Irritable bowel syndrome (IBS) | Mate tikotiko

On this page, you can find the following information:

• What causes IBS?
• What are the symptoms of IBS?
• What triggers symptoms of IBS?
• 当我应该寻求医疗建议吗?
• How is IBS diagnosed?
• 如果我有IBS，我可以尝试什么？
• Should I be taking a probiotic?
• What is the low FODMAP diet?
• 药物用于治疗肠易激综合症吗?

关于IBS的要点

1. IBS is a chronic (ongoing) gastrointestinal (gut) condition. IBS is not the same as炎症性肠病(IBD)，主要指2种长期严重条件，Crohn’s diseaseandulcerative disease。
2. IBS can be uncomfortable but is usually harmless. Symptoms include bouts of abdominal (tummy) discomfort and pain, bloating and changeable bowel habits from diarrhoea (runny poo) to constipation (hard poo).
3. IBS affects 1 in 7 people and is more common in women than men, and in those aged under 50.
4. 有简单的第一行饮食和生活方式改变可以帮助改善症状（请参阅treatment options for IBS）。这包括保持活跃并努力管理压力。但是，如果未通过一线治疗选择来缓解症状，则已经证明了短期低点饮食的症状。
5. If your symptoms are ongoing despite dietary and lifestyle changes, talk to your healthcare provider about medicines to help relieve specific symptoms.

(NHS, UK, 2022)

What causes IBS?

The exact cause of IBS is still not certain. However, there is emerging evidence that changes in your gut bacteria and inflammation of your immune system may play a role in its development.

In particular, factors that contribute to IBS are thought to be:

• sensitivity– you may have a more sensitive gut (sometimes called ‘visceral sensitivity’)
• digestion speed– the contents of your gut may move unusually quickly or slowly (sometimes called ‘altered gut motility’)
• 细菌– you may have an imbalance of ‘good’ and ‘bad’ bacteria in your gut (sometimes called ‘dysbiosis’)
• leaky gut– your gut may be slightly inflamed or ‘leaky’, eg, it may have small cracks or openings that allow partially digested food, toxins and bugs to get through the gut barrier
• infection– you may have had an infection, such as胃肠炎, that trigged the IBS.

What are the symptoms of IBS?

The most common symptoms of IBS are abdominal pain or discomfort, often reported as cramping, along with changes in bowel habits.

Usually the pain or discomfort will be associated with at least 2 of the following 3 symptoms:

• Feeling better after having a bowel movement.
• Having bowel movements more or less often than usual.
• 如下所定义的腹泻或便秘：
  • diarrhoea – having loose, watery stools (poo) 3 or more times a day and feeling urgency to have a bowel movement
  • cintipation-每周少于3肠运动。凳子可能很硬，干且小，使其难以通过。有些人觉得这很痛苦，经常必须紧张才能排便。

For a diagnosis of IBS,these symptoms must occur at least 3 times a month.

Other symptoms of IBS may include:

• feeling that a bowel movement is not completely finished
• passing mucus – a clear liquid made by your gut that coats and protects its tissues
• urinary incontinence (not able to control your bladder)
• faecal incontinence (not able to control your bowel)
• feeling bloated.

What triggers symptoms of IBS?

肠易激综合症可以引发的饮食和生活方式,尤其ally stress and anxiety.

Most people with IBS notice that food triggers symptoms. Common trigger foods include:

• dairy
• fatty foods
• 辛辣食物
• 碳酸饮料
• caffeine
• 人造甜味剂。

Additionally, a group of short-chain carbohydrates calledFODMAPs(fermentableoLigosaCachires，disaccharides,monosaccharides andpolyols) are also known to trigger symptoms in some people.

当我应该寻求医疗建议吗?

If you have the symptoms above, see your healthcare provider for a check-up. See them immediately if have any of the following symptoms:

• 意外或无法解释的减肥
• rectal bleeding (from your bottom) that is not due tohaemorrhoids
• waking from sleep with pain or the need to empty your bowel (poo)
• symptoms first beginning when you are older than 50 years
• a family history of gastrointestinal cancer,炎症性肠病orcoeliac disease
• 腹部肿块或质量
• iron deficiency anaemia。

How is IBS diagnosed?

