Irritable bowel syndrome (IBS) is a disorder of the intestines that causes abdominal pain or discomfort. The pain may occur alone or along with constipation or diarrhea. Other symptoms include bloating, mucus in stools, or a sense that you have not completely emptied your bowels.

In irritable bowel syndrome, the movement of the digestive tract is impaired but doctors can find no change in physical structure, such as inflammation or tumors. The symptoms of IBS are thought to be related to abnormal muscle contractions in any part of the intestines.

IBS is believed to be caused by increased sensitivity of the bowel. It is not known why some people's intestines are more sensitive than those of other people. Psychological stress and eating may bring on the symptoms. Managing stress and changing your diet are the main treatments for the condition. Medications may be used to treat severe symptoms that interrupt daily activities.

Many people find that their irritable bowel syndrome (IBS) symptoms become worse after they eat. Sometimes certain foods make symptoms worse.

No particular foods cause everyone with IBS to have symptoms. Doctors do not advocate a particular diet to manage symptoms. But through trial and error, many people find that they feel better when they stop eating certain foods. These foods may cause the intestines to contract, which can aggravate IBS in people who have diarrhea as their main symptom.

Although there is no particular diet to follow, you can manage your irritable bowel syndrome (IBS) by limiting or eliminating foods that may bring on symptoms, particularly diarrhea. In general, you can change your diet based on whether your main symptom is constipation or diarrhea.

You also can keep a diary of what you eat and how it affects you. In addition, it helps to make sure that mealtimes are relaxing, which may prevent stress from bringing on symptoms.

Following a diet to reduce constipation

Taking the following steps may reduce your constipation:

• Add fiber to your diet. Fiber will absorb water and add bulk to the large intestine, making bowel movements easier and more frequent than you usually experience. Eat high-fiber foods such as fresh fruits (raspberries, pears, apples), fresh vegetables (peas, brussels sprouts), wheat bran, whole-grain breads and cereals, and beans (such as kidney, pinto, and garbanzo). Increase the amount of fiber in your diet slowly to avoid excess gas.
• Drink plenty of water. It is also important to drink 6 to 8 glasses of water daily, because fiber absorbs water. Water will keep stools soft.
• Get regular exercise. Regular, gentle exercise such as walking, cycling, or swimming helps maintain bowel regularity.

If it is difficult to eat enough high-fiber foods, try using a nonprescription fiber supplement or bulking agent that contains crushed psyllium seed or methylcellulose. Examples include Citrucel, FiberCon, and Metamucil. These products are different from laxatives because they do not irritate the lining of the intestine. They are safe for long-term use. To increase their effectiveness, take fiber supplements at the same time you eat. Although you may find the taste or texture unpleasant, most people get used to them over time, and the safety and effectiveness may be worth the inconvenience. Use laxatives (for example, milk of magnesia or bisacodyl-such as Dulcolax) only when recommended by your doctor.

Not all experts agree that eating more fiber will help reduce or prevent your symptoms of IBS. For some people who have IBS, eating more fiber may actually make some symptoms worse, such as bloating. Check with your doctor before increasing the amount of fiber in your diet. Add fiber gradually so your body can adjust to the change; if you do not, you may experience bloating.

Following a diet to reduce diarrhea

You may be able to reduce diarrhea if you limit or eliminate the following foods and beverages:

• Alcohol
• Caffeine, which is found in coffee, tea, cola drinks, and chocolate
• Nicotine, from smoking or chewing tobacco
• Gas-producing foods, such as beans, broccoli, cabbage, and apples
• Dairy products that contain lactose (milk sugar), such as milk, cheese, and sour cream
• Spicy foods, including salsas or many ethnic foods that use chile peppers
• Foods high in acid, such as citrus fruit
• Foods high in fat, including bacon, sausage, butter, oils, and anything deep-fried
• Sorbitol and xylitol, artificial sweeteners found in some sugarless candies and chewing gum

You may try eliminating foods or beverages one at a time to see whether symptoms improve. If a specific food does not seem to be related to symptoms, there is no need to continue avoiding it.

You might want to consult a registered dietitian before eliminating foods from your diet. A dietitian can help you plan a diet to minimize symptoms while maintaining good nutrition.

If you have trouble digesting dairy products, you may have lactose intolerance, a condition that occurs when people have symptoms (such as gas, abdominal pain, and bloating) after consuming foods that contain lactose. If you avoid eating dairy products, be sure to get enough calcium from other sources, such as a calcium supplement or yogurt. Some of the lactose found in yogurt has already been digested by the yogurt cultures, so yogurt may not cause symptoms.

Keeping a food diary

Some people with IBS use a daily food diary to keep track of what they eat and whether they have any symptoms after eating certain foods. The diary also can be a good way to record what is going on in your life. Stress plays a role in IBS: if you are aware that particular stresses bring on symptoms, you can try to reduce those stresses.

Maintaining a pleasant mealtime environment

Try to maintain a pleasant environment when you eat. This may reduce stress that can make symptoms likely to occur. Give yourself plenty of time to eat, rather than eating on the go. Chew your food slowly. Try not to swallow air, which can cause bloating.

Be sure to talk to your health professional before beginning a plan to reduce or eliminate certain foods from your diet. It is fine to eliminate beverages such as alcohol or caffeine or items such as sugarless gum or candy, but be careful before removing entire groups of vegetables or fruits.

You may be able to eat some fruits and vegetables but not others. Your health professional may recommend that you consult a registered dietitian to help you plan a nutritious menu that helps reduce your symptoms.

Organizations

National Digestive Diseases Information Clearinghouse (NDDIC)
2 Information Way
Bethesda, MD  20892-3570
Phone:	1-800-891-5389
Fax:	(703) 738-4929
E-mail:	nddic@info.niddk.nih.gov
Web Address:	http://digestive.niddk.nih.gov/ddiseases/a-z.asp
This clearinghouse is a service of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the U.S. National Institutes of Health. The clearinghouse answers questions; develops, reviews, and sends out publications; and coordinates information resources about digestive diseases. Publications produced by the clearinghouse are reviewed carefully for scientific accuracy, content, and readability. The clearinghouse does not provide medical advice.
American College of Gastroenterology
P.O. Box 342260
Bethesda, MD  20827-2260
Phone:	(301) 263-9000
Web Address:	www.acg.gi.org
The American College of Gastroenterology is an organization of digestive disease specialists. The Web site contains information about common gastrointestinal problems.