Irritable Bowel Syndrome, often just shortened to IBS, is a common, long-term condition that affects the digestive system.
Symptoms include stomach cramps, bloating, constipation and/or diarrhoea. They vary from person to person and last for varying amounts of time, but going to the toilet may ease the symptoms and discomfort felt.
Although the onset of symptoms can vary, as IBS is an unpredictable condition, they may come on particularly during stressful times, or when eating. It is currently still unclear what causes IBS.
People are more likely to develop the functional gastrointestinal (GI) disorder in their twenties, and it affects twice as many women as men. Overall, IBS affects around 15 per cent of the UK population at any one time, and according to the NHS, one in five people will suffer from IBS at any point in their life.
Unmanaged IBS can cause issues in everyday life, including pain and a dependency on toilet access, but dietary and even medical treatment can make living with IBS much easier, and over a number of years, the condition may improve.
Symptoms
There are numerous symptoms of IBS, with some of the main ones being:
- Abdominal pain/cramping
- Bloated stomach
- Diarrhoea/constipation
- Excessive wind
- Feeling like your bowels are not empty despite having gone to the toilet
- Having urgent needs to go to the toilet
- Passing mucus from your bottom
Some people also experience the following problems too:
- Backache
- Bladder problems
- Feeling pain during sex
- Feeling sick
- Having a lack of energy
- Incontinence
If you find yourself experiencing any symptoms of IBS, then you should visit your doctor, who will be able to diagnose or advise on any symptoms that you have.
Understandably, the symptoms of IBS can have a major impact on the daily life of sufferers. Anxiety and depression can develop as a consequence. If you feel you may be experiencing depression or anxiety, it is recommended to go and speak to your doctor – just because it isn’t necessarily a ‘physical’ symptom, it does not mean it should be ignored.
Causes
Experts do not know the exact cause of IBS yet, but the majority of them believe it is to do with an increased sensitivity in the gut, as well as problems digesting food. Other ideas suggested include inflammation, diet or infections. So far, none of these ideas have been proven to be the cause of IBS.
It is thought that for sufferers of IBS, the process of food being moved through the digestive system is altered from how it would normally occur, happening either too slowly or too quickly. The muscles of the intestines squeeze and relax to move the food along, normally in a rhythmical way.
Food moving too slowly or too quickly through the gut
Constipation is caused by food moving too slowly through the digestive system, with too much water being absorbed by the digestive system. Meanwhile, diarrhoea is caused by food moving through too quickly, because there isn’t enough time for water to be absorbed from the food.
Sensitivity in the gut and IBS
The theory that an increased sensitivity in the gut causes IBS stems from the belief that sufferers could be oversensitive to nerve signals in the digestive system. This leads to what would otherwise be mild indigestion becoming quite intense stomach pain, for those suffering from IBS.
The mind, emotions and IBS
Psychological factors have been linked to IBS as well. Very emotional states, such as being anxious or stressed, may lead to the digestive system being affected, due to chemical changes taking place in the body. This can happen to anyone, such as those taking exams, even if they do not have IBS.
Other causes of IBS
The symptoms of IBS may also be triggered by any of the following:
- Alcohol
- Chocolate
- Drinks with caffeine
- Fatty food
- Fizzy drinks
- Snacks such as biscuits and crisps
Diagnosis
Because it doesn’t result in observable abnormalities within the digestive system, doctors do not have specific tests to diagnose IBS.
Instead, doctors will look to see if you have had any of the symptoms of IBS, over a period of at least six months. Doing this can allow the doctors to rule out other conditions, essentially.
Taking a sample of your stools, for example, can be done to see if calprotectin is present. It is a substance which could indicate you have Inflammatory Bowel Disease (IBD), with the gut producing calprotectin when it is inflamed. Other options include taking blood tests, which can rule out a number of infections or celiac disease, which is a digestive condition caused by the body reacting adversely to gluten.