Your healthcare provider will usually make a diagnosis based on your symptoms. Because the symptoms of IBS are similar to those of more serious conditions, you may have one or more of the following tests:

• 乙状结肠镜检查
• 粪便（便便）测试
• acolonoscopy。

如果我有IBS，我可以尝试什么？

There is no cure for IBS, but there are treatments that can make a big difference. Talk to your healthcare provider about what might be best for you.

The following approaches help a lot of people to manage their symptoms.

Keep a food, mood and symptom diary

保留您的症状日记以及改变的东西（食物或生活方式）。它将帮助您查看何时感觉好些以及何时感觉更糟。请注意您的感受，因为压力和焦虑之类的感觉会影响您的症状。

Eat mindfully and regularly

• The gut loves regularity so eating meals at regular times throughout the day (and not skipping meals!) will help your digestion. This may mean 3 main meals or 3 smaller meals with snacks in between. Intermittent fasting is not useful for people with IBS as skipping meals can slow down your digestion.
• Make sure you chew your food and eat slowly to support your digestion.
• 吃掉你的饥饿水平。我们经常出于习惯，所以在进食之前，问自己有多饥饿。如果您不太饿，请吃较小的饭菜或小吃。当您饱满或舒适时停止进食。这也将帮助您吃更多的常规餐。

Choose nourishing foods

Eat a variety of foods from the 4 food groups. Learn more about the4 food groupsand健康饮食。

Food swaps for specific symptoms

Certain foods are known to make symptoms worse.

腹泻：

• Replace fluids by drinking 8-10 cups of water per day.
• Limit aggravating foods such as fatty foods, spicy foods, caffeine and alcohol.
• 从人造甜味剂中休息一下，通常在咀嚼牙龈和无糖饮料中发现。
• Slightly reduce insoluble fibre intake and slowly eat more soluble fibre. Learn more aboutfibre。
• Trial a dairy free diet for two weeks. Try lactose free milk, soy, oat or almond milk. Hard cheeses like Edam and tasty have no lactose, so you can still eat these. After two weeks, if it makes no difference, re-introduce dairy back in.

For constipation:

• Try to slowly increase your fibre intake with whole gains, fruits, vegetables, legumes, nuts & seeds. Learn more aboutfibre。
• Try green kiwifruit (1-2 per day) or prunes (1-4 per day).
• Drink at least 8 glasses of fluid each day
• Try whole or ground linseed: start with 1 teaspoon per day and increase every few days to a maximum of 3 teaspoons. Make sure you have 50mls of fluid with each teaspoon of ground linseed.
• Try Psyllium husk, which is available on prescription from your healthcare provider. Start slow increasing from 10g to 30g over 2–4 doses throughout the day, trial for 3 months.

For reflux/indigestion:

• Eat small, frequent meals.
• Sit upright after eating; reclining or lying down will make reflux worse. Avoid eating within 1–2 hours of sleep.
• Avoid fizzy drinks, alcohol and caffeine.
• Reduce spicy foods and fatty foods.

Drink plenty – but choose wisely

• Try to have at least 8 cups (250ml) of water a day.
• 咖啡因会刺激您的肠子。每天不要喝超过3种咖啡因饮料（茶，咖啡，可乐）。减少咖啡摄入量可能会改善症状。
• Fizzy drinks may make bloating or reflux worse. Try not to have fizzy drinks.
• Alcohol irritates and speeds up the gut, so try a period of reduced alcohol.

Managing Stress

Researchers have also found that reducing your stress can help to ease your symptoms. Read more aboutstress and how to manage it.

Physical activity

有证据表明，更多的活跃可以帮助减轻IBS症状。这可能是因为它有助于消化的食物在肠道中移动，减少气体和腹胀。阅读更多有关benefits of physical activity.

