Stress reduction

IBS is well known to be aggravated by stress. Moreover, the symptoms and the disruption they cause can themselves become a source of stress, creating a vicious cycle of stress and discomfort. How does stress affect the gastrointestinal system? It turns out that the largest concentration of neurons outside of the brain and spinal cord is in the gastrointestinal tract, making it particularly susceptible to stress and creating a strong brain-gut connection. Stress hormones can alter movement through the gastrointestinal tract (speeding it up or slowing it down) and cause the muscles in the intestines to spasm and cause pain. Thus, for people who experience a lot of stress in their lives, learning stress-reduction techniques can be instrumental in reducing the frequency and severity of IBS-related symptoms.

Several clinical trials have demonstrated that two stress-reduction techniques — meditation and mindfulness-based interventions — can significantly reduce abdominal pain and improve bowel habits. To be most effective, these tools should be practiced daily, as over time they retrain the nervous system and reduce the amount of time that it operates in the stress (fight-or-flight) response. It’s important to remember that meditation and similar techniques are learned skills that take time and practice to build, so you are unlikely to notice an immediate improvement in IBS-related symptoms after the first or second try. There are many meditation apps, internet tutorials, and even evidence-based courses offered through major hospitals that offer opportunities to learn these invaluable skills.

Other stress-reducing approaches have also shown benefit for IBS-related symptoms. These include gut-directed hypnotherapy (a popular protocol in Europe), cognitive behavioral therapy, and possibly yoga.

Special diets

Studies have shown that foods high in FODMAPs (dietary sugars known as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) can exacerbate IBS-related symptoms by providing fuel for certain bacteria in the gastrointestinal system. The byproducts from these bacteria can cause pain and bloating. On the other hand, low-FODMAP diets can reduce the abdominal pain, bloating, diarrhea, and constipation associated with IBS. Although safe to follow for short-term use, there are no long-term studies of this diet, and sustaining this eating pattern can be challenging.

For some patients with diarrhea-predominant IBS, reducing intake of gluten, a protein found in wheat, rye, and barley, can help. This may be the case even if you do not have celiac disease, as gluten can modify the barrier function of the gut lining.

Supplements

For individuals with constipation-predominant IBS, a soluble fiber supplement (Metamucil or others containing psyllium) can be helpful. Large amounts of fiber can hinder the absorption of medications, so take your medications one to two hours before the fiber supplement. Soluble fiber is also found in foods such as beans, avocados, oats, and dried prunes. Be sure to consume plenty of water with fiber to avoid worsening the constipation.

A recent analysis of nearly 1,800 patients from multiple studies demonstrated that probiotics reduce pain and symptom severity in IBS compared to placebo. Probiotics are “good” bacteria touted to help maintain digestive health. However, given the variety of different probiotics that have been studied, it is difficult to know exactly which ones are most useful or how much to take.

Finally, peppermint oil is well known for its ability to relax the smooth muscles of the gastrointestinal system, and can help reduce the abdominal pain associated with IBS. To reduce the potential for heartburn, enteric-coated capsules (typically containing 0.2 milliliters or 181 milligrams of peppermint oil) are recommended. The dose for adults is one to two capsules up to three times per day.

Mind-body tools, a low-FODMAP diet, and some supplements can help relieve IBS-related symptoms and are generally safe for most people. They can also be used in combination with most IBS medications. If you have IBS, talk with your healthcare professional, as he or she may be able to provide you with resources to help you implement these tools in your life.