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A questionnaire in 2006 designed to identify patients’ perceptions about IBS, their preferences on the type of information they need, as well as educational media and expectations from health care providers, revealed misperceptions about IBS developing into other conditions, including colitis, malnutrition, and cancer.[67]

The survey found IBS patients were most interested in learning about foods to avoid (60%), causes of IBS (55%), medications (58%), coping strategies (56%), and psychological factors related to IBS (55%). The respondents indicated that they wanted their physicians to be available via phone or e-mail following a visit (80%), have the ability to listen (80%), and provide hope (73%) and support (63%).

Diet

There are a number of dietary changes a person with IBS can make to prevent the overreaction of the gastrocolic reflex and lessen pain, discomfort, and bowel dysfunction. Having soluble fiber foods and supplements, substituting milk products with soy or rice products, being careful with fresh fruits and vegetables that are high in insoluble fiber, and eating frequent meals of small amounts of food, can all help to lessen the symptoms of IBS. Foods and beverages to be avoided or minimized include red meat, oily or fatty and fried products, milk products (even when there is no lactose intolerance), solid chocolate, coffee (regular and decaffeinated), alcohol, carbonated beverages, especially those containing sorbitol or other artificial sweeteners. Care, however, should be taken to avoid adding foods to the diet to which the patient is allergic or intolerant.[68]

Definitive determination of dietary issues can be accomplished by testing for the physiological effects of specific foods. The ELISA food allergy panel can identify specific foods to which a patient has a reaction. Other testing can determine if there are nutritional deficiencies secondary to diet that may also play a role. Removal of foods causing IgG immune response as measured using the ELISA food panel has been shown to substantially decrease symptoms of IBS in several studies.[69]

There is no evidence that digestion of food or absorption of nutrients is problematic for those with IBS at rates different from those without IBS. However, the very act of eating or drinking can provoke an overreaction of the gastrocolic response in some patients with IBS due to their heightened visceral sensitivity, and this can lead to abdominal pain, diarrhea, and/or constipation.[70]

Several of the most common dietary triggers are well-established by clinical studies at this point; research has shown that IBS patients are hypersensitive to fats and fructose.[71][72]

It also appears that some foods are more difficult for the gut as evidenced by elevated food-specific IgG4 antibodies being present,[73][74] while others increase colonic contractions, which may be painful, due to increased visceral sensitivity in IBS sufferers.[75]

Fiber

In patients who do not have diarrhea predominant irritable bowel, soluble fiber at doses of 20 grams per day can reduce overall symptoms but will not reduce pain. The research supporting dietary fiber contains conflicting, small studies that are complicated by the heterogeneity of types of fiber and doses used.[76] The one meta-analysis that controlled for solubility found that only soluble fiber improved global symptoms of irritable bowel and neither type of fiber reduced pain[76] Positive studies have used 20-30 grams per day of psyllium seed.[77][78] One study specifically examined the effect of dose and found that 20 grams of ispaghula husk was better than 10 grams and equivalent to 30 grams per day[79]An uncontrolled study noted increased symptoms with insoluble fibers.[80] It is unclear if these symptoms are truly increased compared to a control group. If the symptoms are increased, it is unclear if these patients were diarrhea predominant (which can be exacerbated by insoluble fiber[81][82]), or if the increase is temporary before benefit occurs. There is a mistaken presumption that fiber therapy only works for those with constipation. In actuality soluble fiber can act as a counterbalance to both constipation, by retaining water in the bowel, and for diarrhea, by absorbing excess water.

Psychotherapy and hypnotherapy

There is a strong brain-gut component to IBS, and cognitive therapy may improve symptoms in a portion of patients in conjunction with antidepressants.[104] In a randomized controlled trial of referred patients, cognitive behavioral therapy helped even though patients in this study did not have any psychiatric diagnoses.[105]

Gut-directed or gut-specific hypnotherapy or self-hypnosis is one of the most promising areas of IBS treatment. An uncontrolled study shows that symptom reduction/elimination from IBS hypnotherapy can last at least five years.[106]

Relaxation therapy in four 90-minute group sessions was found to help in a randomized controlled trial.[107]