What is irritable bowel syndrome?
Irritable bowel syndrome (IBS) is a common digestive condition that affects between 10 and 20% of people in the UK. Everyone has tummy trouble at one time or another. The difference with IBS is that bouts of diarrhoea, constipation, or both, keep coming back. IBS is not life-threatening but varies in severity and can seriously affect your quality of life. IBS symptoms are often triggered by stress or eating certain foods.
What are the symptoms of IBS?
IBS has a range of symptoms, most commonly: stomach ache and a change in bowel habits. You may have; diarrhoea, constipation, or both, cramps in the lower abdomen, frequent toilet trips, hard or loose stools, excess wind and a visibly bloated tummy. Symptoms often worsen after eating. Some people have related issues such as urinary or sexual problems. IBS is usually diagnosed as one of three types: 'diarrhoea predominant', 'constipation predominant', or an alternating pattern of both, depending on the symptoms.
What causes IBS?
The specific cause of IBS is not known but it's associated with increased sensitivity in the digestive system, perhaps triggered by a bout of food poisoning or stress. One theory suggests IBS may be caused by over sensitivity to digestive nerve signals. The nerves relay information to the brain signalling hunger, fullness or the need to go to the toilet. In IBS, it's thought these signals may be misread, causing abnormal intestinal muscle contractions, or spasms. The result is pain, cramping and disruption of digestion. Usually, patients have no physical sign of inflammation, damage or abnormalities in the gut.
Who's at risk of IBS?
IBS often starts between 20 and 30 years of age, although it is also prevalent in older people and anyone at any age can be affected. It's twice as common in women and more likely to affect people with a family history of IBS. Bouts of IBS are sometimes linked to bouts of anxiety or depression.
When is IBS suspected?
As IBS does not cause any visible physical abnormalities, there's currently no specific test to diagnose it. Your GP may suspect IBS if one of these criteria applies:
- You have bloating or stomach pain that is relieved by going to the toilet
- You have stomach pain associated with diarrhoea, constipation or both
- You are having bowel movements more often than normal
The National Institute for Health and Care Excellence (NICE) recommends that a stool sample test, called a faecal calprotectin diagnostic test, is used in certain circumstances to help distinguish between IBS and bowel conditions such as Crohn’s disease and ulcerative colitis.
Living with IBS
Living with IBS can take a heavy toll on your everyday life. Coping with bouts of frequent, urgent diarrhoea, may make you reluctant to go out and it may be especially difficult to commute to work or travel long distances by car or by air. Explore ways to reduce stress. Planning can help. Find out where the toilets are if you are headed to an event. Sit in the back or the end of rows at concerts or the cinema. Check the menu ahead of time if you are dining out to avoid triggers. Finally, be honest and tell people you have a medical condition if you find yourself in an awkward situation.
IBS practical help
Easy access to public toilets can be very important if you struggle with IBS and have a sudden need to go to the toilet. There are two UK initiatives that can help:
- The 'Can't Wait Card' is provided by the IBS Network, which helps with immediate access to toilets in shops, offices and UK businesses
- Disability Rights UK provides the National Key Scheme which supplies access to around 9,000 locked toilets in the UK
IBS and stress
While there are few outward signs of IBS – the condition is certainly not "all in the mind". There is good evidence that psychological factors, like stress and anxiety, play a role in IBS – triggering chemical changes that interfere with the normal digestive process. Stress over coping with the condition often produces more stress - causing a vicious cycle. Research also suggests that a traumatic childhood event, such as abuse, bereavement or serious illness may also lead to IBS in later life.
What triggers IBS?
Common triggers of IBS include: eating certain food or drink, stress, hormonal changes and certain medicines. It's important to identify your personal triggers, for example, by keeping a food diary to record what sets off a bout of IBS. Keep in mind that no specific foods have been universally linked to IBS symptoms, so a diary can help you pinpoint a problem food for you.
Treating IBS: Diet
There is no "cure-all" diet for people with IBS as triggers vary but changing what you eat is a good start. It may help to limit caffeine, alcohol, fizzy drinks, processed snacks and fatty or fried foods. If you suffer from diarrhoea you may want to limit the amount of insoluble fibre you eat and avoid pith, pips and skin in fruit and veg. If you suffer from constipation, getting more fibre or water may improve your symptoms. Using a diary, foods you suspect may trigger IBS can be ruled out one at a time. Eat regular meals, don't skip meals, take your time eating and replace lost fluids by drinking plenty of water.
