What is it?
Common, unknown direct cause. Suspected: muscle in the digestive tract = changes in speed, strength and coordination of digestive enzymes. Visceral hypersensitivity. Altered intestinal microbiota. |
Other factors: restrictive diets, stress/anxiety, genetics, environmental interactions. |
IBS-C = more type 1-2 |
IBS-D = more type 6-7 |
IBS-M = Alternating diarrhoea and constipation |
Common in EDs and pt w/ anxiety |
Diagnosis
Recurrent abdominal pain (≥1 day/week, in 3/12), with an onset ≥ 6/12 |
Abdominal pain is classified as 2 of these: pain related to defecation, change in stool frequency, change in stool form or appearance |
Strategies
Peppermint tea, or peppermint oil capsules (menthol acts as an antispasmodic). Can have with or after meals. Mintec - 0.2mL (180mg) |
↑ soluble fibre |
Limit alcohol & caffeine |
Probiotics and prebiotics for general gut health |
Limiting the obvious, ‘big’ fodmaps first |
Low FODMAP flavour additives: fresh chives, Dijon mustard, vinegar, citrus juice, fresh herbs, soy sauce, spices, ginger, capers, olives |
MI to remain flexible and encourage after challenges |
Creating a calm, relaxed eating environment |
MONASH app & cookbook |
Facebook groups for social support |
S/S
Abdo pain |
Bloating |
Abdo distention |
Diarrhoea |
Constipation |
Excess gas |
Worsening symptoms with stress or menstruation |
Urgency or straining during bowel movements |
Sensation of incomplete evacuation |
Guidelines & References
Brian et al. ACG clinical guideline: management of irritable bowel syndrome. (2021) |
McKenzie et al. British Dietetic Association systematic review and evidence-based practice guidelines for dietary management of IBS (2016 update). |
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FODMAPs
temporary diet to relieve S/S & find triggers. Series of challenges to eliminate a few high FODMAP sources. |
Fermentable |
In the L.I. 6 CHO that are considered FODMAPS |
Oligosaccharides |
Fructans (FOS) - garlic, onion, leek, wheat/rye/barley, dried apricots, peaches, watermelon, banana (ripe) Galactooligosaccharides (GOS) - beans, green peas, pistachios, cashews, soy milk, oat milk |
Disaccharides |
Lactose - cows milk, condensed milk, yoghurt, custard, evaporsted milk, ice-cream |
Monosaccharides |
Fructose - artichoke, snow peas, apples, figs, dried fruit, mango, pears, watermelon, honey, most juices |
And |
Polyols |
Sorbitol - apples, apricots, plums, peaches, artificial sweeteners (mannitol (mushrooms, snow peas, watermelon), xylitol, isomalt, erythritol) - Attract water into the bowel - diarrhoea common |
Phases
1. Low FODMAP (2-6 weeks) |
Full elimination low FODMAP diet. |
2. Reintroduction (8-12 weeks) |
IF symptoms improve, reintroduce each FODMAP group one at a time - challenges. Have one FODMAP everyday for 3 days in a row. |
3. Personalisation (long-term) |
Use Step 2 to identify which FODMAPS are tolerated & which to avoid. |
Low FODMAP foods
Vegetables |
Eggplant, green beans, bok choy, green capsicum, carrot, cucumber, lettuce, potato, bean shoots, zucchini |
Fruits |
Rock melon, kiwi fruit, mandarin, orange, pineapple, strawberries, dried cranberries |
Dairy & alt |
Almond milk, brie/camembert, feta, hard cheeses, lactose-free milk, soy milk (from soy protein) |
Protein |
Eggs, firm tofu, plain meats/seafood, tempeh, lentils, chickpeas |
Breads/cereal |
GF corn flakes, oats, quinoa, rice, corn pasta, rice cakes, sourdough spelt bread, wheat/rye/barley free breads |
Sweeteners |
Dark chocolate, maple syrup, rice malt, normal sugar |
Nuts/Seeds |
Macadamia, peanuts, pumpkin seeds, walnuts |
Flavour enhancers |
garlic infused oil, chives, green tips spring onion, Dijon mustard, vinegar, citrus juice, fresh herbs, soy sauce, spices, ginger, capers, olives |
IN LOW QUANTITIES |
broccoli (head only), beetroot, corn, cabbage, cauliflower, celery, peas, sweet potato, pumpkin, tomato, avo, dates, lychee |
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NERVA
6-week program of gut-directed hypnotherapy (GDH) to help people manage symptoms |
Daily 15-minute audio hypnotherapy sessions |
Includes breathing exercises, educational content, and a flare-up toolkit |
Improvements in abdo pain, symptom severity, anxiety and overall mental wellbeing |
Similar results to low FODMAP |
Around $150-$300 (depending on plans) |
Red flags
Unexplained weight loss |
family hx of bowel cancer |
age onset 50+ years |
fever |
rectal bleeding |
recurrent vomiting |
Consider
stress/anxiety - work? home life? |
disorder eating patterns |
coeliac testing |
pregnancy |
medications/supplements (antibiotics?) |
alcohol consumption |
Example PESS
Altered GI function (bloating) (NC-1.4) |
Inadequate energy intake |
Example low FODMAP meals
Lemon/herb grilled chicken/fish with roast veg (carrot, potato, capsicum, zucchini, eggplant) & quinoa |
Grilled Fish/Chicken Tacos (GF wraps) w/ lime juice, shredded lettuce, grated carrot, cucumber |
Omelette/frittata - zucchini, spinach, feta, chives, herbs, broccoli |
Stir-Fry with Rice (green beans, bok choy, carrot, green capsicum) |
Fried rice - corn, carrot, green capsicum, spring onion, egg |
Homemade Pizza (GF base): green capsicum, cheese, tomato paste, grilled chicken |
Rice paper rolls - cucumber, capsicum, herbs, prawns |
Snacks: Carmens nut or fruit free muesli bar, corn chips, LF Yoghurt, hard-boiled eggs, rice cakes w/ peanut butter, hard cheese, rice crackers, corn/rice cruskits, plain popcorn, pretzels, dark choc, zucchini slice |
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