Irritable Bowel Syndrome - Causes, Symptoms, Diagnosis, Prevention & Treatment
Health Education

Dealing with Irritable Bowel Syndrome

Dr.Kishore V Alapati profile Authored by Dr.Kishore V Alapati on 24 Nov 2013 - 20:07.

Irritable bowel syndrome (IBS) is a common gut disorder. Symptoms can be quite variable and include abdominal pain, bloating, and sometimes bouts of diarrhoea and/or constipation. Symptoms tend to come and go. There is no cure for IBS, but symptoms can often be eased with treatment says Dr. Kishore Alapati, Surgical Gastroenterologist.

Irritable bowel syndrome (IBS) is a common functional disorder of the gut, (The gut includes the bowels) where the gut does not function normally although the structure is perfect. IBS can affect anyone at any age, but it commonly first develops in young adults and teenagers. IBS is twice as common in women as in men.

So, in IBS, the function of the gut is upset, but all parts of the gut look normal. IBS causes various symptoms (listed below). 

The cause is not clear. It may have something to do with over activity of part or parts of the gut. The gut is a long muscular tube that goes from the mouth to the anus. The small and large bowel (also called the small and large intestine) are parts of the gut inside the abdomen. Food is passed along by regular contractions (squeezes) of the muscles in the wall of the gut. Pain and other symptoms may develop if the contractions become abnormal or overactive. The area of over activity in the gut may determine whether constipation or diarrhoea develops.

The cause of over activity in parts of the gut is not clear. One or more of the following may play a part:

  • Stress or emotional upset may play a role. About half of people with IBS can relate the start of symptoms to a stressful event in their life. Symptoms tend to become worse during times of stress or anxiety.
  • Infection and bacteria in the gut. IBS is not caused by an ongoing gut infection. However, in about 1 in 6 cases, the onset of symptoms seems to follow a bout of gastroenteritis (a gut infection which can cause diarrhoea and vomiting). So, perhaps a virus or other germ may sensitise or trigger the gut in some way to cause persisting symptoms of IBS.

Also, in some cases, symptoms get worse after taking a course of antibiotics. Antibiotics kill certain harmless or good bacteria in the gut, which changes the balance of bacterial types in the gut.

What are the symptoms of irritable bowel syndrome?

  • Pain and discomfort may occur in different parts of the abdomen. The pain often eases when you pass stools (motions or faeces) or wind (air). The severity of the pain can vary from mild to severe, both from person to person, and from time to time in the same person.
  • Bloating and swelling of your abdomen may develop from time to time. You may pass more wind than usual.
  • Stools (sometimes called motions or faeces):
    • Some people have bouts of diarrhoea, and some have bouts of constipation.
    • Some people have bouts of diarrhoea that alternate with bouts of constipation.
    • Sometimes the stools become small and pellet-like. Sometimes the stools become watery or ribbony. At times, mucus may be mixed with the stools.
    • You may have a feeling of not emptying your rectum after going to the toilet.
    • Some people have urgency, which means you have to get to the toilet quickly. That is, you feel an urgent need to go to the toilet several times shortly after getting up. This is often during and after breakfast.
  • Other symptoms include: nausea (feeling sick), headache, belching, poor appetite, tiredness, back ache, muscle pains, feeling quickly full after eating, heartburn, and bladder symptoms.

Some people have occasional mild symptoms. Others have unpleasant symptoms for long periods. Some doctors group people with IBS into one of three categories:

  • Those with abdominal pain or discomfort, and the other symptoms are mainly bloating and constipation.
  • Those with abdominal pain or discomfort, and the other symptoms are mainly urgency to get to the toilet, and diarrhoea.
  • Those who alternate between constipation and diarrhoea.

Note: passing blood is not a symptom of IBS. You should tell a doctor if you pass blood.

Does it have specific tests to confirm IBS?

There is no test that confirms the diagnosis of IBS. A doctor can usually diagnose IBS from the typical symptoms.

However, a blood sample is commonly taken to do some tests to help rule out other conditions such as ulcers, colitis, coeliac disease, gut infections, etc. The symptoms of these other diseases can sometimes be confused with IBS. Tests done on the sample of blood commonly include:

  • Full blood count (CBP) - to rule out anaemia, which is associated with various gut disorders.
  • Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) - which can show if there is inflammation in the body (which does not occur with IBS).
  • Antibody testing for coeliac disease.

Endoscopy may be done only if symptoms are not typical, or if you develop symptoms of IBS in later life (over the age of about 45) when other conditions need to be ruled out.

Stress or emotional upset may play a role in the normal functioning of the gut. About half of people with IBS can relate the start of symptoms to a stressful event in their life. Symptoms tend to become worse during times of stress or anxiety. So, identifying individual stress and working on it to reduce it, can help in the proper functioning of  the digestive system, say doctors.