Treating IBS: Probiotics
Probiotics are 'friendly bacteria' often credited with keeping the digestive tract healthy. Studies suggest they do this by helping reduce the growth of other harmful bacteria in the bowel. There are lots of probiotic products, including yoghurt with 'active cultures'. NICE says if you try them for IBS you should take them daily for at least a month at the recommended dose to see if they are likely to help. The NHS says there is no scientific evidence to prove that probiotics work but if you do try them follow the manufacturer's instructions.
Treating IBS: Diarrhoea medication
If changing what you eat is not working for you, your GP may recommend prescription or over-the-counter medication to target specific symptoms. Antispasmodic medication may help with pain and cramping. Antimotility medication can help slow the working of the intestines, but this medication can cause constipation, so keep your GP updated on your progress. Sometimes antidepressants are prescribed for pain and cramps.
Treating IBS: Constipation medication
Your GP may prescribe a bulk-forming laxative that increases the density and softness of the stool making it easier to pass. NICE recommends that people should be discouraged from taking Lactulose, an osmotic laxative. Stimulant laxatives speed up the movement of stool and ideally should only be for short-term use.
Treating IBS: Antidepressants and antispasmodics
A low dose of antidepressants may be prescribed for IBS but this may not mean you are depressed. These medications can be used to block the perception of pain in the gut. The type of antidepressant used will depend on your symptoms. SSRI (selective serotonin reuptake inhibitor) antidepressants can cause side effects like nausea, diarrhoea or loss of appetite. Tricyclic antidepressants are usually prescribed for IBS with diarrhoea and can have side effects of dry mouth, blurred vision or drowsiness.
Treating IBS: Peppermint oil
Some people use peppermint oil as a natural remedy for IBS. The oil is antispasmodic and relaxes the muscles in the bowels, and some studies suggest it may improve symptoms, including pain and bloating. You can get peppermint oil capsules on prescription from your doctor or buy them over the counter. Avoid breaking or chewing them as they can irritate your mouth. Side effects can include heartburn, nausea and irritation of the skin around the anus. Check with your GP before taking peppermint oil if you're taking other medications.
Treating IBS: Psychotherapy
Stress management can help relieve the symptoms of IBS and help you cope with flare-ups. Therapies include:
- Cognitive-behavioural therapy (CBT) - psychotherapy that helps replace negative thoughts with more positive ones
- Yoga and meditation
- Regular exercise
- Hypnosis and relaxation therapy
Some people have used acupuncture or herbal remedies for stress relief but there is little scientific evidence that they work for IBS. Some traditional herbal remedies for stress symptoms, such as valerian, are registered with the regulator the MHRA. Registration doesn’t mean there's proof a herb works but it confirms traditional use and manufacturing standards.
Treating IBS: Hypnosis
Hypnosis creates an altered state of consciousness and some research suggests it may help people be more receptive to suggestions - making the pain fade away. Hypnosis is used to reduce pain, digestive symptoms, and anxiety linked to IBS. It may also help people avoid overreacting to stressful situations and people. Two Swedish studies evaluated a form of treatment that could be utilised beyond specialist hypnotherapy centres. 40% of participants showed a reduction in symptoms. If you are thinking about hypnotherapy, you should consult an approved therapist who should be a member of the British Medical Hypnotherapy Association.
Treating IBS: Biofeedback
Biofeedback teaches people to recognise and change the body's response to stress. Subjects are often able to become more relaxed and slow down their own heart rate after a few sessions. This can help relieve both the stress and symptoms of IBS.
Treating IBS: Relaxation therapy
There are many forms of relaxation therapies from hypnotherapy to meditation, guided imagery or deep breathing. Studies suggest these techniques can help relieve IBS symptoms like pain, diarrhoea or constipation. The goal is to get the mind and body in a calm, peaceful state.
IBS and exercise
You may not feel like being active when you are experiencing a bout of IBS but most people find physical activity does help digestion, reduce stress and induces an overall sense of wellbeing. Opt for low-impact activities that are strenuous enough to increase your heart and breathing rates. Aim for a minimum of 30 minutes moderate intensity exercise a day, at least 5 times a week. Brisk walking and walking uphill are good examples. Your GP will be able to advise you on the type of exercise that is suitable for you.
IBS: Long-term outlook
It's important to understand that while IBS is a long-term condition, it does not lead to more sinister conditions such as cancer. You may experience quieter periods followed by flare-ups. However, IBS pain and discomfort can have a significant psychological impact. It's estimated that 3 out of 4 people with IBS will have at least one episode of depression. Just over half will develop generalised anxiety disorder (GAD). Fortunately, the symptoms of IBS usually don't get worse over time. Keeping a diary of food, feelings and symptoms can help uncover hidden triggers and help you cope better with the condition.