Managing a patient's IBS in primary care

Managing IBS and Diverticular Disease: A Holistic Approach to Long-Term Relief

Living with Irritable Bowel Syndrome (IBS) and diverticular disease can be a daily challenge, especially when flare-ups become more frequent and difficult to manage.

This was the case for a 76-year-old male patient who sought help from his GP after years of struggling with these conditions. The patient was referred to a PCN dietitian, and in this case study, we look at how he was supported and what changes he made.

Patient Background and Initial Consultation

The patient, referred by his GP, had a long-standing history of IBS characterized by alternating constipation and diarrhea, abdominal cramps, and reflux. Despite being prescribed mebeverine, an antispasmodic medication commonly used to treat IBS, he continued to experience frequent flare-ups, leading to increased discomfort and frustration.

During the first appointment, an in-depth dietary history was taken to identify potential triggers for his symptoms. The assessment revealed a high intake of lactose, caffeine, and resistant starches—common culprits in exacerbating IBS symptoms. These findings provided a foundation for developing a tailored management plan aimed at reducing the frequency and severity of flare-ups.

Tailored Dietary and Lifestyle Interventions

Based on the identified triggers, several dietary and lifestyle changes were recommended:

1. Reducing Caffeine Intake: Caffeine is known to stimulate the digestive tract, potentially worsening IBS symptoms. The patient was advised to gradually reduce his caffeine consumption and replace it with regular, uncarbonated fluids that are free from caffeine and artificial sweeteners.
2. Trialing Lactose-Free Dairy: Since lactose can be a major trigger for IBS, the patient was encouraged to try lactose-free dairy products to see if this would alleviate his symptoms.
3. Avoiding Resistant Starches: Cooked and cooled pasta and potatoes contain resistant starches that can be difficult to digest for some individuals with IBS. Alternatives were identified that aligned with the patient’s food preferences, ensuring he could enjoy his meals without exacerbating his symptoms.
4. Mebeverine Compliance: It was noted that the patient had not been consistently taking his prescribed mebeverine. He was counseled on the importance of this medication in managing his symptoms and encouraged to use it as needed (prn) for best results.

In addition to dietary adjustments, the consultation took a holistic approach by exploring lifestyle changes that could support overall digestive health:

1. Regular Exercise: Regular physical activity is essential for maintaining healthy bowel function, reducing stress, and supporting weight management—all crucial factors in managing IBS. The patient enjoyed swimming, so a goal was set for him to swim three times a week.
2. Managing Diverticular Disease: The patient was educated on how to manage diverticulitis flare-ups, emphasizing the importance of consistent fiber intake across the day to prevent issues and reducing fiber intake during active flare-ups.

SMART (Specific, Measurable, Achievable, Relevant, Time-bound) goals were established, with plans to review progress in one month.

One-Month Review: Progress and Adjustments

At the one-month review, the patient had successfully implemented all the recommended changes. He reported using Mebeverine as needed and found it helpful in managing his symptoms. As a result, his IBS symptoms had significantly improved, with fewer and less severe flare-ups.

During this review, the patient was also counseled on how to use a food and symptom diary to further investigate any potential triggers for future flare-ups. This proactive approach empowered him to take control of his health by understanding how different foods and habits affected his symptoms.

Two-Month Review: Identifying Additional Triggers and Final Outcomes

By the two-month review, the patient had identified legumes as another trigger for his IBS symptoms. By reducing portion sizes of legumes, he experienced further improvement in symptom management.

This demonstrated his growing confidence in self-managing his condition, using the tools and knowledge gained through the consultations. With his symptoms well-controlled and a clear understanding of how to manage potential triggers, the patient was discharged with a Patient Initiated Follow-Up plan, ensuring he could seek help if needed in the future.

Conclusion

This case study highlights the power of a personalised, holistic approach to managing IBS and diverticular disease. By focusing on the patient's unique dietary needs, lifestyle preferences, and medication management, significant improvements in symptoms and quality of life were achieved. For those living with chronic digestive conditions, this approach offers a path to long-term relief and self-management, empowering patients to live more comfortably and confidently.

Learn more about how dietitians work within primary care, drop us a message at info@primarycaredietitians.co.uk or visit our website to learn more! www.primarycaredietitians.co.uk.