IBS (irritable bowel syndrome)

What is irritable bowel syndrome (IBS)?

IBS is a gastrointestinal disease or condition that causes a group of symptoms that affect your digestive system.^2,3 It is characterised by abdominal discomfort associated with your bowel movements.⁵

IBS is a chronic (long-term) condition, meaning it can’t be cured.³ However, most people can manage their symptoms with some lifestyle and IBS dietary changes, as well as IBS medication and IBS tablets.^2,3 Though some people with IBS experience severe symptoms that require more intensive treatment approaches.⁴

Importantly, IBS is not the same as inflammatory bowel disease (IBD).⁵

Irritable bowel syndrome symptoms

You will likely have better days and worse days with IBS, depending on whether you’re going through a flare-up (a worsening of symptoms).^3,6

When they occur, IBS symptoms include:^3,6

• Stomach pain or cramps (usually worse after eating and better after passing an irritable bowel movement)
• Excess gas and bloating
• Diarrhoea
• Constipation
• Mucus in your stools
• Feeling like you haven’t fully emptied your bowels after passing a stool
• Tiredness and a lack of energy
• Feeling sick
• Backache
• Problems with peeing, like needing to pee a lot or urgently
• Not always being able to control when you pass a stool

Depending on the symptoms you experience most, there are four subcategories of IBS:^3,5

• IBS-D – mostly diarrhoea and abdominal discomfort (IBS-D)
• IBS-C – mostly constipation and abdominal discomfort (IBS-C)
• IBS-mixed – alternating loose stools and constipation with abdominal discomfort
• IBS-U – an undefined subtype when symptoms vary

Irritable bowel syndrome triggers

The cause of an IBS flare-up isn’t always apparent, but triggers can include:^3,4,6

• Drinking alcohol
• Having caffeine
• Carbonated drinks
• Eating spicy or fatty foods
• Eating foods including wheat, dairy products, citrus fruits, beans, cabbage
• Feeling stressed or anxious
• Using antibiotics regularly
• Being on your period

Causes of irritable bowel syndrome

Researchers haven’t yet identified a single cause for IBS.^3,7 Instead, the condition has been linked to problems with the gut-brain interaction, which describes how your gut and your brain work together.

If there is a communication difficulty between your gut and your brain, your gastrointestinal (GI) muscle may struggle to move food through your GI tract (dysmotility) and contract more, causing cramps. Problems with the gut-brain interaction can also cause you to have extra-sensitive nerves in your GI tract (visceral hypersensitivity), which can exacerbate abdominal pain.

IBS has also been linked to a number of other contributing factors:^3,5,7

• Severe bacterial infections in your digestive tract
• A bacterial overgrowth in your small intestine
• Food intolerances or sensitivities
• Stressful or difficult events in early life

Risk factors for irritable bowel syndrome

IBS affects twice as many women as men, although the symptoms of IBS in females do not differ.^3,5 Most sufferers develop their first symptoms before the age of 40, with many experiencing an onset of symptoms during childhood or young adulthood.⁵

Other risk factors include:^3,5,8

• A family history of the condition
• Food intolerances
• A severe digestive tract infection
• A history of abuse
• Anxiety, depression and post-traumatic stress disorder
• Other chronic pain conditions, such as fibromyalgia, chronic fatigue syndrome and chronic pelvic pain

How is irritable bowel syndrome diagnosed?

If you think you have IBS, you should visit your GP who will ask you some questions about your symptoms and medical history, such as:^3,9

• What symptoms you have
• When they started
• If they come and go
• If they’re triggered by anything
• How often you get them
• Whether you’ve had another illness recently
• Whether you’ve suffered a stressful event recently

There is no specific test for IBS, but your GP can rule out other conditions using:^3,9

• A blood test – for coeliac disease
• A stool test – for infections and IBD

How to treat irritable bowel syndrome

There is no one IBS treatment that works best for everyone.¹⁰ However, there are things you can try to help improve your symptoms or avoid triggering a flare-up:^10,11

• Eat a healthy, balanced diet
• Avoid any foods that trigger your symptoms
• Avoid foods that are hard to digest (cabbage, broccoli, cauliflower, brussels sprouts, beans and onions)
• Increase your intake of soluble fibre (oats, pulses, carrots, peeled potatoes and linseeds)
• Get plenty of sleep
• Try to find ways to relax
• Exercise regularly
• Try probiotics for a month to get your gut bacteria back to normal
• Eat regular meals
• Don’t eat too fast
• Avoid fatty, spicy foods
• Try not to eat more than three portions (80g) of fresh fruit a day
• Don’t drink more than three caffeinated beverages a day
• Avoid alcohol and fizzy drinks
• Try taking laxatives if you’re constipated
• Avoid products containing sorbitol (a sweetener)
• Try buscopan or peppermint oil
• Eat plenty of fibre if you’re constipated or cut down on high-fibre foods if you have IBS diarrhoea
• Try loperamide (imodium) if you have diarrhoea

If these changes to your diet and lifestyle don’t help to improve your symptoms of IBS, your GP could refer you to a dietician who may recommend trying a low FODMAP diet.¹²

This irritable bowel diet avoids foods that the gut finds difficult to digest, such as some types of:^12,13

• Fruit (e.g., apples, cherries, pears, peaches)
• Vegetables (e.g., artichokes, asparagus, onions, garlic)
• Beans and pulses
• Dairy products (e.g., milk, yoghurt, ice cream)
• Wheat products (e.g., cereal, bread, crackers

Your GP may also prescribe antidepressants which can help to ease the symptoms of IBS, such as:¹²

• Amitriptyline
• Citalopram

Alternatively, to help you manage your anxiety, which may be contributing to your symptoms, your GP may refer you for cognitive behavioural therapy.¹²

Sources

1. https://cks.nice.org.uk/topics/irritable-bowel-syndrome/background-information/prevalence/
2. https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/
3. https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs
4. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016
5. https://www.hopkinsmedicine.org/health/conditions-and-diseases/irritable-bowel-syndrome-ibs
6. https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/symptoms/
7. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/symptoms-causes
8. https://cks.nice.org.uk/topics/irritable-bowel-syndrome/background-information/causes/
9. https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/getting-diagnosed/
10. https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/diet-lifestyle-and-medicines/
11. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/diagnosis-treatment/drc-20360064
12. https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/further-help-and-support/
13. https://www.hopkinsmedicine.org/health/wellness-and-prevention/fodmap-diet-what-you-need-to-know