Red Flags
There are a number of ‘red flag’ symptoms, which could indicate the person has cancer or other serious conditions:
- Anemia
- Bleeding from the rectum
- Lump or swelling in either the stomach or rectum
- Unexplained weight loss
If you display any of these symptoms, then you will need to undergo further tests, which may also occur if you are over the age of 60 years and have experienced a change to your bowel habits for more than six weeks, or if your family has a history of ovarian or bowel cancer.
In such situations, your doctor may recommend that you have a colonoscopy. This procedure involves an endoscope being inserted into your rectum and used to examine the colon and rectum, to check if there are any abnormalities in the gut.
Treatment
An improved understanding of IBS and the symptoms that are experienced can help lead to smarter lifestyle and diet choices. These will hopefully make the condition more manageable, and improve the quality of life for the sufferer.
Diet
Although there is no ‘one’ diet to help all people who have IBS, changing your diet could play a significant role in treating it. Everyone is different so you will need to pay attention to what personally works best for you, in terms of your diet.
It is recommended to keep a food diary, because if your symptoms suddenly get better or worse, you may be able to look back at your records and identify foods which could have caused this to happen. Foods which appear to trigger the symptoms can therefore be avoided, where possible, or just restricted from your diet.
General diet tips
There are numerous eating tips which may improve the symptoms:
- Reduce alcohol and fizzy drink consumption
- Restrict coffee and tea consumption to three cups per day
- Avoid sorbitol (an artificial sweetener found in sugar-free products) if suffering from diarrhoea
- Reduce resistant starch consumption
- Restrict fresh fruit consumption to three portions per day
- Do not skip meals or have long gaps between them
- Take your time to eat, and ensure you have regular meals
- Drink a minimum of eight cups of water or other non-caffeinated drinks per day
- Consider consuming oats and linseeds if you are bloated and have wind
Fibre
Changing the amount of fibre being consumed, depending on the symptoms you are experiencing, is often recommended. This is because the two main types of fibre can affect your bowel habits, and taking advantage of this can help relieve the symptoms of IBS. Your doctor can recommend how much fibre you should consume.
Insoluble fibre cannot be digested by the body, and foods containing it include:
- Bran
- Cereal
- Nuts and seeds (although golden linseeds contain soluble fibre)
- Wholegrain bread
Reducing your consumption of these foods can help relieve diarrhoea.
Soluble fibre can be digested by the body, and foods containing it include:
- Barley
- Fruit
- Oats
- Root vegetables
- Rye
Increasing your consumption of these foods, in addition to drinking plenty of water, can be helpful in relieving constipation.
Low FODMAP diet
FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are types of carbohydrates. They ferment quickly in the gut, with gases being released during the process, which can cause bloating.
The low FODMAP diet restricts your consumption of foods high in FODMAPs, ultimately, and it can be effective for people who frequently experience bloating. According to King’s College London, 70 per cent of people with IBS following the low FODMAP diet find it effective.
Certain fruits and vegetables, beans, wheat products, dairy foods and drinks can be high in FODMAPs, and will therefore either be removed from your diet, or restricted.
If you choose to follow the low FODMAP diet, a qualified dietician should give you guidance throughout. For a referral, you could talk to your doctor.
Medication
There are numerous medications that be taken to help treat IBS, such as antispasmodics, low-dose antidepressants, antimotility medicines and laxatives. It is recommended to talk to your doctor before taking any medication, and to report any problematic side effects if they occur.
Antispasmodics
Therapeutic peppermint oil and mebeverine are examples of antispasmodics, which help to make the muscles in the digestive system relax. This can help reduce stomach pain and cramps, although a few people may experience heartburn and skin irritation on their bottom, as a result of taking peppermint oil.
Low-dose antidepressants
Tricyclic antidepressants (TCAs) are a type of antidepressant, and can be used to treat IBS. They prevent the nerves in the digestive system from receiving and sending signals, and TCAs may be recommended if antispasmodic medicine fails to deal with the symptoms.
