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Date issued: March 2024

Review date: March 2026

Ref: C-468/AC/Colorectal/Irritable Bowel Syndrome (IBS) v2

PDF: Irritable Bowel Syndrome (IBS) 2024 v2.pdf[pdf] 539KB

Irritable bowel Syndrome (IBS) can be debilitating for many individuals, with symptoms of abdominal pain and bloating, particularly after eating. You may have symptoms of constipation with your bowels not working regularly, or for others, it can be bothersome loose stools. Some individuals can also suffer with both constipation and loose stools, due to having ‘constipation with overflow diarrhoea’.

Unfortunately, there is no ‘one size fits all’ treatment with IBS. There are suggestions included in this booklet for you to try, some may help and others not. Please do take the time to try them.  It is helpful to keep a food diary for a period, to look at what you eat and how your gut responds.  This can reveal certain foods that can ‘trigger’ your symptoms and perhaps worth avoiding.  

Please do not expect quick results; it can take at least 6 months for symptoms to settle.

Other valuable sources of information:

• British Dietetic Association IBS leaflet
• NHS Irritable Bowel Syndrome (IBS)

Foods that are more likely to affect your IBS symptoms are usually high in carbohydrates, fat, fibre or are highly processed. Most people find that fresh meat, poultry, eggs, fish, shellfish, tofu, and tempeh do not cause an increase in symptoms.

Below is a table of foods that can cause symptoms; with some tips/alternatives on what to try.

 

Food group

Food group	Suggestions	Tips
High fibre	Flour or Bread: wholemeal, granary, multigrain, rye varieties including soda bread, naan bread, pitta bread, ciabatta, focaccia sourdough, spelt, tortilla wraps   Wheat or bran-based cereals for example Weetabix®, branflakes, Shredded Wheat®, spelt flakes   Oats: porridge, oat bran, oat-based bread   Rice: brown, rice bran   Pasta and noodles:  fresh or dried wholemeal   Potato: all types, with skin   Snack foods: oatcakes, rye crispbreads, wholemeal/wholegrain crackers, brown rice cakes/crackers	Try to include a source of starchy carbohydrate with each meal/snack.   Think about fibre, some people find the high fibre varieties of these foods can help their IBS symptoms but other find they can make them worse. Experiment to find what is best for you.   Oats, rice, potato and corn usually cause less bloating and discomfort in most people.   Oats are really good for constipation. Try to include these every day.     Linseeds (also known as flaxseed) ground or whole can also help with constipation. Try adding a tablespoon to foods such as porridge, soup, salad, and yogurt. Make sure you drink a small glass of fluid with the linseeds, around 150mls.   Try to cook with fresh ingredients, where possible.   Limit your intake of fatty and processed foods such as chips, pastry, pizza, garlic bread, biscuits, cake and chocolate.
Low fibre	Flour or bread:  white varieties including soda bread, naan bread, pitta bread, ciabatta, focaccia sourdough, spelt, tortilla wraps   Rice or corn-based cereals: rice krispies® or puffs, cornflakes   Rice: white, basmati   Pasta and noodles®: fresh or dried white   Potato: all types, without skin   Snack foods:  corncakes, white flour crackers, water biscuits, white rice cakes/crackers
Fruit and vegetables	There are lots of fruit to choose from including fresh, tinned, frozen and dried varieties.   A portion of fruit is: One large fruit for example an apple, orange, banana or pear. Two smaller fruit such as plums, satsumas. A slice of large fruit, such as melon, pineapple. 1 handful of grapes. 2 handfuls of berries. 1 heaped tablespoon of dried fruit such as raisins and sultanas. 150mls fruit juice or smoothie. A portion of vegetables is: 3 heaped tablespoons of vegetables (raw, frozen, cooked or tinned). 3 heaped tablespoons of pulses, beans. 1 cereal bowl of lettuce, spinach or watercress.	Always try to consume at least 5 portions of fruit and vegetables a day, variety is key: ‘eat a rainbow of colours’   Too much fruit in one sitting can sometimes cause symptoms. If this is the case, limit a portion of fruit to 80g but still try to have 2-3 portions spread out throughout the day.   Avoid drinking large amounts of fruit juice or smoothies.   If wind and bloating is a problem, try limiting your intake of gas-producing foods such as beans, pulses, sprouts and cauliflower.   If you think that too much fibre is causing a problem, try choosing more tinned, peeled, soft fruit and well-cooked vegetables.
Drinks	Drink at least 8 cups of fluid per day (approx 2 litres). And try to aim for 3-4 of these being water. Sip throughout the day.   Try flavouring the water, such as cordials or a squeeze of fresh lemon.   Try to limit caffeine intake to 3 cups a day.   Try to limit alcohol to 2 units a day and at least 2 alcohol free days a week.	Add a slice of lemon/lime to water.   Try flavoured teas.   Keep a bottle of water chilled in the fridge   Avoid drinking large amounts of fruit juice or smoothies   Fizzy drinks may increase your bloating.   Ciders, sweet wines and rum may worsen your symptoms.
Other		Avoid foods with artificial sweeteners, particularly those ending in ‘ol’

Hints and Tips

• Make one change at a time so that you can see what really helps. Try keeping a food and symptom diary to help monitor your symptoms whilst changing your diet

• Try smaller portions rather than large meals, perhaps having 4 to 5 meals across the day

• Do not skip meals, the more routine you have, the better your bowel will behave!

