Irritable Bowel Syndrome (IBS) – A Guide for Patients

IBS is a digestive disorder that affects a growing number of people, especially women. Unfortunately, endometriosis also promotes the development of irritable bowel syndrome. For a long time symptoms IBS was often ignored, diagnosed primarily by excluding other, more serious conditions, and knowledge of treatment options was poor. In recent years, the approach to IBS has changed significantly, and the condition has been classified as a serious disorder of the brain-gut axis requiring a multidisciplinary approach. In this article, we present the most important information about IBS to help you take better care of yourself, whether you've been diagnosed or suspect you have IBS. 

What is IBS?

Irritable bowel syndrome (IBS) is a gastrointestinal disease classified as a gut-brain axis disorder and a functional disorder. I will tell you more about functional disorders in the section on diagnostics, but for now let's focus on the brain-gut axis, because understanding it is crucial to understanding what IBS is.  

The gut-brain axis is a form of two-way communication that occurs continuously between the digestive tract and the nervous system. Simply put, our gut and brain are constantly talking to each other, exchanging information and influencing each other's work. This communication occurs through hormones, neurotransmitters, and other biochemical substances produced by the gut microbiota. Intestinal function and the health of the microbiota influence our mood, cognitive function, and nocturnal regeneration. Meanwhile, nervous system function, stress, and sleep determine the functioning of the digestive tract. 

IBS creates a vicious cycle. Intestinal disorders negatively impact our stress resistance, nervous system regeneration, well-being, and anxiety levels. survey, which show that IBS patients are much more susceptible to depressive disorders than the general population. Lower stress tolerance, low mood, overstimulation, and emotional fatigue worsen intestinal function, thus perpetuating the cycle. 

What does this mean for you in practice? IBS is a complex disease that requires a very comprehensive approach. A week of a healthy diet or a new supplement isn't enough. I'm absolutely not writing this to scare you. Quite the opposite! In my experience, most failures and problems in treating IBS stem from a misunderstanding of the condition and an incorrect approach to treatment. I want you to be careful in your process and avoid making the same mistakes that so many people make. It's not your fault that eliminating gluten and lactose didn't work. There's nothing wrong with you if you don't see any improvement after using a supplement that's popular on social media. Treatment IBS is a difficult but possible process, and you don't have to, and shouldn't, go through it alone. 

How to recognize IBS? 

Irritable bowel syndrome is classified as a functional bowel disease. Functional bowel diseases are a set of disorders that are not caused by any specific organic change or damage to the intestines that can be identified with specific diagnostic tests. Therefore, IBS cannot be diagnosed with blood tests because there are no specific markers for this condition. Imaging tests, such as ultrasound or MRI, are also not used in diagnosis, as IBS is not caused by any anatomical changes. Such tests are performed only as part of a differential diagnosis to rule out other problems. However, if IBS is suspected, the so-called Rome IV criteria are used. According to them IBS is recurrent abdominal pain that occurs for at least 3 months on average for at least 1 day a week. Additionally, the pain must meet at least 2 of the following criteria:

• It has to do with bowel movements,

• It is associated with a change in the frequency of bowel movements (diarrhea or constipation),

• It is related to a change in the shape (appearance) of the stool.

Analyze your symptoms and consider whether they fit the definition of IBS. If so, consider this a sign to schedule an appointment with your doctor. Also read our article about sibo, because it may co-occur with IBS. 

Symptoms of irritable bowel syndrome

The most common symptoms of IBS are:

• Pain located in the lower abdomen,

• Diarrhea,

• Constipation,

• Alternating diarrhea or constipation,

• Flatulence

• Excessive gas,

• Enlarged abdominal circumference. 

Depending on the predominant symptoms, there are three types of IBS: diarrhea-related, constipation-related, and mixed. Each type may require a slightly different approach – I'll provide different dietary and supplementation recommendations for a patient with diarrhea-related IBS than for a patient with constipation-related IBS. If you're just starting your diagnostic process and are looking for the causes of your problems, spend some time self-monitoring. The more accurately you can describe your symptoms to a specialist, the better they'll be able to help you. 

IBS and endometriosis – what is the connection?

Now you know what IBS is, how to recognize it, and what symptoms to look out for. Let's now look at the connection between the gut and endometriosis, because this connection is crucial and unfortunately often overlooked. Here are the key facts:

• It is estimated that IBS occurs 2-3 times more often in women suffering from endometriosis.

