Managing IBS Symptoms When Travelling

Irritable Bowel Syndrome ( IBS ) also known as a Functional Gut Disorder is a benign condition that affects about 15% of people worldwide.

The condition is not life threatening and it does not increase risks of developing bowel malignancies or any other more serious Gastro – Intestinal (GI) Disease, but IBS symptoms can severely reduce quality of life and sufferers often report being unable to leave the house for fear of not getting to the toilet in time, or having a bout of severe abdominal pain.

I am a Registered Dietitian with a special interest in GI conditions. (here in the UK, that meant for me a BSc Honours Degree in Nutrition and a two year Postgraduate qualification in Nutrition and Dietetics)  I  currently work as a clinician for the National Health Service in the UK and I regularly treat newly diagnosed IBS patients. I am often asked about how to manage IBS when travelling or even just when going out, which can sometimes be difficult or filled with anxiety for IBS sufferers.

Some of my patients might report that they actually feel better when on holiday, since they find that being relaxed and chilled on holiday greatly improves their IBS symptoms.

IBS sufferers often feel that they will get symptoms as soon as they eat anything and therefore it is not surprising that food is often blamed for an IBS flare up. Sufferers will often be restricting certain foods that they believe to be the culprit and therefore putting themselves at risk of nutritional deficiencies.  I recommend to always consult a qualified health professional, such as a Registered Dietitian before starting on any dietary restriction.

Food is not the only trigger of IBS symptoms; stress, anxiety, changes of routine, certain medication etc can also cause a symptom flare up.

Symptoms of IBS vary a lot from mild to very severe and the most common symptoms include abdominal pain/discomfort, bloating, wind, diarrhoea, constipation or both, passing mucus, a feeling of urgency and/or incomplete evacuation.

Although IBS has been researched for many years we are yet to find the cause. There are various theories about how the condition can develop such as following a traumatic life event, following a course of antibiotics and/or regular use of antibiotics and certain medications, following an episode of gastroenteritis due to food poisonous or a virus, hormonal changes, stress and anxiety etc. It does appear to be quite common in people that have other conditions such as anxiety, depression, Fibromyalgia, ME, migraine, etc., and it can often overlap with other GI conditions such as Diverticular Disease, Inflammatory Bowel Disease, Coeliac Disease etc.

We do know that sufferers have a hypersensitive colon that can react to certain foods and in particular to certain carbohydrates that ferment in the large intestine. Food allergies are often blamed, but true food allergies are rare and it is more likely that IBS symptoms could be caused by food intolerance, rather than allergy.

There is at present not one specific test to diagnose IBS and it is usually diagnosed by your doctor once other GI conditions such as Coeliac Disease, Inflammatory Bowel Disease, Bowel Cancer etc have been ruled out.  A visit to your doctor and getting an accurate diagnosis is the first step towards getting to grips on how to best manage the condition.

Before your trip

Preparation is key, so plan your journey careful with some thought into how long the journey is going to take, best places to stop for a break, are there good toilet facilities on the way? If travelling by plane you might want to book your seat near the facilities and have an aisle seat instead of a window seat for fast and easy access.

If you already know that you are intolerant to certain foods, discuss your dietary needs ahead of the trip by contacting your hotel/airline/cruise company etc., research ahead and maybe consider self catering options.

Pack a good first aid kit with over-the-counter medication such as anti-diarrhoea, antispasmodics, re-hydration solution etc., check with your Pharmacist or doctor what could be recommended and ensure that any over the counter medication will be safe and not interact with any of your regular prescription medication.

Bring a change of clothing in your hand luggage in the event of lost luggage.

During your trip 

Keep to a good routine of regular meals and snacks, avoid skipping meals and eating late at night, take your time when eating your meal, relax and enjoy it. Travelling across time zones can change your body clock and alter your appetite, sleep pattern and bowel movements. As much as possible try to maintain some good routines and be consistent with meal times and bedtimes.

Eating out can be challenging and therefore take your time when choosing the most appropriate meal choices for you, avoiding the foods that you already know can cause you an IBS flare up, take with you a list of safe foods and have them translated into the local language if necessary.

If suffering with constipation I do recommend ground flaxseed, starting with one tablespoon every day and increasing it if necessary. It can be added to your breakfast cereal or to your yoghurt, and be sure to drink plenty of purified/ boiled/ bottled water.