• Try to avoid eating late into the evening; allow your bowel time to rest and repair

• Take time to chew your food

• Try some fermented foods, such as Kimchi, Sauerkraut, Kefir

• Avoid chewing gum, sucking sweets, smoking, drinking through a straw as all can ingest air, which again will increase the risk of bloating

Take some exercise, any forms of movement helps stimulate the bowels, can help to move trapped wind and improve your mood. Do any movement that you enjoy. Research has shown that a 20 minutes’ walk can improve constipation.  Find a ‘walking buddy’, this will help with motivation and encourage you to go out. There are many free classes to join online, such as yoga, Pilates, HIIT workouts.

Watch the NHS Pilates and yoga exercise videos

Prioritise Sleep. Try an aim for 7-9 hours of sleep a night.  Avoid using technology, such as phones, iPad at least an hour before bed.

Stress and anxiety can play a significant part in how your bowel behaves, so it is important to try and manage your stress levels, with activities you enjoy, such as reading, walking, exercises, and breathing techniques.

There is much research available about the ‘gut brain axis’, which is the link between the gut and bran via the Vagus nerve. This nerve is one of the biggest nerves connecting our brain and gut and plays an important role in digestion.  A ‘troubled’ bowel can send signals to the brain, just as a ‘troubled’ brain can send signals to the gut. Therefore, a person’s stomach or intestinal distress can be the cause  or  the product of anxiety, stress, or depression.  If your symptoms improve when you are on leave/holiday, this may help you to know whether your mental health is impacting on how your bowel behaves. Treatment to help reduce stress and anxiety can be discussed with your GP.

Studies have been performed which show that gut microbes play an essential role in how the gut behaves, but also in improving mood. Probiotics and prebiotic rich foods have been shown to help. Your local health food shop can advise on a course of probiotics, alternatively the supermarkets sell brands such as Activia® or Yakult®. Decide which you would like to try and follow the manufacturer’s instructions for at least 4-6 weeks. They may cause an increase in bloating initially, but this should settle down. Try not to make changes to your diet at the same time as testing a probiotic.

Prebiotics : are a type of fibre that humans cannot digest. They serve as food for probiotics, which are tiny living microorganisms. The following foods are good choices for prebiotics but note that in some people prebiotics can make the symptoms worse.

Vegetables and Fruit

Vegetables & Fruit	Grains & Nuts	Beans & Pulses
Asparagus, Beetroot, Leeks, Garlic	Almonds, Cashews, Hazelnuts, Pistachios, Rye, Spelt	Black beans, Butter beans, Chickpeas
Apricots, Dates, Nectarines, Prunes, Dried Figs, Watermelon

Good Bowel Habits: Aim to sit on the toilet at the same time each day, approximately 30mins after breakfast is a good time to try, as this is when your bowels are trying to work. Otherwise go when you get the urge, do not ignore it as this can lead to/worsen constipation. Do not take your phone, iPad or gadgets with you, you need to be able to concentrate on the important task of trying to open your bowels.

Check your toilet position is correct and you are adopting the correct muscles to help you with emptying better.

For further information on using good toilet position to empty your bowels watch the How to Empty Your Bowels Without Straining video

Try and relax when on the toilet as this can improve emptying. Take a few slow inhales, try not to strain and take your time.  If nothing is happening within 5 to 10 minutes, try again later.

And finally, try not to let eating become a chore and something you do not enjoy. If you have children, encourage some home cooking so that you all get involved. Select seasonal vegetables and fruit which are widely available at the supermarkets. For example, strawberries are at their cheapest in the summer and parsnips in the winter months. Tinned and frozen fruit and vegetables are a quick and easy solution and even consider buying the supermarket’s ‘Wonky fruit and vegetables’!

Try your best to meal plan, eat things that you enjoy and you know will not upset your tummy. Meal planning also allows you to know what you need when you shop and can save you money and time! Batch cooking and freezing meals are a great way to save time on busy school nights and when you do not really feel like cooking.

Eating your ‘5 a day’ may sound like a challenge but the essential nutrients in them will help with lifelong health living.

Eat Well: Spend Less, Food Fact Sheet by the British Dietetic Association

How to Ease Bloating:

• Reduce foods which are hard to digest and can cause wind, for example, onions, beans, cauliflower, broccoli, cabbage.

• Avoid foods and drinks that contain the sweetener, Sorbitol.

• Try switching your morning breakfast to porridge.

• Sprinkle one tablespoon of milled linseed on top of your breakfast, to a salad, or yoghurt.

Medication

If you are struggling with symptoms of urgency, abdominal pain and bloating, over the counter medication can help, such as Buscopan, Mebeverine, or Peppermint capsules.  Your Nurse, GP or local Pharmacist can advise you.