Foods, drinks and lifestyle

People with erratic lifestyle and have irregular food habits, normally suffer from digestive disorders. A healthy diet is important for all of us. Current national guidelines about IBS include the following points about diet, which may help to minimise symptoms of IBS:

  • Have regular meals and take time to eat at a leisurely pace.
  • Avoid missing meals or leaving long gaps between eating.
  • Drink at least eight cups of fluid per day, especially water or other non-caffeinated drinks such as herbal teas. This helps to keep the faeces (stools) soft and easy to pass along the gut.
  • Restrict tea and coffee to three cups per day (as caffeine may be a factor in some people).
  • Restrict the amount of fizzy drinks that you have to a minimum.
  • Don't drink too much alcohol. (Some people report an improvement in symptoms when they cut down from drinking a lot of alcohol, or stop smoking if they smoke.)
  • Consider limiting intake of high-fibre food (but see the section above where an increase may help in some cases).
  • Limit fresh fruit to three portions (of 80 g each) per day.
  • If you have diarrhoea, avoid sorbitol, an artificial sweetener found in sugar-free sweets (including chewing gum) and in drinks, and in some diabetic and slimming products.
  • If you have a lot of wind and bloating, consider increasing your intake of oats (for example, oat-based breakfast cereal or porridge) and linseeds (up to one tablespoon per day). You can buy linseeds from health food shops.

The foods that are most commonly reported to cause IBS symptoms are: wheat (in bread and cereals), rye, barley, dairy products, coffee (and other caffeine-rich drinks such as tea and cola), and onions.

Probiotics: are nutritional supplements that contain good bacteria. That is, bacteria that normally live in the gut and seem to be beneficial. Taking probiotics may increase the good bacteria in the gut which may help to ward off bad bacteria that may have some effect on causing IBS symptoms. You can also buy foods that contain probiotic bacteria. These include certain milk drinks, yoghurts, cheeses, frozen yoghurts, and ice creams. They may be labelled as 'probiotic', 'containing bacterial cultures', or 'containing live bacteria'.

There is some evidence that taking probiotics may help to ease symptoms in some people with IBS. At present, there are various bacteria that are used in probiotic products.

Other lifestyle factors: Regular exercise may also help to ease symptoms. Stress and other emotional factors may trigger symptoms in some people. So, anything that can reduce your level of stress or emotional upset may help say healthcare experts.

Decision Aids: Decision Aids icon

Doctors and patients can use Decision Aids together to help choose the best course of action to take. Many people are reassured that their condition is IBS, and not something more serious such as colitis. Simply understanding about IBS may help you to be less anxious about the condition, which may ease the severity of symptoms. Symptoms often settle for long periods without any treatment. If symptoms are more troublesome or frequent, one or more of the following treatment options may be advised:

Fibre

The advice about fibre in treating IBS has changed somewhat over the years. The role of fibre can be confusing. It is recommend by experts to 'adjust fibre intake according to symptoms'.

What seems to be the case is that the type of fibre is probably important. There are two main types of fibre - soluble fibre (which dissolves in water) and insoluble fibre. It is soluble fibre rather than insoluble fibre that seems to help ease symptoms in some cases. So, if you increase fibre, have more soluble fibre and try to minimise the insoluble fibre.

  • Dietary sources of soluble fibre include oats, ispaghula (psyllium), nuts and seeds, some fruit and vegetables and pectins. A fibre supplement called ispaghula powder is also available from pharmacies and health food shops. The recent review of treatments for IBS by Ford et al - mentioned earlier - mentions ispaghula as the fibre supplement that seems to be the most beneficial.
  • Insoluble fibre is chiefly found in corn (maize) bran, wheat bran and some fruit and vegetables. In particular, avoid bran as a fibre supplement.

Foods, drinks and lifestyle

A healthy diet is important for all of us. Current national guidelines about IBS include the following points about diet, which may help to minimise symptoms:

  • Have regular meals and take time to eat at a leisurely pace.
  • Avoid missing meals or leaving long gaps between eating.
  • Drink at least eight cups of fluid per day, especially water or other non-caffeinated drinks such as herbal teas. This helps to keep the faeces (stools) soft and easy to pass along the gut.
  • Restrict tea and coffee to three cups per day (as caffeine may be a factor in some people).
  • Restrict the amount of fizzy drinks that you have to a minimum.
  • Don't drink too much alcohol. (Some people report an improvement in symptoms when they cut down from drinking a lot of alcohol, or stop smoking if they smoke.)
  • Consider limiting intake of high-fibre food (but see the section above where an increase may help in some cases).
  • Limit fresh fruit to three portions (of 80 g each) per day.
  • If you have diarrhoea, avoid sorbitol, an artificial sweetener found in sugar-free sweets (including chewing gum) and in drinks, and in some diabetic and slimming products.
  • If you have a lot of wind and bloating, consider increasing your intake of oats (for example, oat-based breakfast cereal or porridge) and linseeds (up to one tablespoon per day). You can buy linseeds from health food shops.

