS Trust, 2010. All rights reserved. Not to be reproduced in whole, or in part, without the permission of the copyright owner.

What is irritable bowel syndrome (IBS)?

IBS is the term used to describe a variety of gastrointestinal tract or gut-related symptoms. It is the most common disorder of the gut in the western world. A third of people in Britain have occasional symptoms of IBS; 1 in 10 has symptoms bad enough to require medical attention. Symptoms vary from one individual to another and appear to be due to an increased sensitivity of the bowel, which results in spasm of the bowel muscle. The most common symptoms are: diarrhoea, constipation or both; lower abdominal pain, which may ease after going to the toilet; feeling bloated; feeling you still need to go to the toilet when you have just been; passing mucus even on its own; and a feeling of urgently needing to go to the toilet. Other symptoms may include: loss of appetite; nausea and / or vomiting; tiredness; belching / excessive wind; pain during sexual intercourse; and worsening of symptoms during periods (women). It is not normal to pass blood, have diarrhoea waking you from sleep or have unintentional weight loss of more than 2 kg (4 lb) if you have IBS. If this does happen, it is important to consult your GP. If you think you have IBS, discuss your symptoms with your GP before trying any of the treatments discussed in this booklet.

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What causes IBS?

It is not known exactly what causes IBS. In some cases, symptoms may start after having a tummy bug or a stressful life event.

Can IBS cause cancer?

No, there is no evidence to suggest that IBS and cancer are related.

What can I do to relieve my symptoms?

The suggestions in this booklet are based on the following steps: Step 1 Look at your lifestyle. Step 2 Adjust your diet according to your symptoms. Make the changes to your diet gradually, as your gut will need time to adjust. Allow 3 4 weeks for any improvement. If your symptoms still have not improved after 4 6 weeks: Step 3 onsult a dietitian for further advice. Ask your GP or hospital C to refer you. You may find it helpful to keep a diary of your diet and symptoms as you make these changes. This will remind you of what has helped.

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Step 1 Look at your lifestyle

If you have a busy life, you may be relying on ready meals, high fat snacks or takeaways. While these are OK to have occasionally, you may not be getting all the nutrients you need and these foods could be making your IBS symptoms worse. Try these simple lifestyle changes. Follow these guidelines to ensure your diet is well balanced. Eat three regular meals each day dont be tempted to skip meals. Try making more meals using fresh ingredients instead of having ready meals. Chew food well and take time to sit and eat. Drink plenty of fluid at least eight cups a day but not all tea, coffee or fizzy drinks as these can worsen symptoms. Alcohol can also make symptoms worse. Water, sugar-free squash and herbal teas are good choices. Take regular exercise such as walking, cycling or swimming. Make the most of your leisure time and take time to relax. Stressful situations can make IBS worse. Try to find out what affects you. Relaxation tapes, yoga, aromatherapy or massage may help. How much fibre should I have? This depends on the symptoms you experience. Fibre (also known as non-starch polysaccharides or NSP) can be split into two types. The balance of these two types, as well as the amount, may need to be altered. The two types of fibre are: insoluble fibre which provides the bulk, helping waste to move through the gut; and soluble fibre which absorbs fluid in the gut and helps to make the stool softer and easier to pass. See pages 9 11 for more information about fibre.

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How do I make sure my diet is balanced?

Choose a variety of foods from each of the five food groups shown below.
Fruit and vegetables Bread, cereals, rice, pasta, potatoes

Meat, fish, eggs, poultry, beans and pulses

Foods containing fat or sugar

Milk and dairy products

Fruit and vegetables Aim for five portions of these each day. Have a variety of these foods. Bread, cereals, rice, pasta, potatoes Have one of these foods at every meal time. Meat, fish, egg, poultry, beans and pulses Aim for 2 3 portions of these each day. Foods containing fat or sugar (such as biscuits, cakes, crisps, chocolates, sweets, margarine / butter and cooking oils) Keep these to a minimum. Milk and dairy products Try to have 2 3 portions of these each day. Choose low fat versions such as skimmed or semi-skimmed milk and low or reduced fat cheeses or yoghurts. If you still have symptoms after following the advice in Step 1, continue on to Step 2.
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Step 2 Adjust your diet according to your symptoms.

