IBS (Irritable Bowel Syndrome) Triggers and Prevention

The anatomy of the GI tract.

• Irritable bowel syndrome (IBS) is a recurrent disease of the bowel. Treatment and management of symptoms include psychological support, dietary measures, management of food intake, and management of medications and/or psychological conditions.
• Foods and drinks that dehydrate the body can trigger constipation in people with irritable bowel syndrome.
• Fatty foods can trigger diarrhea in people with the condition, but specific food triggers of diarrhea and other symptoms may vary between individuals.
• Stress and anxiety can stimulate symptoms in many people with IBS.
• Drugs like antibiotics, antidepressants and/or medicines that contain sorbitol may trigger symptoms.
• In many women with IBS, menses and/or menstrual pain is related to the onset of symptoms.
• Other triggers for symptoms may include
  • a chronic lack of exercise,
  • frequently eating while under stress, and
  • eating foods that are very hot or very cold.
• There are several ways to reduce or stop many of the causes that trigger symptoms; for example, eat a balanced diet, avoid food and drinks that dehydrate the body or may cause diarrhea, keep a journal to identify personal triggers, reduce stressors or causes of anxiety, and discuss medications you are taking that may be triggering your symptoms with your doctor.
• Consequently, for each individual, it is important to determine what foods, medications and/or conditions trigger symptoms. This short article is designed to be an introduction to treatment and management and provides common triggers of the condition. These are general descriptions of IBS triggers.
• IBS is not contagious from person to person and researchers are actively trying to determine the cause of this disease.

Irritable bowel syndrome (IBS) is a chronic relapsing gastrointestinal (mainly the large intestine or colon) disorder with signs and symptoms that may include:

• Abdominal cramping or pain
• Bloating
• Mucus in the stool
• Gassiness
• Altered bowel habits (alternating periods of diarrhea and constipation)

IBS is a chronic condition that can be triggered by diet, medications and/or by other conditions such as stress.

Some health care professionals categorize and term IBS into one of four categories:

1. IBS-D (predominant symptoms is diarrhea)
2. IBS-C (predominant symptoms is constipation)
3. IBS-M (mixed diarrhea and constipation)
4. IBS-U (unclassified)

Not all health care professionals recognize these four categories.

Stress and anxiety may be triggers for IBS and the development of recurrent symptoms. Chronic stress experienced early in life (less than age 18) may increase the chances of developing the condition. Moreover, people diagnosed with IBS can have stress or anxiety trigger symptoms, such as:

• Diarrhea
• Constipation
• Abdominal bloating
• Mucus defecation
• Feelings of incomplete bowel movements

Some studies show that many women with IBS have worse symptoms during their menstrual periods. Although the mechanism is not clear, some gastrointestinal cells have receptors for estrogen and progesterone so that changes in the hormone levels during the menstrual cycle may trigger increasing IBS symptoms. Women are twice as likely to develop IBS as men.

Any foods or fluids that tend to dehydrate a person are likely to trigger constipation in people with irritable bowel syndrome. Foods that may promote constipation should be avoided in an IBS diet and include:

• Chocolate
• Dairy products such as milk and cheese (particularly those that contain lactose)
• Red meat
• Unripe bananas
• Items that contain caffeine if you are slightly dehydrated.
• Coffee, carbonated drinks and alcohol may lead to dehydration and constipation in IBS patients (and other people, too).

Foods that help prevent constipation in IBS

Foods that help prevent constipation and should be included in an IBS diet include:

• Prunes
• Various types of beans
• Whole grain breads like rye bread
• Pears and fruits like kiwi
• Vegetables that will help boost fiber intake

• Several foods may play a role in developing diarrhea in people with IBS. Major categories of foods that may trigger IBS are those that contain fats (fatty meats, fatty dairy products, for example). Each individual is slightly different and may respond differently to food types. Consequently, dietitians and health care professionals who treat people with IBS often suggest that they keep a journal or diary to track those foods that cause diarrhea.
• Some foods that trigger diarrhea do so because they are ingested in large quantities; for example, a bite of a banana may not cause diarrhea, but eating a whole banana may trigger diarrhea in some people with IBS.
• Other foods that contain high levels of fructose, artificial sweeteners, high FODMAP foods, and fried foods may also trigger diarrhea.
• Broccoli, onions, cabbage and large helpings of beans may produce gas and increase the discomfort of diarrhea.
• Probiotics may help reduce the symptoms of diarrhea and gas in some individuals.

Some drugs can trigger IBS symptoms resulting in colonic spasms, constipation and/or diarrhea. Such drugs include antibiotics (especially those administered over a long period of time), tricyclic antidepressants, for example, amitriptyline (Elavil, Endep), nortriptyline (Pamelor), and doxepin, and medicines containing sorbitol (for example, some cough syrup preparations and common pain medicines like Advil gel capsules). Consequently, patients with the condition should check the ingredients, both active and inactive, for the presence of sorbitol as sorbitol is often listed as an "inactive" ingredient.

Other triggers of IBS are variable and differ from person to person. However, some other common triggers include:

• Lack of exercise
• Eating foods too quickly
• Eating while under some other stress such as driving or working
• Eating foods that are very hot or cold
• Chewing gum

Keep a journal and record the symptoms and the activities you are doing when symptoms develop. This can help you determine your personal triggers for any symptoms. Researchers also suggest that changes in hormone levels and/or other acute illnesses such as infectious diarrhea may also trigger symptoms.

Which specialties of doctors treat irritable bowel syndrome?

Although a patient's primary care physician may care for IBS patients, specialists in gastroenterology, immunology, psychiatry and dietary professionals may be consulted to help patients manage the condition.

There are many different ways to help prevent triggering IBS symptoms such as:

• Eat a balanced diet with a moderate amount of fiber.
• Avoid extremes of food temperatures (very hot or cold foods).
• Do not eat while experiencing anxiety or under stressful conditions (for example, while working or driving).
• Avoid foods and drinks that may cause dehydration or diarrhea.
• Keep a journal to help identify those foods that do or do not trigger symptoms.
• Try biofeedback, exercise, meditation, or yoga to reduce anxiety.
• Discuss medications you are taking that may be triggering symptoms with your doctor.
• Avoid those foods and drinks that are likely to increase or trigger symptoms.
• Avoid foods that increase intestinal gas (some legumes and vegetables like broccoli, cauliflower, cabbage, and Brussels sprouts).
• Talk to your doctor or health care professional about taking probiotics.