IBS Practical Advice for Patients

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Dora Chase
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1 IBS Practical Advice for Patients Sarah Keogh MSc., BSc., Dip., MINDI Consultant Dietitian The Albany Clinic, Dublin

2 Introduction Every person with IBS is different and treatment needs to be individual Symptoms will generally worsen before they improve Any changes need to be gradual and staged

3 Types of IBS Diarrhoea Predominant Constipation (and bloating) Predominant Alternating Constipation and Diarrhoea Many people experience all three types Need a different approach for each type of IBS

4 Where to Start Diet Fibre Probiotics Fish and Fish oils Stress & Rest Eating habits Food allergies & intolerance

5 Fibre Two types of fibre: Soluble e.g. oats Insoluble e.g. bran Soluble and insoluble fibre is useful for constipation type IBS Soluble fibre is useful in diarrhoea and alternating type IBS

6 Fibre and Constipation Type 77% of Irish adults don t t eat enough fibre Majority of patients think that they do Need 24g of fibre everyday, Irish average intake is 14g per day. IBS Patients may open their bowels everyday but: Hard stools Small pieces Difficult to pass

7 Adding Fibre for Constipation Type Start with: High fibre cereal days per week, preferably oat based Beans and lentils per week Fibre supplement e.g. Fybogel 1 per day Introduce one at a time over days Advise patients that for the first 1-21 weeks: bloating will worsen Some cramping will occur May have bowel movements per day

8 Adding in Fibre for Constipation After weeks Type Increase fruit and vegetables aim for 5 a day Add seeds e.g. split or ground linseeds, sunflower seeds etc tablespoons per day Wholemeal bread, pasta & rice Nuts & dried fruit as snacks Again, gradually over weeks Plenty of water is essential 3-44 pints /2 litres per day It takes weeks for bowel to fully recover

9 Fibre and Diarrhoea Type Avoid insoluble fibre/roughage for a few weeks Soluble fibre can help to reduce diarrhoea Thickens stool Slows movement of diarrhoea Reduces urgency

10 Fibre & Diarrhoea Type Avoid insoluble Fibre No bran, nuts or seeds, Limit fruit to one piece per day and choose root vegetables Gradually increase soluble fibre content of diet Start with oats e.g. porridge Pulses beans, lentils Fybogel

11 Fibre and Diarrhoea Type Increase fibre gradually This needs to be slower than for constipation Increase fluid 3-44 pints/1 ½ -22 litres water per day As diarrhoea settles, gradually add fruit vegetables and other fibre foods

12 Probiotics Help to regulate the rhythm of the bowel Useful for both constipation and diarrhoea types Use a proven probiotic daily Avoid hot drinks for 20 minutes before or after taking probiotic Probiotics may initially increase bloating but will regulate movement of the gut

13 Fish and Fish Oils Some evidence that omega-3 3 fats may help reduce symptoms of IBS Oil-rich fish and fish oils are the best sources of omega-3 Salmon, trout, mackerel, herring, sardines at least once a week Fish oil supplement of 500mg EPA plus DHA per day.

14 IBS, Food Allergies & Intolerance Some studies show up to 50% of patients with food allergy or intolerance Most patients will link symptoms to foods but don t t always have the same reaction to the same food Elimination diet under supervision of a qualified Dietitian

15 IBS & Eating Habits Always sit down to eat Eat slowly at least 15 minutes Chew your food Never fill your stomach Try to sit for 20 minutes after eating

16 IBS & Stress

17 IBS and Stress Stress has a number of effects on the bowel: Draws blood away from the bowel Slows movemenr of food through thesmall bowel Increases movement of food through large bowel May cause symptoms similar to allergy

18 Stress & Rest Do something to relax everyday Bath, read, music, relaxation CD Regular exercise Rest In bed before 10pm 3 nights per week Rest during the day Refer for further advice if necessary.

19 Other Factors Sorbitol Caffeine Depression Obesity Adequate time for defecation

20 IBS Practical Advice Check fibre in the diet & introduce gradually Take a probiotic Increase oil-rich fish and/or fish oil Deal with stress and/or learn relaxation techniques Learn some good eating habits Remember: it takes time 6 weeks to 3 months

21 Thank you

22 IBS Guidelines NICE Guidelines on IBS: Guideline.pdf American Gastroenterological Association:

23 IBS Checklist Get a diagnosis & rule out Lactose Intolerance & Coeliac Disease. Explain IBS and lack of serious health problems. Find out about fibre intake Discuss effects of stress/busy lifestyles Refer for counselling/therapy if necessary

24 Studies on Irritable Bowel Many studies, few consistent results Differences in definitions, end points etc. Treatments only marginally better than palcebo Most guidelines are based on clinical experience than evidence from studies

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