If there is no improvement after four weeks, ask for a referral to a dietitian for further advice. Please refer to pages 9 11 for a list of fibre sources. Symptom Diarrhoea with or without wind and bloating Reduce your intake of Tea or coffee not more than three cups per day. Alcohol not more than two units per day and no more than five out of seven days each week. Fizzy drinks Fruit not more than two pieces per day. Fruit juice not more than one small glass per day. Sorbitol (found in sugar-free sweets). High fibre foods (see pages 9 11). Biscuits, cakes, crisps, ready meals, tinned / packet soups, cook-in sauces. Constipation / Diarrhoea with wind and bloating Tea or coffee not more than three cups per day. Alcohol not more than two units per day and no more than five out of seven days each week. At least eight glasses of fluid throughout the day such as water, sugarfree squash, herbal teas. Foods low in fibre see pages 9 11 and oats or oatmeal and linseeds. Have a regular intake of At least eight glasses of fluid throughout the day such as water, sugarfree squash, herbal teas. Small meals. Foods low in fibre see pages 9 11. Live yoghurt try a variety of brands.

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Symptom Constipation / Diarrhoea with wind and bloating (continued)

Reduce your intake of Fizzy drinks Fruit not more than three pieces per day. Fruit juice not more than one small glass per day. Sorbitol (found in sugar-free sweets). Foods high in insoluble fibre (see pages 9 11). Biscuits, cakes, crisps, ready meals, tinned / packet soups, cook-in sauces.

Have a regular intake of Live yoghurt try a variety of brands.

Constipation / Diarrhoea without wind and bloating

Tea or coffee not more than three cups per day. Alcohol not more than two units per day and no more than five out of seven days each week. Fruit not more than three pieces per day. Fruit juice not more than one small glass per day. Sorbitol (found in sugar-free sweets).

At least eight glasses of fluid throughout the day such as water, sugarfree squash, herbal teas. A variety of foods but take care not to have more than three pieces of fruit per day.

Constipation with wind and bloating

Alcohol not more than two units per day and no more than five out of seven days each week.

At least eight glasses of fluid throughout the day such as water, sugarfree squash, herbal teas.
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Symptom Constipation with wind and bloating (continued)

Reduce your intake of Fizzy drinks Foods high in insoluble fibre (see pages 9 11).

Have a regular intake of Foods low in fibre see pages 9 11 and oats or oatmeal and linseeds*.

Constipation without wind and bloating

Wind and bloating only

Biscuits, cakes, crisps, Live yoghurt try a variety of brands. ready meals, tinned / packet soups, cook-in sauces. At least eight glasses Foods low in fibre of fluid throughout the see pages 9 11 day such as water, sugarexcept meat, fish and free squash, herbal teas. alternatives and milk and dairy products. Foods containing insoluble and soluble fibre (see pages 9 11). At least eight glasses Foods high in of fluid throughout the insoluble fibre day such as water, sugarAlcohol not more free squash, herbal teas. than two units per day and no more than five out of seven days each week. Fruit not more than three pieces per day. Fruit juice not more than one small glass per day. Biscuits, cakes, crisps, ready meals, tinned / packet soups, cook-in sauces. Foods low in fibre see pages 9 11 and oats or oatmeal and linseeds. Live yoghurt try a variety of brands.

