An Overview of Irritable Bowel Syndrome (IBS)

This month is devoted to raising awareness about IBS and to encourage people who experience symptoms of IBS to seek medical advice. Everyday this April, we will be rolling out a series of blogs and social media posts about IBS and the Low FODMAP Diet – think food swaps, recipes, myth busting and more!!

To kick off this month, we will be sharing an overview of IBS.

What is IBS?

IBS is a gastrointestinal disorder in which a person experiences chronic, relapsing abdominal pain or discomfort, in the absence of other structural or biochemical gastrointestinal abnormalities. Symptoms vary between individuals and may include constipation, diarrhoea, bloating, excessive wind, cramping or a combination of these. These symptoms are often unpredictable and can place a significant impact on daily living and quality of life. The prevalence of IBS globally is estimated to be 10-15% however it is thought that IBS often remains under diagnosed.

What is the cause of IBS?

The underlying cause of IBS is still unclear however it is likely multi-factorial. Factors may include heightened pain sensitivity of the bowel, altered gut-brain connections, inflammation and genetics.

How is IBS diagnosed?

As there is no diagnostic test for IBS, positive diagnosis is based on the person’s symptoms and exclusion of any gastrointestinal abnormalities or diseases such as inflammatory bowel disease, coeliac disease, bowel cancer and infections.

Important reminder: If you are suffering from gastrointestinal symptoms similar to the above, it is important not to self-diagnose. A number of gastrointestinal diseases share similar symptoms to IBS so it is paramount to seek medical advice.

Rome IV Criteria

After ruling out other possible medical causes, a person will be diagnosed with IBS using the Rome IV diagnostic criteria if they have experienced recurrent abdominal pain for 6 months before diagnosis, on average at least 1 day per week in the last 3 months, associated with 2 or more of the following criteria:

1. 1. Symptoms related to defecation

2. Symptoms associated with a change in frequency of stool

3. Symptoms associated with a change in form (appearance) of stool, based on the Bristol Stool Form Scale (BSFS)

Based on the person’s reported predominant bowel habit, IBS can be broken down into 3 sub-types:

• IBS-C (predominant constipation- Bristol types 1 and 2)
• IBS-D (predominant diarrhea – Bristol type 6 and 7)
• IBS-M (IBS with mixed bowel habits – Bristol type 1 and 6)
• People who have symptoms that do not fit into any of the above categories are considered to have IBS unclassified.

How is IBS treated?

Currently, there isn’t a cure for IBS. However, a low FODMAP diet can help relieve symptoms in about 75% of people with IBS following the diet. Other ways for symptom management include pharmacological therapy, gut-directed hypnotherapy and cognitive behavioural therapy (CBT). Talk to your GP to find out more. Stress management is also important, as stress can often heighten the severity of symptoms. Examples of ‘de-stressing’ activities include yoga classes or mindfulness training.

Low FODMAP Diet

FODMAPs are a group of carbohydrates that can be poorly absorbed in the small intestine and move on to be fermented in the large intestine. The production of gases from the fermentation can trigger symptom in people with IBS.

The low FODMAP diet is the current best dietary management for IBS. It consists of three phases:

1. 1. The elimination phase, usually take 2-6 weeks, as guided by your practitioner
2. 2. The re-introduction (or challenge) phase, to establish your tolerance levels to each FODMAP group
3. 3. The maintenance phase, an individualised, modified low FODMAP diet for long-term adherence as advised by your practitioner.

It is highly recommended to seek guidance from a dietitian to oversee your progress across the three phases. Your dietitian can help to develop an individualised, low FODMAP nutrition plan but can also determine your degree of tolerance to each FODMAP group which will allow you to increase the variety of food in your diet during the maintenance phase.

Find a specialised Dietitian near you via the Dietary Specialists tab in our FODMAP Friendly app.

While you are following a low FODMAP diet, FODMAP Friendly certified products are suitable for you during all 3 phases. When you see the FODMAP Friendly logo on a food packaging, you can be confident the food product has been laboratory tested to be low in all FODMAP sugars.

Keep your eyes peeled for daily posts throughout this month to raise awareness on IBS!