• Endometriosis may predispose to IBS, but untreated IBS may worsen the course of endometriosis,
• Some symptoms are common, e.g. constipation and abdominal pain, occur in both endometriosis and IBS, which can complicate diagnosis and prolong the process,
• The foundation of endometriosis diet therapy is diet anti-inflammatory, however, in the case of co-occurring IBS, it may prove insufficient and it is necessary to adjust the diet to the dominant symptoms of irritable bowel syndrome.

For some patients it may also be difficult to distinguish the so-called endobelly and IBS. I wrote about endobelly in the article "Endobelly - how to deal with a belly like a balloon?” Their symptoms are similar—bloating, pain, diarrhea, constipation. However, they are distinct problems. Endobelly is closely related to endometriosis, the phase of the menstrual cycle, and inflammation. It is a symptom of endometriosis, not a disease in itself. However, IBS symptoms are not directly related to the menstrual cycle and are a separate condition requiring treatment. Knowing these differences will help you plan appropriate treatment. 

IBS treatment

Can IBS be cured? Unfortunately, not entirely. It's a chronic condition that can recur. The goal of treatment is to minimize symptoms so they don't cause discomfort or negatively impact daily functioning. To maintain remission for as long as possible, however, you should make permanent changes to your diet and lifestyle. Therefore, don't treat this process as a rush. Give yourself time and be understanding; the results will be worth it!

IBS medications

Pharmacotherapy for IBS is a controversial topic, requiring a highly individualized approach. There are no medications that will permanently resolve IBS; they are selected primarily based on the predominant symptoms. Given that IBS is a disorder of the brain-gut axis, psychiatric medications are increasingly being used, including:

• Neuromudulators of the gut-brain axis,
• Tricyclic antidepressants,
• Selective serotonin reuptake inhibitors (SSRIs).

Additionally, your doctor may prescribe rifaximin therapy, a eubiotic that restores the normal composition of the intestinal microbiota. In cases of severe diarrhea, loperamide, which has a symptomatic effect, may be considered. 

Dietary recommendations for IBS

In 2017, the UK National Institute of Health and Care Excellence (NICE) developed specific guidelines and dietary recommendations for patients with irritable bowel syndrome. NICE and the British Gastroenterological Society recommend this as the first-line treatment. Below, you will find all NICE recommendations:

• • Eat meals regularly and take care of food hygiene (chewing thoroughly, eating in a quiet atmosphere),

• Do not skip meals and avoid long breaks between them,

• • Drink at least 8 glasses of fluids a day, mainly still water and caffeine-free drinks,

• Limit your coffee and tea consumption to 3 glasses a day,

• Reduce your consumption of alcohol and carbonated drinks,

• • Limit high-fiber foods (e.g. whole grain flour, bread, high bran flakes, whole grain cereals, brown rice),
  • Reduce your intake of "resistant starch" – it is a starch that is resistant to enzymatic digestion and is formed as a result of cooling cooked starchy products (e.g. by pouring cold water over cooked pasta),
  • Limit your intake of fresh fruit to 3 servings a day (1 portion is approx. 80 g),
  • If you have diarrhea, avoid sorbitol, a sweetener found in chewing gum and sugar-free sweets and drinks,
  • Eat oat products regularly, especially in case of bloating and gas,

• Eat 1 tablespoon of flaxseed daily. 

These recommendations should be implemented for at least 4-6 weeks (although some experts recommend 3 months) and monitored. If you don't notice any improvement, your doctor and dietitian may suggest switching to a low-FODMAP diet. 

Low FODMAP Diet for IBS

Gastroenterological societies recommend the low-FODMAP diet as a first- or second-line treatment for irritable bowel syndrome. This is a three-step dietary protocol that should be implemented under the supervision of a clinical dietitian. Unfortunately, an incorrectly implemented low-FODMAP diet can cause unfavorable changes in the composition of the gut microbiota and promote nutritional deficiencies. Complications and lack of effectiveness of the low-FODMAP diet are most often a consequence of its use without specialist supervision, not the diet itself. 

What is the low FODMAP diet? It involves limiting foods high in FODMAPs, or easily fermentable carbohydrates, which are characterized by limited absorption in the small intestine, intense bacterial fermentation, and high osmotic activity. The effectiveness of a well-conducted low FODMAP diet in IBS patients is up to 86%, So it's definitely worth considering. It's an elimination diet, so it should be followed for a maximum of 5-7 weeks, and then gradually expanded. Eliminated foods include:

• Apples, pears, mangoes, cherries,
• Onion vegetables,
• Cauliflower and broccoli,
• Asparagus, 
• Dairy products containing lactose, 
• Honey,
• Xylitol, sorbitol, mannitol. 

