Irritable bowel syndrome: how to care for it

01

What IBS is and how it is recognized

IBS is diagnosed from clinical history and by ruling out other causes. Under the Rome IV criteria, there is recurrent abdominal pain, on average at least one day a week over the last 3 months, related to two or more of these: bowel movements, a change in how often you go, or a change in stool form. Symptoms must have started at least 6 months earlier.

Before concluding it is IBS, the doctor needs to rule out other causes, such as celiac disease, inflammatory bowel disease, SIBO, intolerances and thyroid changes. Do not diagnose yourself.

02

What may be behind it

IBS has a multifactorial origin, and the cause varies from person to person. Among the factors studied:

• Visceral sensitivity: the gut reacts with pain and discomfort to stimuli that would not normally bother.
• Changes in motility, that is, in the rhythm of the gut's movements.
• The gut-brain connection: stress, anxiety and depression influence symptoms, and symptoms influence mood.
• Previous gut infections, which can leave the intestine more sensitive (post-infectious IBS).
• Changes in the microbiome, gut permeability, low-grade inflammation and bile acids.
• Genetic factors and family history, which may influence inflammation, sensitivity and gut function.
• Adverse events, such as childhood trauma, physical or psychological stress and abusive relationships.

Some traits, such as perfectionism and self-criticism, may be linked to more symptoms, but that does not mean IBS is a matter of personality or that the person is to blame. What we feel influences the gut, and the gut influences what we feel.

03

Triggers worth watching

Diet does not cause IBS and does not cure it, but some habits can worsen symptoms. Keep a diary to see whether any of these make a difference for you:

• Lots of simple sugars and sweetened drinks.
• Dehydration.
• Dairy, in people with milk allergy or lactose intolerance.
• Too much fiber at once, especially insoluble fiber such as wheat bran.
• Large amounts of fat and greasy food.
• Too much caffeine, and alcohol.
• Artificial sweeteners and polyols, such as sorbitol and xylitol.
• Supplements not indicated for you, such as sodium bicarbonate and citrate.
• Fermentable carbohydrates (FODMAPs), especially during flares.
• Eating too fast, skipping meals or eating while stressed.

04

The FODMAP diet, in stages

FODMAPs are fermentable carbohydrates (such as those in garlic, onion, wheat, honey and apple) that some people absorb poorly. They reach the large intestine and are fermented by bacteria, producing gas and discomfort. The diet is done in three phases, with guidance:

The diet should not be followed indefinitely and should not be started without guidance. The guide “The FODMAP diet: an anti-fermentation approach” explains each phase in more detail.

05

Fiber, peppermint oil and other options

06

Caring for brain and gut together

Because brain and gut are in constant conversation, non-nutritional strategies are part of treatment, not a minor extra:

07

And when constipation predominates?

Constipation means a more sluggish gut. In the last 3 months, did you have two or more of these signs?

• Straining to have a bowel movement.
• Stool types 1 and 2 on the Bristol Scale.
• A feeling of incomplete evacuation.
• Needing a footstool or a squatting position to go.
• Fewer than 3 spontaneous bowel movements a week.

If so, it is worth talking to a health professional. Care starts with habits: more water, fiber increased gradually, physical activity, stress management and respecting the gut's schedule. When needed, factors such as digestion, gut inflammation, the microbiome and nutrient deficiencies can be investigated. It is not necessary to cut flour and milk for everyone: restrictions should follow individual tolerance. The guide “Constipation” has more details.