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Irritable bowel syndrome

Irritable bowel syndrome is common – it affects up to 1 in 7 adults. It’s a lifelong gastrointestinal condition that usually begins in late teens or early adult years, more often in women.

IBS causes pain or discomfort in your abdomen, but is usually harmless. It is not the same as inflammatory bowel disease, a more serious condition sometimes called Crohn’s disease or ulcerative colitis.

The cause of IBS is not fully understood.

Symptoms of IBS

IBS covers a range of abdominal symptoms that affect people differently. The main symptoms are abdominal pain or discomfort such as bloating or stomach cramps. With this pain or discomfort you also find some other features:

It tends to get better after you have a poo (bowel movement).
You will have more or fewer bowel movements than usual.
You notice a change in pooing habit and consistency, mainly towards constipation or diarrhoea, but these can alternate from one to the other.

Having diarrhoea means you have loose, watery poos three or more times a day and a sense of needing to get to the toilet urgently.

Having constipation means you have fewer than 3 bowel movements a week. Poo can be hard, dry, small and difficult or painful to pass, and sometimes requiring some straining to do so.

Symptoms tend to come and go over time, and can last for days, weeks or months at a time. The severity of symptoms also goes up and down.

How is IBS diagnosed?

There is no medical test to diagnose IBS. For your doctor to diagnose IBS, abdominal pain or discomfort plus 2 out of 3 of the main bowel (gut) symptoms above need to affect you at least 3 times a month. Other less common symptoms may also contribute to the diagnosis as well.

Talking with your doctor about the problem is really helpful for reaching a diagnosis and finding a plan to help you. It might help your doctor to know:

what symptoms you have
if they come and go
how often you get them
when you get them (eg, after eating certain foods)
how long you've had them.

Your doctor may also recommend you have a few tests to exclude other causes, such as coeliac disease or infection. These might require a blood sample or a poo sample.

How is IBS treated?

There is no cure for IBS but changes to your diet or lifestyle and taking some medicines can help with symptoms.

Diet is a key part of treatment

You might know some foods trigger your symptoms and you already avoid them (including perhaps drinks containing alcohol or caffeine). If not, there are some foods known to worsen IBS in many people and, with dietary advice from your doctor, it might help to try cutting down on:

High sugar fruits (eg, apples) and vegetables (eg, onions)
dried fruits
honey
artificial sweeteners (eg, sorbitol)
wheat breads and cereals
cows’ milk.

These foods are just a small part of a long list of foods called FODMAPs – foods not easily broken down in the gut and known to worsen IBS by causing bloating and gas. Bloating can trigger pain in the lower gut if you have IBS.

Cutting out all FODMAPs for life is not recommended. The idea is, with dietary advice, to remove and reintroduce foods slowly to see how you react. Your doctor or a dietitian will be able to help you try this safely so that you still get good nutrition.

How and when you eat is also important. Missing breakfast (when your body is ready to digest food) and hurrying larger meals later in the day can both make IBS worse.

Very large, spicy or fatty meals are not advised if you have IBS. Eating regular, unhurried meals using fresh ingredients, not takeaways or convenience foods, is much more likely to help you reduce symptoms.

Probiotics are sometimes taken for IBS symptoms but it is uncertain whether they help.

Taking a recommended probiotic for 4 weeks might give you an idea whether they improve your symptoms.

Reduce stress

IBS is not caused by stress but stress can worsen IBS symptoms. This makes some sense as a 100 million of your body’s nerve cells are in your gut and they interact with those in your brain.

Exercise is a wonderful way to reduce stress and help digested food move through your gut, reducing bloating.

If you are stressed or anxious, talking therapies such as cognitive behavioural therapy, or medications for stress are shown to help with IBS symptoms as well.

Medicines for IBS

Your doctor may recommend you try a medicine for your particular IBS symptoms, including:

laxatives for relief of constipation
anti-diarrhoeal medications to relieve chronic diarrhoea
anti-spasmodic medications to assist in relieving abdominal pain and cramps
anti-depressant medication to help with pain and bowel movements.

When to seek help urgently for gut pain

Some bowel symptoms can have several possible causes and are hard to pinpoint. These require the immediate attention of your doctor just to make sure they know what is causing them. Pay a visit to your doctor to get checked out if you have:

bowel symptoms beginning after the age of 50
a family history of gastrointestinal cancer, inflammatory bowel disease or coeliac disease
bleeding from your rectum (bottom)
unexplained or unplanned weight loss
being awoken at night due to abdominal pain or diarrhoea
large volumes of diarrhoea every day (be careful not to become dehydrated)
complete loss of bowel control (incontinence)
abdominal lump or mass
iron deficiency anaemia.