Resist doing too much and getting over tired and hungry, again here plan ahead with appropriate snacks and drinks which can make a trip a lot less stressful and decreasing the risks of having an IBS flare up. As long as you are not allergic, unsalted nuts (most are suitable in moderation, such as a small handful) such as peanuts, pecans, pine nuts, almonds, walnuts, Brazil’s tend to be an easy and healthy snack to have in your bag. Also seeds such as sesame, pumpkin, sunflower and dry fruit such as raisins are also suitable in moderation.

Be careful with alcohol and caffeine, since they are a gut stimulant and irritant that can increase IBS symptoms, and be sure to stay hydrated by taking adequate fluid such as water (bottled/boiled water is best if travelling in countries where the water could be contaminated).

Protect yourself from travellers’ diarrhoea by avoiding under cooked meats, seafood and vegetables and be careful with salads, raw vegetables and fruit. Good hand hygiene is also crucial in the fight against those pesky little microbes (it might sound obvious but it is surprising how often people forget to wash hands before eating a meal).

The Low FODMAP diet

This dietary approach to treat symptoms of IBS was first researched in Australia at Monash University, by Consultant of Gastroenterology Prof. Peter Gibson, Dietitian Sue Shepherd and others and it has been very successful at helping to reduce IBS symptoms in some IBS sufferers.

FODMAPs are carbohydrates that are poorly absorbed in the small intestine and so they pass along the gut to the large intestine were there are billions of bacteria. The bacteria ferment these poorly absorbed carbohydrates releasing gas and causing some of the common IBS symptoms such as wind, bloating, abdominal distension and pain. These small particles can also bring water into the large bowel via osmosis making stool loose or liquid.

It is a dietary approach that can be difficult to follow without expert guidance, and is best when delivered and followed up by a Registered Dietitian.

We don’t know what is the long term effect of restricting FODMAPs, therefore another good reason to follow advice from a medically trained health professional, such as a Dietitian.

If you live in the UK and you have been diagnosed with IBS, you can easily request for your GP to refer you to your local NHS Dietitian, who will see you, completely free of charge, courtesy of our great NHS.

Alternatively you might prefer to see a private Dietitian and I would suggest for you to ensure you select a Registered Dietitian by checking on the Health and Care Professions Council (HCPC)  website also check the website: www.freelancedietitians.org

Probiotics

Probiotics are live micro-organisms that are added to foods such as yogurt and fermented dairy products or it can be consumed as capsules, powders or tablets. They exert their effect in the gut via various mechanisms that have long been studied, but are not yet fully understood. The idea is that when the normal healthy populations of colonic bacteria are depleted or disturbed by  antibiotic use, illness,  food poisoning, stress etc., probiotics might help to restore a healthy balance of gut bacteria.

Normally, probiotics do not permanently colonise the gut and usually the probiotic bacteria will be found at high counts during the intake period and up to one week afterwards. Therefore if you wish to trial a probiotic to help reduce your IBS symptoms it is recommended to have it every day for at least one month, at the suggested daily dosage. If there is no benefit, discontinue it or try a different product/ strain. There is at present little evidence to support their efficacy in treating or preventing IBS and although there have been some very positive indicators a specific product can not be recommended.

Most of the strains used as probiotics are safe to use, but it is not recommended for people who are immunocompromised or HIV-positive. And may not be suitable for people with severe lactose intolerance.

Prebiotics

Prebiotics are fermentable dietary fibre or complex sugars that our good gut bacteria can feed on, in other words prebiotics are food for our gut bacteria. Inulin and Oligofructose are the two most studied prebiotics. They are found naturally in wholegrain, fruits and vegetables such as artichokes, chicory, onion, garlic, leeks etc. Fermentation of prebiotics by gut bacteria release gas and therefore can often aggravate some IBS symptoms. Prebiotics are high in FODMAPs.

The advertising and sale of probiotics and prebiotics in the UK is regulated by trading standards and commercial communications covering medical and health claims. It is best to pick a product from a trusted manufacturer. Look at International Scientific Association for Probiotics and Prebiotics (ISAPP).

Be careful when following any dietary advice from the internet. 

There is a lot of unreliable dietary advice on the internet and therefore do ensure to get advice from reliable sources only. The British Dietetics Association website has some good up to date leaflets for some first line advice on IBS and diet:

www.bda.uk.com/foodfacts /ibs

Also have a look at:

www.theibsnetwork.org/the-self-care-plan/diet/so-what-can-I-eat-the-eatwell-plate

The benefits and rewards of travelling can be life changing, so do not let IBS get in the way of getting out there and having fun. You might be surprised to learn that your symptoms could potentially  improve when you are out and about having fun and focusing on the adventure and beauty of the world around you. Safe travels!