I have prepared a separate article about the low fodmap diet:Low FODMAP diet – use in endometriosisIf you want to learn more about it, I encourage you to read on.

H3: Supplementation for IBS

It's worth supplementing your diet with supplements. The following ingredients are most useful for treating IBS: 

• • Peppermint oil – It has antispasmodic and carminative properties, reducing visceral hypersensitivity, pain, and other IBS symptoms. It is most often recommended for patients experiencing severe bloating. How to use peppermint oil for IBS? Choose capsules containing 180-200 mg of the oil and take them 2-3 times daily for 2-4 weeks. 

• Psyllium – This plant is high in soluble dietary fiber, recommended for IBS by the Canadian Society of Gastroenterology, among others. It helps reduce bloating and abdominal pain and has a beneficial effect on bowel movements. It can be used for both constipation and diarrhea. Remember to stay hydrated when taking psyllium. This is crucial for its proper function and avoidance of side effects. Start with small doses, e.g., 1 teaspoon daily (3-5 g), and gradually increase your intake to as much as 15-20 g daily. For every gram of psyllium, drink at least 25 ml of water. 

• Sodium butyrate – A 3-month supplementation with sodium butyrate at a daily dose of 300 mg may alleviate IBS symptoms such as abdominal pain, excessive gas, diarrhea, constipation, nausea and vomiting. It is best to choose preparations that contain microencapsulated butyrate. 

Probiotics are also helpful for IBS. Lactobacillus plantarum 299v is a probiotic strain that may reduce bloating, abdominal pain, and improve stool consistency in IBS patients. It also has the added benefit of increasing iron absorption from the gastrointestinal tract and has anti-inflammatory and modulating effects. The next strain is Saccharomyces boulardii CNCM I-745, It works well for patients with diarrhea-type IBS. It has antimicrobial and anti-inflammatory properties and restores balance to the intestinal microbiota. Once you have completed your IBS treatment and your symptoms have improved, you may want to consider our EndoBiotic, which, in addition to probiotics, contains substances with a strong anti-inflammatory effect. 

Lifestyle and IBS

Diet alone isn't enough for irritable bowel syndrome. Your overall lifestyle is also important – physical activity, exposure to stress and the ability to cope with it, sleep duration and quality, and relationships. You already know that IBS is a disruption of the brain-gut axis, so the emotional and mental aspects are crucial. For many patients, results can only be observed after combining diet therapy with cooperation with a psychologist or psychotherapist. This is crucial, especially if you feel you're struggling to manage your emotions on your own. A psychologist or therapist will give you tools that will be effective both in the short term and in the long term. You probably know best that life is unpredictable, and no matter how hard we try, we can't avoid difficult moments. It's worth developing your own stress-coping techniques, which you can use whenever you need them. What else should you consider?

• Sleep duration and quality Trouble falling asleep, short sleep, and frequent waking up during the night are common problems for IBS patients. Furthermore, even a single night of poor sleep can worsen intestinal symptoms the next day. This is related to, among other things, increased inflammation and the production of proinflammatory cytokines, as well as disruption of the gut's circadian rhythm. The recommended sleep duration is 7-9 hours. It's also worth implementing the 3C rule in your bedroom – quiet, dark, and cool. These are ideal conditions for facilitating sleep and sleep regeneration. Try not to take your phone to bed with you. Before falling asleep, choose a book, meditation, or listening to calming music.
• Physical activity Physical activity is crucial for IBS, but you need to be careful not to overdo or underdo it. Both of these extremes are stressful for the body and can hinder healing. Try to get a daily dose of moderate exercise—for example, a 30-minute walk. Additionally, incorporate workouts that combine elements of yoga, Pilates, and stretching. If you enjoy more intense activities like running or strength training, you absolutely don't have to give them up, but approach them sensibly. Perform them at 70-80% of your capacity, and take breaks and recovery. If you can't recover after a workout for several days, it's a sign that it was definitely too intense.
• Mindfulness training Mindfulness for IBS is not a fad, but a technique with a real, documented impact on symptom reduction and improved quality of life. Psychological stress, overstimulation, and a heavy workload activate the so-called fight-or-flight response, stimulate the production of stress hormones, disrupt the gut microbiome, and increase inflammation. Mindfulness training helps regulate stress responses, increase nervous system resilience, and better manage emotions. Research shows that even a six-week mindfulness training can significantly reduce pain and bowel habits in IBS patients and improve the quality of daily life. Take advantage of our free supporting materialsto incorporate more mindfulness techniques into your life. 

