Irritable Bowel Syndrome

What is Irritable Bowel Syndrome (IBS)?

Irritable bowel syndrome (often called IBS) is the name given to a collection of symptoms which affect the bowel. It is an extremely common problem and one of the most common health problems affecting the bowels in the Western world. Women are slightly more commonly affected than men, and it can occur at any age but it never changes into anything worrying or serious such as cancer despite the symptoms being similar (this is why it is important to have a doctor diagnose your symptoms). Although we don't know what causes IBS, about half of all people will date the start of their symptoms to a major life event such as change of house or job, or bereavement, suggesting that there may be a psychological trigger in susceptible patients. A number of people date the start of their symptoms to an acute gastroenteritis episode but in the remainder of cases, the trigger factor remains unidentified.

What are the symptoms?

Symptoms of IBS can be extremely varied and are different for everyone and depend on which parts of the gut are involved - there is often overlap between areas of the gut. Some people may experience problems in only one part of the gut, others in several. Symptoms can also vary over time but commonly include lower abdominal pain (often with bloating), along with diarrhoea, constipation or a mixture of both. There may also be other symptoms not linked to the bowel such as backache, sluggishness, gynaecological problems and urinary discomfort. Many people find that there may be weeks or months where there are few symptoms, followed by days of discomfort and problems – these episodes where symptoms occur can often be linked to times of stress.

How is IBS diagnosed?

IBS is usually diagnosed after all other possibilities have been excluded and so tests are sometimes required, although not everyone will need to have these done – it all depends on the symptoms. There is no single blood test, X-ray or scan that will diagnose IBS and the diagnosis is often made on the basis of the presence of typical symptoms. However, as patients with IBS get older, the diagnosis increasingly involves excluding other conditions. This means more investigations are performed to ensure the diagnosis is correct. These may include;

  • gastroscopy: endoscopic examination of the oesophagus (the gullet), stomach and duodenum (the first part of the small intenstine/gut)
  • ultrasound
  • barium studies: involving using the natural element barium to look at the body within an X-ray
  • colonoscopy: endoscopic examination of the large bowel.

How is IBS treated?

Fortunately, most attacks of IBS do not last too long and so need little active treatment. If treatment is needed, this tends to be targeted on the particular symptom so pain – usually caused by spasm or ‘cramp’ of the bowel – can be treated with drugs. There is a range of treatments available for treating IBS, including medicine for stomach cramps (antispasmodics), poo/stool-softening laxatives if constipation is a major problem, and medicine for the treatment of gas and stomach rumbling, in cases where these are a major problem. Other drug options include tricyclic antidepressants to help relieve pain in people who have not responded to other treatments, and antidiarrhoeals such as loperamide, if diarrhoea is a major problem. Constipation is treated by increasing fluid and fibre intake, but bloating can be sometimes difficult to treat successfully.

How can IBS be self-treated?

If certain foods seem to make your symptoms worse then avoid them.  Helpful dietary tips include drinking lots of water, preferably three litres a day and having a high-fibre diet to improve digestion. The amount of fibre must be increased gradually to allow the stomach to get used to it. Avoid food or beverages that make the symptoms worse - coffee and milk are frequent offenders – and it may be helpful to keep a diary in which you note down the foods that seem to upset your stomach. Avoid strong spices and foods that give you wind.  Avoid large meals, but eat regularly, and limit your alcohol intake.

Some people find natural treatments such as aloe vera helpful during an attack - but make sure the aloe vera brand you use is high in mucopolysaccharides, as this is the active ingredient that will help. Take a daily vitamin B supplement and a probiotic  to build up levels of friendly bacteria in the gut, and cut out stimulants such as caffeine, alcohol and cigarettes. Peppermint oil capsules are often a great help in easing bowel spasm too.

What else can improve IBS?

  • Physical activity and exercise can improve digestion and reduce stress.
  • Heat treatment with hot packs, hot-water bottles or electric blankets may relieve the symptoms.
  • Try to reduce the number of stressful situations in your life. You might like to experiment with some of the different relaxation techniques, such as meditation.
  • Try to keep things in perspective. Excessive worrying about digestive problems could lead to social and psychological problems.

What symptoms should not be ascribed to IBS?

Because irritable bowel syndrome can mimic so many other intestinal disorders, it's important to identify those symptoms that require you to see your doctor:

  • Difficulty in swallowing when food gets stuck
  • Indigestion-type pain that wakes you up at night
  • Abdominal bloating that does not get better overnight
  • Significant and unexplained weight loss
  • Bleeding from the back passage
  • Chronic, painless diarrhoea.

In general, first-time symptoms of IBS in a person over the age of 40 should always be assessed by a doctor.