They will generally take at least three to four weeks to have an effect, but they may result in side effects such as drowsiness, constipation, a dry mouth and blurred vision.
There is also an alternative form of antidepressant to treat IBS, known as selective serotonin reuptake inhibitors (SSRIs). Paroxetine, citalopram and fluoxetine are all examples of SSRIs, which may cause side effects such as dizziness, constipation, diarrhoea or blurred vision.
Antimotility medicines
For those who experience IBS-related diarrhoea, they may benefit from taking loperamide, an antimotility medicine.
Loperamide causes food to pass more slowly through your digestive system, by making the muscles in the bowel contract slower. Because of this, there will be more time for the stools to harden, becoming more solidified.
This medication may cause side effects such as dizziness, drowsiness, rashes, bloating and stomach cramps.
Laxatives
For those who experience IBS-related constipation, they may benefit from taking bulk-forming laxatives. They work by making stools softer, so they are easier to pass, ideally making it a less painful process.
It is very important to start with low doses. If it is required, the dosage can be gradually increased a few days apart, until, every day or two, there are one or two stools being produced. Bulk-forming laxatives should not be taken before bed.
The laxatives may cause side effects, such as wind and bloating, but often this can be avoided if the dosage is increased gradually.
Exercise
A large number of people reportedly find exercise to be a good way to relieve the symptoms of IBS. To find out which forms of exercise should be most beneficial to you, ask your doctor for advice.
Each week though, you should aim to carry out at least 150 minutes of aerobic exercise, at a moderate intensity. The goal of the exercise is to raise your heart rate and breathing rate. If they do not rise, this would indicate the exercise isn’t strenuous enough.
Reducing stress levels
It may be possible to reduce both the severity and the frequency of the symptoms of IBS, by reducing your stress levels. There are a range of ways in which people can successfully reduce their stress levels.
Performing physical activities such as yoga, tai chi, or pilates, as well as exercising regularly, can be effective ways to reduce stress levels. Relaxation techniques such as breathing exercises or meditation are also effective, while Cognitive Behavioural Therapy (CBT) and counselling may be beneficial to those feeling particularly stressed.
Probiotics
Probiotics are dietary supplements, which it is claimed can provide health benefits such as improved digestion and a healthier gut. However, medical evidence supporting this is very limited.
Some people strongly believe taking probiotics helps improve their situation, although it is not clear which types may be the most effective, due to the lack of conclusive research. If you do choose to take them however, it is recommended to try a certain product for four weeks or more, to see if there are any signs of improvements with your symptoms.
Psychological treatments
Psychological intervention may be recommended by doctors if the symptoms of IBS are still problematic, even after one year of treatment, with good evidence supporting it as a being an effective method of treatment for some people who have IBS.
There are several methods of psychological therapy which can be performed, and they will generally teach people a number of techniques which can be utilised to improve their control over the condition.
Cognitive Behavioural Therapy (CBT)
Based on the idea that a person’s thoughts and beliefs affect their emotions and how they behave, this method looks to teach the person how they can alter their thinking and behaviour, in order to cope better with the situation.
Hypnotherapy
With this method, the unconscious mind is trained to change its attitude towards the symptoms of IBS, through hypnosis.
Psychotherapy
This is where a therapist will hold a discussion to try and help the person delve deeper into the problems and concerns they are experiencing, in order to help them deal with the condition.
Complimentary therapies
Although there is no medical evidence to support these treatments as being effective, some people believe that reflexology and acupuncture can help treat IBS. They are not recommended as a form of treatment for IBS.
Public toilet access
Being able to access public toilets easily is very important for sufferers of IBS, due to the possibility of sudden diarrhoea. Fortunately, there are two schemes which can help out in such situations.
There is the National Key Scheme (NKS) run by Disability Rights UK, which helps grant people access to many locked disabled toilets in the country.
There is also the Can’t Wait Card, provided by the IBS Network to its members. This card grants them immediate access to toilets in shops, offices, and many other businesses in the UK, should it be needed.
