What You Need to Know to Manage IBS

The team at IrritablebBowelSyndrome.net conducted their annual "IBS in America Survey" for 2018 and the results are giving us some fantastic insight - particularly into how people prefer to manage their IBS.

The data shows us that about half of people living with irritable bowel syndrome prefer to make lifestyle and/or diet changes rather than take prescription medications. As a dietitian who specializes in IBS and gut health, this aligns with what I see in practice. My clients are often equally as hesitant to use medications, especially if they can potentially shift their diet and lifestyle to avoid or reduce them!

That being said, a portion of the population with IBS will need prescription medication at some point in treatment and this isn’t necessarily bad! Instead of scorning all medication, I try to approach treatment with my patients as a tiered process; a sort of step-by-step approach where we try lifestyle-based treatment first and move toward medication management if necessary.

Diet and lifestyle changes: first line of treatment for IBS

Interestingly, the same study also showed that 59% of people living with irritable bowel syndrome have never followed the low FODMAP diet before. This number is big! As an IBS dietitian, I would love to help more IBS patients learn about the potential of food to improve their condition.

If you need a quick refresher, the low FODMAP diet is one of the most evidence-based dietary approaches to IBS management. With this diet, the main objective is to remove fermentable carbohydrates from the diet for a period of time to identify whether symptoms improve. These same fermentable carbohydrates are then reintroduced strategically to identify whether and how much of these foods an individual can tolerate.

In my own practice, the low FODMAP diet is often our first line management strategy for IBS. The response rate is overall quite good; we see that 70-80% of our clients see significant symptom improvement on the low FODMAP diet. Talk about great odds! This is exactly why we like to start here - low risk, high reward!

Let’s not forget however, food is only one leg holding up our metaphorical IBS table. Other lifestyle management strategies are equally as important. In particular, stress plays a huge role in symptom management. For this reason, it is often recommended to work with a psychologist and/or adopt mindfulness-based stress reduction techniques into your daily life. These could include meditation, deep breathing, or body scan exercises.

Medications: second line of treatment for IBS

As I previously noted, it is totally valid and acceptable to manage IBS with pharmacological therapies if necessary. There seems to be such a stigma about this in the IBS community! Trust me - you are not accepting defeat if you need medication to help you feel good in your body!

There are a few types of medications that we commonly use in conjunction with lifestyle and dietary management strategies. Medications that may be recommended by your healthcare team could include:

• Antidepressants
• Laxatives
• Anti-diarrheal medications
• Bulking agents
• Antispasmodics

Irritable bowel syndrome is also known to be a condition in which you may have "flare-ups" or episodes that are worse than others. Many of my clients prefer to use medications and non-pharmacological herbal products (or both) during these more painful and distressing times. Depending on the severity of your symptoms and your lifestyle, this may be a great option for you as well.

I like to refer to this as “emergency IBS management” and I encourage my clients to create a plan for those times when they may need more support in the form of medication. A great example - traveling! Your digestive system can take a significant hit when you’re on vacation or traveling for work. This is also a time when we tend to have less control over our food choices, so calling for back-up may be just the thing!

If you feel you need support finding the right combination of dietary, lifestyle, and/or pharmacological management tools for your IBS, it is best to speak with your doctor and a dietitian who specializes in digestive health. Remember, each individual is different, so getting one-on-one support is a great way to get a customized plan that will work for you and your symptoms.