Irritable bowel syndrome (IBS) is a common condition with symptoms causing around 1 in 10 people to seek help from their GP at some point in their lives. The condition is more common in women than it is in men.
The condition is a combination of abdominal discomfort or pain and altered bowel habits: either altered frequency ( diarrhoea or constipation) or altered stool form (thin, hard, or soft and liquid).
IBS is not a life-threatening condition and it does not make a person more likely to develop other colon conditions, such as ulcerative colitis, Crohn’s disease, or colon cancer or any diseases of the heart or nerves. Yet IBS can be a long-term problem that can significantly impair quality of life in those that have it. For example, people with IBS miss work more than people without IBS and the condition is associated with absenteeism from school, decreased participation in activities of daily living, alterations of one's work setting (shifting to working at home, changing hours) or giving up work altogether.
What are the symptoms of IBS?
Among the symptoms associated with IBS are:
- Diarrhoea (often described as violent episodes of diarrhoea)
- Constipation alternating with diarrhoea
- Abdominal pains or cramps, usually in the lower half of the abdomen that are aggravated by meals and relieved by having a bowel movement. Often the person has more frequent bowel movements when they have pain and the stools are looser
- Excess wind or bloating
- Harder or looser stools than normal (rabbit-like pellets or flat ribbon stools)
- Visible abdominal distension.
Some people with IBS have other symptoms not related to their digestive tract, such as urinary symptoms or sexual problems.
Symptoms of IBS tend to worsen with stress.
People with IBS have traditionally been described as having "constipation-predominant", "diarrhoea-predominant", or an alternating pattern of constipation and diarrhoea. Each type represents about a third of the overall IBS population.
What causes IBS?
Two hundred years after the condition was first described, experts still don't completely understand what causes IBS symptoms.
Many experts think that it is a problem of bowel motility, the muscles in the bowelsdon't contract normally, affecting the movement of stool. But some studies don't show that the poor bowel motility correlates with symptoms. Also, drugs that alter motility don't seem to benefit most people with IBS.
Newer studies suggest that in IBS, the colon is hypersensitive, overreacting to mild stimulation by going into spasms. Instead of slow, rhythmic muscle contractions, the bowel muscles spasm. That can either cause diarrhoea or constipation.
Another theory suggests that a number of substances that regulate the transmission of nerve signals between the brain and GI tract may be involved. These include serotonin, gastrin and others.
Some have also suggested that there is a hormonal component to the condition, as it occurs in women much more frequently than in men. So far, studies have not borne this out.
A number of factors can trigger IBS symptoms, including certain foods, medicines, the presence of gas or stool and emotional stress.
How is IBS diagnosed?
The diagnosis of IBS relies on the recognition of the symptoms as well as an extensive evaluation to rule out other causes for the symptoms. There are no specific laboratory tests that can be done to diagnose IBS. Therefore, your doctor may conduct some tests to rule out other conditions such as:
- Food allergies or food intolerances, such as lactose intolerance and poor dietary habits
- Medications such as high blood pressure drugs, iron and certain antacids
- Enzyme deficiencies where the pancreas isn't secreting enough enzymes to properly digest or break down food
- Inflammatory bowel diseases (IBD) like ulcerative colitis or Crohn’s disease. Faecal calprotectin testing is a testing option to help distinguish between IBD and IBS.
The clinical diagnosis of IBS can be made by your doctor after a thorough history and examination. If your symptoms and examination suggest IBS then your doctor may perform blood tests including FBC, ESR, CRP and antibody testing to exclude coeliac disease as the diagnosis. Only if you have other 'red flag' symptoms will other investigations be requested or a referral to a specialist be arranged.
How is IBS treated?
Treatment of IBS involves a collaborative effort between the doctor and the patient to manage symptoms and may consist of lifestyle changes and drug treatments.
Diet and lifestyle changes
Nearly all people with IBS can be helped, but not all treatments work for everyone. Usually, with a few basic changes in diet and activities, IBS will improve over time. Here are some steps you can discuss with your doctor which may help reduce symptoms of IBS:
- Cut down on caffeine (found in coffee, teas and fizzy drinks).
- Cut down or increase insoluble fibre in your diet (wholegrain bread, bran, cereals, nuts and most seeds) - some people find benefit from having more, or less, fibre.
- Eat regular meals and don't eat too fast, don’t skip meals or leave too long between meals.
- Drink at least eight glasses of water or fluid a day.
- Cut down on alcohol and fizzy drinks.
- Eat less starch, found in processed or re-cooked foods.
- Keep stress under control
Keep a record of the foods you eat so you can work out which foods trigger bouts of IBS.
- Antispasmodic drugs may be prescribed to control colon muscle spasms, but experts are unsure that these drugs play a significant role in treating IBS. They also have side effects, such as sedation and constipation that further limit their use.
- Anti-diarrhoeal medications, such as loperamide, may help with diarrhoea.
- Laxatives may be useful in the short-term management of constipation associated with IBS.
- Bulking agents, such as psyllium, wheat bran, and corn fibre, help slow the movement of food through the digestive system and may also help relieve symptoms.
- Antidepressants may also be prescribed to help relieve symptoms.
- Guanylate cyclase-C receptor agonists (GCCA), Linaclotide (Constella) is from this new class of drugs and was licensed in Europe in 2012 for the treatment of moderate-to-severe irritable bowel syndrome with constipation in adults.
It is important to follow the doctor's instructions when taking IBS medications.
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