Dear Mayo Clinic: I was diagnosed with a mild case of irritable bowel syndrome and talked to my doctor about managing my symptoms without medication. I am interested in trying to focus more on diet to manage my condition. Are there certain things I need to be aware of, or will medication be the only way to control my symptoms?
Answer: Although medications can be used to treat irritable bowel syndrome, not everyone who has this disorder will require or need medications.
For some people, particularly those with mild symptoms, lifestyle adjustments such as diet modification, stress management, and regular exercise are enough to control symptoms. For moderate to severe symptoms, a combination of lifestyle changes and medications may be needed to control irritable bowel syndrome.
Irritable bowel syndrome affects the large and sometimes the small intestine. The walls of the intestines are lined with layers of muscles that contract and relax in a coordinated rhythm as they move food through the digestive tract.
When you have irritable bowel syndrome, those contractions may be stronger or more noticeable than normal. That can lead to abdominal cramps and pain as food, gas, or stool passes through the intestines.
Irritable bowel syndrome is also associated with bowel irregularities, such as diarrhea or constipation. Other symptoms may include gas and bloating.
In those diagnosed with irritable bowel syndrome, it is important to note that some abdominal problems are not associated with this disorder and could indicate another underlying problem.
In particular, these symptoms require immediate medical attention: blood in the stool, unexplained or rapid weight loss, severe or unrelenting abdominal pain, unexplained vomiting, significant pain or difficulty swallowing, or an abdominal mass or lump.
Irritable bowel syndrome is a chronic condition, and symptoms tend to come and go over time. There is no cure, but symptoms can often be relieved through diet, lifestyle, and stress management.
More than 60% of people with irritable bowel syndrome say their symptoms are related to food in some way. However, because symptoms vary significantly from person to person, it is difficult to give specific dietary advice that will work for all people with this disorder.
However, in general, eating high-fiber foods and drinking plenty of fluids are beneficial for many people with irritable bowel syndrome. Avoid foods and drinks that contribute to gas and bloating, including carbonated and alcoholic beverages; caffeine; raw fruit; and vegetables such as cabbage, broccoli, and cauliflower. Reducing or eliminating gluten can relieve diarrhea related to irritable bowel syndrome.
Research has shown that certain carbohydrates, known as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), can cause abdominal pain, bloating, and gas in people with irritable bowel syndrome.
These are found in certain fruits and vegetables; wheat; rye; legumes; foods that contain lactose, such as milk, cheese, and yogurt; and artificial sweeteners.
Following a low-FODMAP diet can ease the symptoms of irritable bowel syndrome. But because many foods contain these compounds, it can be difficult for patients to create such a diet for themselves.
Finding a registered dietitian who is familiar with irritable bowel syndrome can help. A dietitian can review a patient’s symptoms and dietary needs, discuss recommended dietary changes, and develop an individualized eating plan to alleviate symptoms.
Stress also affects irritable bowel syndrome, with episodes of increased stress associated with increased symptoms. Using stress-reduction techniques and engaging in stress-relieving activities, such as yoga and meditation, can decrease stress-related flare-ups.
Working with a therapist or counselor experienced in stress management, mindfulness, and behavior modification can also help people with irritable bowel syndrome better manage stress and relieve symptoms.
Regular exercise is recommended for people who have irritable bowel syndrome. Daily physical activity relieves stress, stimulates normal contractions of the intestines, and promotes general well-being.
If lifestyle changes alone aren’t enough to keep irritable bowel syndrome from disrupting daily life, talk to your health care professional about medication options.
A wide variety of prescription and over-the-counter medications are available to treat irritable bowel syndrome.
— Robert Kraichely, MD, gastroenterology, Mayo Clinic, Rochester, Minn.
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