Irritable bowel syndrome (IBS) can be treated with or without involving medication (see Chap. 6). General practitioners and specialists use both approaches to the same degree, but patients with IBS have greater confidence in the nonmedication therapies than in the medications. It has also been found that the nonmedication approach is more effective than that involving medications. The nonmedication therapies include one or more of the following: delivery of IBS-oriented information, dietary management, regular exercise, probiotic intake, gastrointestinal-directed hypnotherapy, acupuncture, herbal therapy, cognitive behavioral therapy, psychodynamic interpersonal therapy, relaxation training, and psychological treatment.

Studies conducted on IBS patients to establish how much they know about IBS have revealed that about 50 % believe that IBS is caused by a lack of digestive enzymes, and about 50 % believe that it is a form of colitis (inflammation in the large bowel). Moreover, many IBS patients believe that their condition will deteriorate with age, and that it can develop into colitis, malnutrition, or cancer.

Most IBS patients are interested in learning about which foods to avoid, the causes of IBS, coping strategies, and medications for IBS. They are also interested in finding out whether or not they will have to live with IBS for the rest of their life, and in reading research studies on the condition. Information and education are both requested by IBS patients and have proven to be beneficial. Thus, a thorough 15-min verbal explanation of the diagnosis and underlying mechanisms of IBS by a gastroenterologist during the first consultation was found to reduce self-perceptions of impairment in daily functioning. Furthermore, a structured 3-h IBS educational class for patients with IBS was reported to improve symptoms and some health-promoting behaviors. A 12-h structured IBS educational program, which included a 2-h informative session with a gastroenterologist, was found to improve both the IBS symptoms and quality of life of patients. Moreover, an effective physician–patient relationship that provides both reassurance and a thorough explanation of the IBS disorder has been found to reduce the use of healthcare resources and the fear of cancer. We believe that information provided by the healthcare provider is important to reassure the patient and to help them to cope with their condition.

Diet plays an important role in the development of IBS symptoms (see Chap. 3). Several studies have shown that restricting FODMAPs intake reduces the symptoms of IBS (Fig. 5.1). However, it is rather difficult to completely avoid FODMAPs over long periods. In our experience, IBS patients’ tolerance to FODMAPs differs considerably from individual to individual, probably because of differences in the composition of large-bowel bacteria. In our clinic, some IBS patients can tolerate small amounts of garlic and onions, while others cannot tolerate these items in any amounts; this also applies to bread, milk, and dairy products. The IBS patient should test the different items listed in Table 3.​1 and elucidate how much she/he tolerate. Furthermore, there are many alternatives to FODMAPs-containing foodstuffs that can be consumed by IBS patients (Table 5.1), and by doing so it is possible for IBS patients to lead a normal everyday life (Figs. 5.2, 5.3, 5.4, 5.5, 5.6 and 5.7).