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Sources of fibre
Food group Bread, other cereals and potatoes Low fibre foods allowed White bread, white chapatis. White pasta. White rice. Rice- or corn-based cereals (such Rice Krispies, cornflakes). Cream crackers. Boiled, mashed or roast potatoes (no skin). Fruit and vegetables Yams, sweet potato. Tinned or stewed pears, peaches, grapes, apples, plums, nectarines, melon, mangoes, lychees and ripe bananas (avoiding the pips and skin of all fruit). Boiled baby carrots, celery, cauliflower florets, cabbage, courgettes, spinach, squash, swede or turnip. Skinned cucumber, lettuce, peppers, skinned and pipped tomatoes, radishes. All meat, poultry and fish. Quorn. Smooth peanut butter. Milk and dairy products Foods containing fat, foods containing sugar Eggs. Milk. Plain or smooth fruit yoghurts. Cheese. Butter, margarine, oil. Plain biscuits such as Rich Tea or Morning Coffee. Cakes, puddings and pastries made with white flour. Ice cream, cream, jelly, milk puddings, sorbet. Sugar, honey, syrup, jelly-type jams and fine cut marmalade. Boiled sweets, chocolate, plain coffee.
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Meat, fish and alternatives

Food group Bread, other cereals and potatoes

Sources of insoluble fibre Wholemeal or granary bread, added fibre white bread, wholemeal chapatis. Wholegrain pasta. Brown rice. Wholegrain cereals such as Bran Flakes, Weetabix, muesli and All Bran. Rye crispbreads, wholemeal crackers. Jacket potato skins. Dried fruit. Mushrooms, sweet corn, spinach, broccoli. Blackberries, raspberries, blackcurrants. Figs, mangoes. All types of nuts and seeds (except linseeds). Yoghurts containing nuts or cereal. Wholemeal biscuits such as digestives. Cakes, puddings and pastries made with wholemeal flour and / or nuts, dried fruit. Jams with seeds or skin, thick cut / chunky marmalade, sweet mincemeat. Sweets and chocolate with fruit or nuts, muesli bars.

Fruit and vegetables

Meat, fish and alternatives Milk and dairy products Foods containing fat, foods containing sugar

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Food group Bread, other cereals and potatoes Fruit and vegetables

Sources of soluble fibre Porridge, Ready Brek, oatcakes.

Oranges and grapefruit. Brussels sprouts, green beans, cabbage, okra, onions, leeks, garlic, peas and avocados. Golden (or cracked) linseeds. Beans, pulses, chickpeas and split peas. Do not eat large amounts of these if you suffer from wind or bloating. Yoghurts containing fruit. Flapjacks. Cakes and puddings made with oats.

Meat, fish and alternatives Milk and dairy products Foods containing fat, foods containing sugar

Some questions answered

Can herbal drinks help? Some people find that herbal drinks such as peppermint or camomile tea help. Some have also found aloe vera juice to be useful although it may make diarrhoea worse. Should I try live yoghurts or fermented drinks? Live or bio yoghurts, such as Loseley, Onken, Nestle LC1, Provamel, Natural Yofu, Danone Activia, and fermented milk drinks, such as Yakult, Actimel or Nestle LC1, contain cultures (bacteria). These bacteria may help further digestion of food in the lower part of the gut. This may reduce symptoms of wind and bloating. However, the amount of live bacteria in different products varies and cannot be guaranteed. You will need to take these every day for at least two weeks for them to work. It may also help to try another brand containing a different bacteria, if the first hasnt helped.

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Do I have a food allergy or intolerance? True food allergies are rare and unlikely to cause IBS symptoms but symptoms could be caused by food intolerance. There are no known reliable tests for food intolerance. An exclusion or elimination diet is the only way to find out if your symptoms are made worse by certain foods. If the advice given in this leaflet has not helped and you feel your symptoms may be due to food intolerance, please ask your GP to refer you to a state registered dietitian.

What else could help?

Medication Several different drugs are available which may help to relieve your symptoms. Your doctor will advise which medicines are suitable to try.

Useful address
The Gut Trust (formerly IBS Network) Unit 5 53 Mowbray Street, Sheffield S3 8EN Tel: 0114 272 3253 Website: www.theguttrust.org

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