Summary

Irritable bowel syndrome (IBS) is a chronic condition that can significantly impact daily life and its quality. However, with proper diagnosis, lifestyle changes, and tailored dietary therapy, its symptoms can be effectively alleviated. Medical support and a conscious approach to diet and stress management are crucial. It's important to remember that each person with IBS requires an individualized approach, so working with a doctor and dietitian is the best way to find optimal solutions.

Źródła:

1. Pietrzak A. Diagnostic and therapeutic recommendations in irritable bowel syndrome, https://ptg-e.org.pl/wp-content/uploads/2022/03/Wytyczne-IBS-pol-2018.pdf [accessed: 17/09/2025]
2. Adrych K. Irritable bowel syndrome in the light of the latest guidelines, https://journals.viamedica.pl/forum_medycyny_rodzinnej/article/view/61827 [accessed: 17/09/2025]
3. Nabi M. Endometriosis and irritable bowel syndrome: A systematic review and meta-analyses, https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.914356/full [accessed: 17/09/2025]
4. Khanna R. Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. https://pubmed.ncbi.nlm.nih.gov/24100754/  [accessed: 17/09/2025]
5. Ingrosso M. Systematic review and meta-analysis: effectiveness of peppermint oil in irritable bowel syndrome, https://pubmed.ncbi.nlm.nih.gov/35942669/ [accessed: 17/09/2025]
6. Ducrotté P. Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome, https://pubmed.ncbi.nlm.nih.gov/22912552/ [accessed: 17/09/2025]
7. Vonderheid S. A Systematic Review and Meta-Analysis on the Effects of Probiotic Species on Iron Absorption and Iron Status, https://pubmed.ncbi.nlm.nih.gov/31816981/ [accessed: 17/09/2025]
8. Bustos Fernández L. Impact of Saccharomyces boulardii CNCM I-745 on Bacterial Overgrowth and Composition of Intestinal Microbiota in Diarrhea-Predominant Irritable Bowel Syndrome Patients: Results of a Randomized Pilot Study, https://pubmed.ncbi.nlm.nih.gov/36630947/ [accessed: 17/09/2025]
9. Radziszewska M. Nutrition, Physical Activity and Supplementation in Irritable Bowel Syndrome, https://pubmed.ncbi.nlm.nih.gov/37630852/ [accessed: 17/09/2025]
10. Jankowiak M. Psychiatric drugs in irritable bowel syndrome, https://www.termedia.pl/gastroenterologia/Leki-psychiatryczne-w-zespole-jelita-drazliwego-IBS-,62494.html [accessed: 17/09/2025]
11. Black C. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis, https://pubmed.ncbi.nlm.nih.gov/34376515/  [accessed: 17/09/2025]
12. Lanen A. Efficacy of a low-FODMAP diet in adult irritable bowel syndrome: a systematic review and meta-analysis, https://pubmed.ncbi.nlm.nih.gov/33585949/  [accessed: 17/09/2025]
13. Naliboff B. Mindfulness-based stress reduction improves irritable bowel syndrome (IBS) symptoms via specific aspects of mindfulness, https://pubmed.ncbi.nlm.nih.gov/32266762/  [accessed: 17/09/2025]
14. Kim S. A Mindful Way Through IBS: Reducing Abdominal Pain And Improving Quality Of Life, https://www.gastrojournal.org/article/S0016-5085(12)00391-5/fulltext  [accessed: 17/09/2025]
15. Gaylord S. Mindfulness Training Reduces the Severity of Irritable Bowel Syndrome in Women: Results of a Randomized Controlled Trial, https://pmc.ncbi.nlm.nih.gov/articles/PMC6502251/ [accessed: 17/09/2025]
16. Johannensson E. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial, https://pubmed.ncbi.nlm.nih.gov/21206488/ [accessed: 17/09/2025]
17. Topan R. Poor Subjective Sleep Quality Predicts Symptoms in Irritable Bowel Syndrome Using the Experience Sampling Method, https://pubmed.ncbi.nlm.nih.gov/37737676/ [accessed: 17/09/2025]
18. Tu Q. Sleep disturbances in irritable bowel syndrome: a systematic review, https://pubmed.ncbi.nlm.nih.gov/27683238/ [accessed: 17/09/2025]