Irritable bowel syndrome (IBS)
If you think you have irritable bowel syndrome (IBS), you are not alone. More than 1 in 10 people are likely to have IBS at some time in their life. It is actually the commonest gut problem that people consult their doctor about. It is most likely before the age of 45 years, but can begin at any age.
How to tell if you have irritable bowel syndrome
Here are nine questions to help you decide if you might have IBS.
- Have you had pain or discomfort in your abdomen for 3 days or more in a month?
- Has this has been going on for the past 3 months or more?
- Does the discomfort improve when you pass faeces?
- Do your faeces look different from previously (loose and watery, or lumpy and hard)?
- Do you need to pass faeces more often than previously (more than 3 times a day)?
- Do you need to pass faeces less often then previously (less than 3 times a week)?
- Do you suddenly have to rush to the toilet to pass faeces (‘urgency’)?
- Does your abdomen feel bloated?
- Is the problem worse in the morning, and does not occur in the night?
If you answered ‘yes’ to questions 1 and 2, and also to some of the other questions, it is quite likely that you have IBS.
It is unwise to make a diagnosis of IBS on your own, without discussing it with your doctor. This is because some of the symptoms might be caused by a more serious condition, such as bowel cancer (although this is much less likely than IBS). You must talk to your doctor if you:
- lose weight
- have symptoms in the night
- find any blood mixed with the faeces
- have relatives with bowel cancer.
What causes irritable bowel syndrome?
IBS really is a mystery illness. The exact cause is unknown. There are probably several different causes acting together. Here are some of the theories.
Abnormal gut contractions. Our gut contains muscle in its wall, and this muscle is constantly contracting and relaxing to push undigested food and food waste along. Some people with IBS may have more of these gut contractions, or they may be clustered together abnormally.
Hypersensitivity to feelings in the gut. The gut sends messages along special nerves to the brain all the time, but normally the brain ignores these messages so we are not aware of them. In IBS these nerves may become more active, sending stronger messages, or the brain may not cancel them out as it normally would.
Gut distension and FODMAPS. Some carbohydrates and other substances in foods are not easily absorbed in the gut and just pass along it. These substances are known as FODMAPs. (Fermentable Oligo-, Di- and Monosaccharides and Polyols) and include various food chemicals such as fructose, lactose and sorbitol (Journal of Gastroenterology and Hepatology 2010;25:252-8). As they pass through the gut they can retain fluid and are acted on by gut bacteria to produce wind. FODMAPS are not the cause of IBS but they may provoke distension of the gut and therefore worsen IBS symptoms, especially in people who have hypersensitivity to gut sensations.
Stress response. Anyone who has ever taken an exam knows that anxiety causes diarrhoea i.e. it increases the normal gut contractions. Psychological stress and anxiety-provoking events trigger the release of stress hormones, and these affect the gut. People with IBS often say that it started after some stressful event in their life, and that it becomes worse when they are under pressure.
Gut infection. A bad gut infection (gastroenteritis) may be followed by IBS. This is called ‘post-infectious IBS’, and the pain can be severe.
How you can help yourself
Diet. Thinking about the balance of your diet is a good first step. Are you taking excessive amounts of fibre, carbohydrates or fats? If so, adjusting the balance might prove helpful. Some people find that wheat or dairy products make their symptoms worse, so it might be worth avoiding either wheat or dairy for a month to see if it has any effect. A diet that avoids FODMAPS (see above) really helps in about 75% of people with IBS, but has little benefit in some. This is a complicated diet that requires advice from a qualified dietician, so don’t try to do it on your own because you could end up with nutritional deficiencies.
If constipation is your main symptom, increasing fibre intake may help, but it does not help other symptoms. You can take various substances to increase fibre, mostly available in health food shops; for example, bran, ispaghula methylcellulose or sterculia. In fact, high-fibre diets based on bran or ispaghula can make symptoms worse in some people; this is less likely to happen with methylcellulose or sterculia.
Probiotics. We all have millions of ‘friendly’ bacteria in our guts. They are very important to our health. They help to detoxify the gut, to reduce inflammation, to boost our immune system and to reduce the risk of infection by bad disease-causing bacteria. Some studies have shown that in IBS the population of these friendly organisms is disturbed. Therefore, providing friendly bacteria (such as lactobacilli and bifidobacteria) and friendly yeasts (such as Saccharomyces boulardii) in the form of probiotics can be beneficial. Research studies indicate that probiotics are particularly helpful for bloating and wind.
Peppermint oil relaxes the muscle in the wall of the gut,i.e. it has an antispasm effect. It also has an antibacterial effect. The bacteria that live in the gut are responsible for producing gas, especially when the balance of bacteria in the gut is disturbed (as occurs in some people with IBS). Therefore it is not surprising that peppermint oil helps to reduce both abdominal pain and discomfort and the feeling of bloating, as well as diarrhoea and constipation (Digestive and Liver Disease 2007;39:530–6).
Loperamide, which you can buy from pharmacies, is very effective if diarrhoea is your main symptom. However, it does not have much effect on abdominal pain or discomfort.
Mebeverine is another medication that can be bought from pharmacies. It is an ‘antispasmodic’ that relaxes the muscle in the wall of the gut, and can help to reduce pain and cramping. It does not have much effect on diarrhoea or constipation.
Relaxation techniques. If your IBS is worse when you feel stressed, relaxation techniques are well worth investigating. Your local library will have books on relaxation, or you may find a class locally or look online (see Useful Contacts).
How your doctor can help
Your doctor has a key role in making sure that you have IBS, and not any serious condition.
Amitriptyline and similar medications (so-called ‘tricyclics’) are an effective treatment for the pain and discomfort of IBS, but require a prescription from your doctor. They are thought to work by inhibiting the pain messages that the gut sends to the brain. The downside is that they can make you drowsy (in which case you should not drive or operate machinery) and give you a dry mouth. They may not work straight away, so it is worth persevering with them for 4 weeks. They are usually continued for 6 months. (These medications are also used for depression, but for IBS the doses are lower and they provide a different effect.)
Will I get better?
IBS usually gradually improves. For example, a study in Bristol found that 5 years after their IBS was diagnosed, 68% of patients had no further symptoms (Lancet 1987;329:963-5). However, people with IBS often report that their gut remains sensitive, so symptoms may come back after any stressful life-event. It can take a long time to recover from IBS that occurs after a gut infection: one study found that after 6 years only 43% of patients had recovered completely(Gut 2002;51:410-3).
Written by: Margaret Stearn
Edited by: Margaret Stearn
Last updated: Friday, March 8th 2013
Useful contacts for Irritable bowel syndrome (IBS)
Click to see all the contacts that you may find useful in relation to irritable bowel syndrome
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