Cognitive Behavioural Therapy (CBT)

Because of the connection between the brain and the gut (the gut-brain axis), talking therapy such asCBT, has been found to be helpful in managing IBS symptoms.

Gut Directed Hypnotherapy

There is strong evidence to suggest that gut-directed hypnotherapy improves symptoms in people with IBS by 70-80%, which is as equally effective as the low FODMAP diet and there are no restrictive diets to follow. There are clinics that offer this in person, however a lower cost option are apps such as神经, a 6 week programme developed by a gastroenterologist at Monash University.

Should I be taking a probiotic?

Probiotics are live, beneficial bacteria found in fermented foods like yoghurt, kefir and tempeh or in pill form. The evidence to support the use of probiotics in IBS is inconclusive, there is some evidence behind certain strains so it’s best to speak to a dietitian.

Probiotics may be beneficial for some people, but in others they may increase wind and bloating.

如果您想试用益生菌，建议您开始缓慢启动并尝试至少4周。如果您没有注意到改变或增加症状，请停止服用。

If you have tried all of the above tips and your symptoms don’t improve, it is recommended that you see a dietitian to follow a short-termlow-FODMAP dietfollowed by a reintroduction phase.

What is the Low-FODMAP diet?

Research suggests that 3 in 4 people with IBS get symptom relief, usually within 1–4 weeks, from following a low-FODMAP diet. These positive effects can continue long term. It’s best if you can see a dietitian experienced in this diet to help support you make the changes needed.

FODMAP要么在您的小肠中吸收不良，要么不可消化。

Because they are poorly absorbed, they reach the end of your digestive system (the large intestine or colon), where most of your gut bacteria live. Here, your gut bacteria ferment them, producing gas. This leads to bloating and flatulence.

FODMAPS also have an osmotic effect, which means they draw water into your colon (bowel). This can cause cramping and more bloating.

Depending on your digestive system, the combination of producing gas and drawing water in can lead to inconsistent or excessive bowel movements, diarrhoea or constipation, and tummy pain.

This process is likely to be made worse by stress and lack of physical activity.

阅读更多有关low-FODMAP dietandcommon foods containing FODMAPs。There is also an莫纳什大学开发的应用to help you follow this diet. It is important that after a period of 4–6 weeks of a low FODMAP diet you start to reintroduce foods that contain FODMAPs so that you don’t have a lifetime of restricted eating and can enjoy a variety of foods.

强烈建议您在整个过程中获得营养师的支持，因为正确遵循饮食并确保您仍保持均衡饮食非常重要。

药物用于治疗肠易激综合症吗?

Medications are sometimes recommended to help treat IBS symptoms. Some examples include:

• 泻药for relief of constipation
• anti-diarrheal medications to relieve chronic diarrhoea
• anti-spasmodic medications to assist in relieving abdominal pain and cramps
• antidepressant medication to help with pain.

阅读更多有关medicines for IBS。

Learn more

IBS Central澳大利亚莫纳什大学
IBS resources澳大利亚莫纳什大学
有点美味FODMAP made easy (paid membership)

参考

1. 成人肠易激综合症 - 不仅仅是一种直觉BPAC, NZ, 2014
2. Irritable bowel syndromeCrohn’s & Colitis, NZ
3. IBS患者的FODMAP饮食功效低 - 证据是什么，我们还需要知道什么？NZ Medical Journal, 2016
4. Johannesson E，RingströmG，Abrahamsson H，Sadik R.Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects世界j胃肠道。2015年1月14日;21（2）：600–608。
5. Qin H-Y, Cheng C-W, Dong Tang X-D, Bian Z-X.心理压力对肠易激综合症的影响世界j胃肠道。2014年10月21日;20（39）：14126–14131。
6. Kinsinger SW。Cognitive-behavioral therapy for patients with irritable bowel syndrome: current insightsPsychol Res Behav Manag. 2017; 10: 231–237.
7. How effective is gut-directed hypnotherapy in people with IBS?澳大利亚莫纳什大学