The cardinal symptom for IBS is recurrent abdominal pain over three months, plus changes in the quality or frequency of your stool. “If you don’t have abdominal pain, you can’t have IBS,” says Brian E. Lacy, MD, PhD, a gastroenterologist at the Mayo Clinic in Jacksonville, Florida, and the lead author of the American College of Gastroenterology’s 2021 clinical guidelines for the management of IBS. “One of the biggest challenges around diagnosing IBS is simply having patients overcome the stigma of discussing embarrassing bowel habits.” The pain can be sharp, throbbing, or cramping, and may come and go. However your particular pain manifests, it can severely affect quality of life. Fortunately, an IBS diagnosis can often be very reassuring because the condition does not lead to inflammation, anemia, or any worse ailments, like bowel cancers. Also, it can be managed effectively through diet, exercise, and medication. Once you have an IBS diagnosis, taking proactive steps can significantly reduce symptoms and make the disorder manageable. The first thing to remember though is that every case is unique, and it will take a period of trial and error to find what works best for you, says Megan Riehl, PsyD, a gastrointestinal (GI) psychologist at the University of Michigan in Ann Arbor. “IBS is multifactorial in nature,” says Dr. Riehl. “Things that can contribute to IBS include diet, stress, and changes to your gut microbiome. It’s not a one-stop shop to get improvements in your IBS.” Here are five strategies that experts recommend for managing IBS symptoms:
1. Try a Low-FODMAP Diet
The 2021 guidelines from the American College of Gastroenterology suggest trying a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyol carbohydrates. Since that doesn’t roll off the tongue easily, it’s called a low-FODMAP diet, and it requires eliminating a lot of foods you may be used to and then slowly reintroducing them to see which foods trigger IBS symptoms. A study published in March 2021 in the Journal of Human Nutrition and Dietetics found that a low-FODMAP regimen reduced abdominal pain by 62 percent, and bloating, gas, and a sense of urgency to go by half. Furthermore, the patients following a low-FODMAP diet continued to feel better nearly a year after starting the diet and drastically reduced the number of times they needed to see their doctor. Knowing exactly how to follow a low-FODMAP diet can be tricky because it eliminates so many foods that may be staples for you. “It’s so effective that it can lead to food anxiety where patients will only eat five things that they know are safe, so it’s best to work with a dietitian who specializes in IBS to broaden what you can eat,” says Riehl. If you don’t have a dietitian on your healthcare team, check out MyGINutrition.com, a site created by GI specialists at the University of Michigan and Cedars-Sinai in Los Angeles that’s entirely dedicated to the ins-and-outs of the low-FODMAP diet.
2. Get Moving
Whatever exercise you like to do is what you should do, advises Riehl. When you run, bike, swim, or simply go for a walk, you lower your levels of cortisol — your stress hormone — and you boost mood-enhancing endorphins. That combination works wonders on the tummy and helps relieve IBS symptoms. A study published in January 2019 in the Journal of Bodywork and Movement Therapies found that people with IBS who spent 30 minutes on a treadmill just three times per week improved the severity of their symptoms and their quality of life. “Exercise and activity improves the messages that go from the brain to the gut and the gut to the brain,” says Dr. Lacy.
3. Get a Good Night’s Sleep
“Exercise also helps you sleep better, and sleep plays a huge in gut behavior and digestive functioning,” Lacy adds. Sleep and IBS are intertwined. A study published in January 2021 in PLoS One found that people with IBS were 2 to 4 times more likely than people without IBS to suffer from insomnia or excessive tiredness. While an older study noted that IBS patients were more likely to suffer disturbed sleep, which leads to worse mood and more pain. “Taking measures to improve sleep can have a profound impact on feeling happier and improving digestion,” says Lacy.
4. Over-the-Counter Treatments
While your doctor may want you to take prescription medicines to relieve the pain associated with diarrhea, bloating, or constipation, plenty of over-the-counter treatments are effective as well, says Lacy. Lacy often tells his patients to drink peppermint tea or take peppermint oil capsules before eating. “It’s cheap, safe, easy, and not addictive,” he says. “Menthol or peppermint acts on smooth muscle so there’s biologic plausibility that it works to aid digestion.” For constipation, Lacy recommends soluble fiber like psyllium, which is found in Metamucil. Bran, on the other hand, does not help. He also recommends laxatives with few side effects like MiraLAX. For diarrhea, Lacy often steers his patients to loperamide, which goes by the brand name Imodium.
5. Talk It Out in Psychotherapy
Since IBS is a disorder in how the brain and the gut communicate with each other, it’s important to learn tips and tricks that foster relaxation and improved digestion. “There are a lot of interventions, like cognitive behavioral therapy and gut-directed hypnosis, that are extremely beneficial,” says Riehl. She adds that the psychotherapy can help patients learn strategies to calm their body down before the bowels rev up anxiety. “The tools you learn can prevent symptoms from happening.” Treatment focuses on providing patients with tools to improve coping, resilience, and stress management. Additionally, brain-gut therapies are evidence-based treatments that target abdominal pain and are recommended in the American College of Gastroenterology’s 2021 clinical guidelines. While hypnosis may conjure images of tracking a swinging pocket watch with your eyes and then losing control of your will, gut-directed hypnosis is far from that. Gut-directed hypnosis steers patients towards relaxing mental images and control of their breath to find relieve IBS symptoms.
