Information for the public

Managing irritable bowel syndrome

Managing irritable bowel syndrome

If you are diagnosed with irritable bowel syndrome, your doctor should give you information and advice to help you live with your condition. This should include advice about physical activity, lifestyle, diet and the medicines you can take to help your symptoms.

Physical activity and lifestyle

Your doctor should assess how physically active you are, which may involve using a questionnaire. If you do not take much exercise, you should be advised to try to increase your daily activity. Your doctor should also explain the importance of finding time to relax or devote to leisure activities that you enjoy.

Diet

Your diet should be assessed and you should be given advice on what you can do to help your symptoms, including the following:

  • Eat regular meals and take time to eat without rushing.

  • Don't skip meals or leave long gaps between eating.

  • Drink at least 8 cups of fluid a day, particularly water or other non‑caffeinated drinks, for example herbal teas.

  • Avoid drinking more than 3 cups of tea or coffee a day.

  • Cut down on alcohol and fizzy drinks.

  • Avoid eating more than 3 portions of fresh fruit a day (a portion is about 80 g)

  • If you have diarrhoea, avoid the artificial sweetener sorbitol, which is found in sugar‑free sweets (including chewing gum) and drinks, and in some diabetic or slimming products.

  • If you have wind or bloating, it may help to eat oats (for example, oat‑based breakfast cereal or porridge) and linseeds (up to 1 tablespoon a day).

If you want to try a probiotic product to see if it helps, you should be advised to keep taking it for at least 4 weeks and take the dose recommended by the manufacturer. You should also record whether it makes a difference to your symptoms. Your doctor should not recommend using a herbal medicine called aloe vera for irritable bowel syndrome because it is unlikely to help and could have side effects.

Managing your fibre intake

Eating the right amount of fibre is important for people with irritable bowel syndrome. You should be given advice on how to adjust how much fibre you eat, including what foods to avoid and what foods or supplements may be helpful.

When you should be offered further advice on diet

If you are following your doctor's advice about diet and lifestyle but it has not helped, you should be offered further advice on your diet. It is important that you get this advice from a healthcare professional who is an expert on diets for people with irritable bowel syndrome (such as a dietitian).The advice should cover diets that involve avoiding or cutting out certain foods that could be making your symptoms worse (for example, a low FODMAP diet).

Medicines for irritable bowel syndrome

Whether any medicine is suitable for you will depend on your symptoms. However, it is still important that you follow your doctor's advice on diet and lifestyle while taking any medicine.

You may be offered a medicine called an antispasmodic, which reduces bowel spasm. If you have diarrhoea, you may be offered a medicine called loperamide, which slows down the activity of your bowel. For constipation you may be offered a laxative but your doctor should not offer you lactulose. If you've had constipation for at least a year and have tried different types of laxative that haven't helped, your doctor may offer you a laxative called linaclotide. They should ask to see you after you've been taking it for 3 months to check if it's helping.

If you are taking a laxative or loperamide, your doctor should show you how to adjust the amount you take until you are producing soft, well‑formed stools.

If laxatives, loperamide or antispasmodics don't help, you may be offered a type of drug called a tricyclic antidepressant (TCA) or (if that isn't effective) a selective serotonin reuptake inhibitor (SSRI). Low doses of these drugs are sometimes offered to people with irritable bowel syndrome because they can help to ease pain. Although this is an 'off-label use' for TCAs and SSRIs, they have been shown to be effective.

When offering you a TCA or SSRI, your doctor should discuss the benefits and possible side effects with you. If it's the first time you've taken either of these drugs for irritable bowel syndrome, they should ask to see you after 4 weeks to check your progress, and then every 6–12 months.

What other treatments are there?

If following your doctor's advice and taking medicines have not helped your symptoms after a year of treatment, you may be offered a referral for a kind of treatment called a psychological intervention. This could include treatments called hypnotherapy, psychological therapy or cognitive behavioural therapy.

Your doctor should not recommend that you use acupuncture or reflexology as treatments for irritable bowel syndrome because they are unlikely to help.

Whatever type of treatment your doctor recommends, he or she should discuss with you when to come back and talk about how you are progressing.When you come back you should be asked if you have experienced any new symptoms since your last visit.

Questions to ask about managing irritable bowel syndrome

  • Please tell me more about managing irritable bowel syndrome.

  • Do I need to avoid eating processed foods and some reheated foods (like potatoes and pasta)?

  • Can you give me some more information about how much fibre I should eat?

  • Can you tell me why I need to avoid eating more than 3 portions of fresh fruit a day? Would it be helpful to eat portions of fruit at different times of the day rather than all in one go?

  • Where can I get more information and advice on probiotics?

  • If I need to take medication, how will the treatment help me?

  • How long will it take to have an effect?

  • Are there any risks associated with this treatment?

  • If I decide to have a psychological intervention, what will this involve?

  • Can you give me any further information (like a leaflet or website address) about how to manage irritable bowel syndrome?