A combination of therapies to help IBS
3rd July 2017
When you've got irritable bowel syndrome (IBS) you'll often try anything to make the symptoms go away.
Although diet is the front line in symptom management there are other alternative,complementary therapies which may help too, even if they don't always have the science to back them up.
Mood can be important when managing IBS as even though it has physical symptoms it has a psychological aspect too.
IBS symptoms and triggers are different for everyone. Some people may have constipation, others diarrhoea. Some may experience both. A therapy may help one person and do nothing for another. It may be a matter of trial and error until you hit upon what works for you.
Diet and IBS
Your diet is the most obvious place to start when it comes to managing IBS. It's not the same advice for everyone - it depends on symptoms and severity.
"People with IBS usually find that eating can trigger their symptoms, but it’s often difficult to identify what component, if any, of the meal may be responsible. For some, certain food and drink may exacerbate symptoms - such as fizzy drinks, dairy, gluten, fatty foods, onions and some fruits. In many cases, it may be the act of eating, what it represents, or just eating in a rush, that is upsetting the gut," says Gillian Goddard, dietitian and diet adviser to the charity The IBS Network.
"Dietary advice is pretty much first call if you have IBS," says Dr Megan Rossi, who's a spokesperson for the British Dietetic Association." First a dietitian would look at how much fibre, spicy food, fats and dairy you are eating - 50% of people respond if changes are made at this stage."
"The second line of treatment would be what's called a 'low FODMAP diet', where about 70% of people with IBS see an improvement in symptoms," says Megan.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are substances naturally present in foods that start to ferment in the gut and can lead to bloating. It's quite a complicated balancing act so follow a low FODMAP diet under the guidance of a registered dietitian. Your GP can refer you to a local dietitian.
Medications for IBS
There's a range of medications that may be used to help treat the symptoms of IBS,depending on your key symptoms.
- Antispasmodics help relieve stomach cramps and pains
- Antimotility medication help reduce diarrhoea
- Laxatives help relieve constipation
- Low-dose anti-depressants may also help reduce pain and cramps in the stomach
Probiotics for IBS
Probiotics are beneficial bacteria that live in the gut, often called 'friendly bacteria'. Some experts think IBS can be improved if there's more good gut bacteria. There's evidence that that taking probiotic supplements can help some people with IBS.
There have been 35 clinical trials into the use of probiotics for IBS and when these results are pooled it's been found that if you take a probiotic supplement you will reduce your risk of IBS symptoms in 21% of cases," says Megan, who runs a gut health clinic.
"There are many probiotics available as single or multi-strain products in a variety of formulations like capsules, powders, fermented milks and yoghurts," says pharmacist Ewa Gabzdyl, who advises The IBS Network. "But to date no probiotic product has had their health claims approved by the European Food & Health Safety Authority (EFSA).”
If you want to give probiotic supplements a go the advice from the National Institute for Health and Care Excellence (NICE) is you should take them for at least 4 weeks to see if your symptoms show any signs of improvement.
Exercise for IBS
Exercise is a great stress reliever and since stress is closely linked to IBS taking physical exercise may help.
Some people with IBS often need to go to the toilet urgently so exercise can sometimes be awkward. It's best not to exercise too intensely at first but build up to a level you are comfortable with. If you have IBS with constipation exercise may help get your digestive system moving.
Herbal remedies for IBS
There's no herbal remedy that is recommended for the treatment of IBS. Some herbal products may help with the symptoms like constipation and bloating.
Wendy Green is author of 'IBS: A self-help guide to feeling better'. There are 3 herbal remedies she recommends for people with digestive problems like IBS. They are ginger, turmeric and peppermint.
"Ginger is great for nausea and helps to improve digestion. Try fresh ginger root or crystallised ginger, or add a third of a teaspoon of dried ginger to a cup of tea, alternatively drink ginger and lemon tea."
Turmeric is thought to relieve tummy cramps and diarrhoea. Sprinkle it over a latte, add it to savoury dishes, or buy it in capsule form.
"Peppermint eases wind, bloating and tummy cramps. Peppermint teabags are widely available, or you can add a few drops of peppermint oil to a tumbler of water," recommends Wendy.
"Peppermint oil capsules can be effective for some people with IBS, although not all, by reducing painful spasms and pressure in the bowel and easing bloating and wind," agrees Ewa.
Stress management for IBS
Stress is a well-known trigger for IBS so stress management techniques can help treat the symptoms. Having IBS can also make people feel more stressed too, if they worry about toilet stops when they’re out.
Anything that helps you deal with stress and relax has the potential to help your IBS too. It may be meditation, yoga, other exercise or talking therapies.
"Yoga can help those with IBS gain a peaceful balance of mind and body so they can better manage the strains of life that may be contributing to their illness. Meditation can help slow down the overactive mind and create a sense of calm, offering the relief of stress to people with IBS," explains Janet Tomlin, a hypnotherapist who works with the IBS Network.
Talking therapies may also reduce stress for some people so may help with IBS symptoms.
"Complementary therapies confer what is often missing from a modern medical consultation - the time to listen, the development of a therapeutic rapport and the use of techniques that reduce emotional tension and establish a sense of harmony," suggests Dr Nick Read, IBS expert at the Sensitive Gut website.
Hypnotherapy for IBS
There's some research of the effectiveness of hypnotherapy on the symptoms of some people with IBS.
Hypnotherapy uses hypnosis to change your unconscious mind's attitude towards your IBS symptoms.
Two studies in Sweden in 2012, involving around 350 patients, suggested hypnotherapy lessened symptoms in 40% of those affected and it was a long-term improvement.
NICE guidelines suggest if IBS symptoms haven't improved after a year of pharmacological treatment referral for hypnotherapy may be considered.
"There is good evidence to suggest that the talking therapies, such as hypnotherapy, can be effective for IBS," says Janet.
"The treatment utilises a very relaxed state of consciousness or ‘trance’ to communicate verbally with the subconscious mind, using the person’s own imagination to achieve changes in perceptions, feelings, thoughts and behaviour. To work effectively it requires motivation and commitment from the individual to make the changes," explains Janet.
"The focused eye contact, modulated voice of the therapist, the safe environment and the calming of areas of tension throughout the body would help," believes Nick. "Such actions resemble the ways mothers calm their infants. Other effects, such as reduction in gut sensitivity and regulation of gut motility, may follow."
Acupuncture for IBS
The British Acupuncture Council suggests that there's research to suggest acupuncture may help alleviate IBS symptoms in a variety of ways, including by providing pain management and by reducing anxiety.
The use of acupuncture for IBS management is controversial. Advice from the government organisation NICE, which reviews the effectiveness of treatments, recommends acupuncture shouldn't be encouraged for the treatment of IBS.
CBT for IBS
Cognitive behavioural therapy ( CBT) may help treat the symptoms of some people with IBS.
It's a type of psychotherapy that teaches you different ways to think and react. You learn to change your behaviour to help you cope better with your situation.
Once again NICE advice is to consider this if after a year if medications haven't worked to help your IBS.
In one study a group of IBS patients was given up to 10 sessions of CBT over 8 weeks. They looked at muscle relaxation, problem-solving skills related to IBS, and how to stop worrying about the condition. Around 80% showed an improvement in symptoms.
IBS is a complex, and often unexplained, condition for which there's no cure but plenty of options for relief of symptoms. Combining conventional and complementary therapies can help relieve symptoms of IBS.