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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.

 Irritable bowel syndrome (IBS) - Patient Pictures

PatientPictures.com: Irritable Bowel Syndrome

How to tell if you have irritable bowel syndrome

Here are nine questions to help you decide if you might have IBS.

  1. Have you had pain or discomfort in your abdomen for 3 days or more in a month?
  2. Has this has been going on for the past 3 months or more?
  3. Does the discomfort improve when you pass faeces?
  4. Do your faeces look different from previously (loose and watery, or lumpy and hard)?
  5. Do you need to pass faeces more often than previously (more than 3 times a day)?
  6. Do you need to pass faeces less often then previously (less than 3 times a week)?
  7. Do you suddenly have to rush to the toilet to pass faeces (‘urgency’)?
  8. Does your abdomen feel bloated?
  9. 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)

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Comments on this article

Posted by pauline Optional on 24/04/2015 at 10:58

it has flared up and i am realy struggling i can not face food and i am in so much pain i have been to the doctors three times they have just changed my tablets i hope this helps my life is on hold because of the wind + and bad smells it has never been this bad i need a booklet om what to eat and what not eat help please r for years i have had ibs

Posted by Gazza B on 06/12/2014 at 10:40

FODMAPS diet dramatically diminished my symptoms by possibly 80% over 4-6 weeks. I learned that generous helpings of good foods such as, prunes, figs, broccoli, cauliflower, nuts, onions, beetroot, can become 'time bombs' for an IBS sufferer. I found from articles in "Mens Health" magazine that the starting point for an IBS sufferer should be gluten free and FODMAPS dietary books such as (in Australia): "Food Intolerance Management Plan" by Dr Sue Shepherd and Dr Peter Gibson; "Low FODMAP Recipes" by Dr Sue Shepherd Those interested might like to check out Dr Sue Shepherd's website, shepherdworks.com.au

Posted by SWR on 30/11/2014 at 08:30

I have been struggling with this and chronic pancreatitis for over 10 years.To add insult to injury the urgency/frequency etc that affected my bowel decided that it too would affect my bladder.I suffer from terrible constant and persistent boughts of abdominal pain and discomfort.Most nights I suffer from bowel leakage and every night I suffer with nocturnal polyuria.The only "Cure" I found for the polyuria is to use a foley catheter at night,this I discovered in hospital where I had the first undisturbed night in years.For years since I have tried to use a foley catheter 24/7 but it causes me too much pain and discomfort and three days is the longest I can go. I am going through the motions of getting a suprapubic catheter put in so at night I can use that and during the day go normally or use the catheter. Bowel wise I have had all the tests/scans etc to no avail.I have a very limited diet as it is but been advised to look at FODMAP diet.Saw the dietician but as I don't east 98% of the trigger items it doesn't leave much left! I regularly pass blood in my stools and the pain is so intense and the cramping/urgency so great that I'm sure it's not IBS,but that is what I am repeatedly told.The recent MRI apparently showed nothing,but I'd love to know where the blood comes from.

Posted by XM on 16/09/2014 at 11:29

I was diagnosed 3 years ago in high school, after many fruitless tests, exams. I quickly lost like 12lbs. The FODMAPs diet helped me immensely; I went to a nutritionist and she walked me through it. If that doesn't work for you (it is very hard and frustrating but stick with it!) There is a blood test that can tell you specifically what your body reacts to, "LEAP" I think. really helped me. I still get sick but hey that's IBS for you.

Posted by keel on 10/03/2014 at 07:55

Diagnosed wiv ibrahim several years ago, iv tried everything from diet change to laxatives suposetries but nothing I do or take improves this. Is anyone able to give me any advise as this is life changing for me in a bad way xxx

Posted by Optional on 20/02/2014 at 08:23

Have found information very helpfully and have tried several times with all suggestions reference diet for Ibsen and also York test several yrs ago but still struggling daily bloated uncomfortable tummy every day worse in evening

Posted by Optional on 17/10/2013 at 02:12

Could the 'how the doctor can help section' be updated to include linaclotide/ Constella?

Posted by AnnOptional on 29/03/2013 at 01:03

Hi I have ibs so I've been told but I go to the toilet about 10 times a day often I don't make it and soil myself if I pass wind there is blood everywhere I wear a towel to bed every night can't go anywhere wit out a change of clothes I'm bleeding all the time dark red blood every time I go to loo I also have weak bladder but I'm getting physio for that its not working could not and will not have a relationship to embarrassed

Posted by Optional on 26/03/2013 at 05:54

Dear Margaret, I was diagnosed with IBS almost a year ago (after ruling out other conditions such as coeliac) I have been struggling to manage the condition and am continually trying to work out my triggers. In the last 3 months I have been suffering from repeat bouts of thrush, which I believe to have started as a result of a UTI requiring two different types of antibiotic. I have read various sites which describe how IBS and thrush may be related; I'd be interested to know your view, or whether you believe it would be worthwhile visiting my GP?

Posted by terry yates on 30/08/2012 at 07:31

need a diet sheet

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