Managing IBS and Diverticular Disease with Diet and Lifestyle Changes

Case Study: Managing IBS and Diverticular Disease with Diet and Lifestyle Changes

Patient Profile

• Age & Gender: Male, 76 years

• Medical History: Long-standing Irritable Bowel Syndrome (IBS) with increasing frequency of flare-ups, including alternating constipation, diarrhea, cramps, and reflux. Referred by GP for dietary advice.

• Current Medication: Mebeverine for IBS management, but poor compliance noted.

Reason for Referral

The patient was experiencing more frequent and severe IBS flare-ups, which were significantly affecting his quality of life. In addition to his IBS symptoms, he had been diagnosed with diverticular disease, and he needed tailored advice to manage both conditions through diet and lifestyle changes.

Initial Assessment and Dietary Intervention

In the first appointment, an in-depth dietary history was taken to identify potential triggers for his symptoms. The patient’s diet was found to be high in lactose, caffeine, and resistant starches.

• Caffeine Reduction: The patient was advised to reduce his caffeine intake to help alleviate symptoms.

• Fluid Intake: Encouraged regular uncarbonated fluids without caffeine or sweeteners to maintain hydration and bowel regularity.

• Lactose-Free Dairy: Suggested trialling lactose-free dairy to manage lactose intolerance and reduce IBS flare-ups.

• Resistant Starch: Advised against consuming cooked and cooled pasta/potatoes, as these foods can worsen IBS symptoms. Alternative meal options that fit the patient's preferences were discussed.

The patient was also counselled on his poor compliance with the mebeverine medication. The purpose of the medication was explained, and the patient was encouraged to trial it as needed (prn) to manage flare-ups.

Holistic Approach to Care

In addition to dietary changes, a more holistic approach was introduced:

• Exercise: Discussed the benefits of regular exercise for maintaining healthy bowel function, managing stress, and supporting weight management. The patient enjoys swimming, so a goal was set for him to swim three times a week.

• Diverticulitis Management: Educated the patient on managing diverticulitis flare-ups by maintaining a consistent intake of fiber throughout the day and from day to day to prevent flare-ups. During flare-ups, a temporary reduction in fiber intake was advised to reduce strain on the digestive system.

• SMART Goals: Specific, Measurable, Achievable, Relevant, and Time-bound (SMART) goals were set for the patient, with a review scheduled in one month.

One-Month Review

At the one-month review, the patient reported the following improvements:

• Mebeverine Compliance: The patient had started using mebeverine appropriately and found it helpful in managing his symptoms.

• Improved IBS Symptoms: The frequency of IBS flare-ups had reduced, and he felt much better overall.

• Food and Symptom Diary: The patient was encouraged to keep a food and symptom diary to further track flare-ups and identify additional triggers.

Two-Month Review

By the two-month review, the patient had made significant progress:

• Identification of New Triggers: The patient identified legumes as a trigger for his symptoms and had successfully reduced their portion sizes, leading to improved results.

• Self-Management Confidence: The patient expressed confidence in managing his IBS independently moving forward.

Outcomes and Discharge

The patient had successfully implemented all the agreed-upon SMART goals and had experienced significant improvements in his IBS symptoms. With a clearer understanding of how to manage his condition through diet and lifestyle changes, he was discharged by the service, empowering him to continue self-managing his symptoms.

Conclusion

This case highlights the effectiveness of a holistic, tailored approach to managing both IBS and diverticular disease. By focusing on dietary triggers, medication adherence, exercise, and stress management, the patient was able to reduce flare-ups, improve bowel health, and gain confidence in managing his condition independently. The dietitian’s role in providing individualized education and support proved essential in achieving these positive outcomes.