The foods that are most commonly reported to cause IBS symptoms are: wheat (in bread and cereals), rye, barley, dairy products, coffee (and other caffeine-rich drinks such as tea and cola), and onions.

Probiotics: are nutritional supplements that contain good bacteria. That is, bacteria that normally live in the gut and seem to be beneficial. Taking probiotics may increase the good bacteria in the gut which may help to ward off bad bacteria that may have some effect on causing IBS symptoms. You can also buy foods that contain probiotic bacteria. These include certain milk drinks, yoghurts, cheeses, frozen yoghurts, and ice creams. They may be labelled as 'probiotic', 'containing bacterial cultures', or 'containing live bacteria'.

There is some evidence that taking probiotics may help to ease symptoms in some people with IBS. At present, there are various bacteria that are used in probiotic products.

Other lifestyle factors: Regular exercise may also help to ease symptoms. Stress and other emotional factors may trigger symptoms in some people. So, anything that can reduce your level of stress or emotional upset may help.

Antispasmodic medicines: These are medicines that relax the muscles in the wall of the gut. Your doctor may advise one if you have spasm-type pains. There are several types of antispasmodics. For example, mebeverine, hyoscine and peppermint oil. They work in slightly different ways. Note: pains may ease with medication but may not go away completely.

Treating constipation

Constipation is sometimes a main symptom of IBS. If so, it may help if you increase your fibre as discussed earlier (that is, with soluble fibre such as ispaghula). Sometimes laxatives are advised for short periods if increasing fibre is not enough to ease a troublesome bout of constipation.

Treating diarrhoea

An anti-diarrhoeal medicine may be useful if diarrhoea is a main symptom. Loperamide is the most commonly used anti-diarrhoeal medicine for IBS. You can buy this at pharmacies (but it is quite expensive). The dose of loperamide needed to control diarrhoea varies considerably.

Antidepressant medicines

An antidepressant medicine in the tricyclic group is sometimes used to treat IBS. In particular, it tends to work best if pain and diarrhoea are the main symptoms. Unlike antispasmodics, you need to take an antidepressant regularly rather than as required. Therefore, an antidepressant is usually only advised if you have persistent symptoms, or frequent bad flare-ups that have not been helped by other treatments.

Psychological treatments (talking treatments)

Situations such as family problems, work stress, examinations, recurring thoughts of previous abuse, etc, may trigger symptoms of IBS in some people. People with anxious personalities may find symptoms difficult to control. 

The relationship between the mind, brain, nervous impulses, and over activity of internal organs such as the gut is complex. Psychological treatments are generally mainly considered in people with moderate-to-severe IBS, when other treatments have failed.

What is the outlook (prognosis)?

“In most people with IBS, the condition tends to persist long-term. However, the severity of symptoms tends to wax and wane and you may have long spells without any symptoms, or with only mild symptoms. Treatment can often help to ease symptoms when they flare up. IBS does not shorten your expected life span, does not lead to cancer of the bowel, and does not cause blockages of the gut, or other serious conditions,” says Dr. Kishore Alapati.

Simply understanding about IBS may help you to be less anxious about the condition, which may ease the severity of symptoms. Symptoms often settle for long periods without any treatment. If symptoms are more troublesome or frequent, one or more of the following treatment options may be advised:

What seems to be the case is that the type of fibre is probably important. There are two main types of fibre - soluble fibre (which dissolves in water) and insoluble fibre. It is soluble fibre rather than insoluble fibre that seems to help ease symptoms in some cases. So, if you increase fibre, have more soluble fibre and try to minimise the insoluble fibre.

  • Dietary sources of soluble fibre include oats, ispaghula (psyllium), nuts and seeds, some fruit and vegetables and pectins. A fibre supplement called ispaghula powder is also available from pharmacies and health food shops. The recent review of treatments for IBS by Ford et al - mentioned earlier - mentions ispaghula as the fibre supplement that seems to be the most beneficial.
  • Insoluble fibre is chiefly found in corn (maize) bran, wheat bran and some fruit and vegetables. In particular, avoid bran as a fibre supplement.

Foods, drinks and lifestyle

A healthy diet is important for all of us. Current national guidelines about IBS include the following points about diet, which may help to minimise symptoms:

  • Have regular meals and take time to eat at a leisurely pace.
  • Avoid missing meals or leaving long gaps between eating.
  • Drink at least eight cups of fluid per day, especially water or other non-caffeinated drinks such as herbal teas. This helps to keep the faeces (stools) soft and easy to pass along the gut.
  • Restrict tea and coffee to three cups per day (as caffeine may be a factor in some people).
  • Restrict the amount of fizzy drinks that you have to a minimum.
  • Don't drink too much alcohol. (Some people report an improvement in symptoms when they cut down from drinking a lot of alcohol, or stop smoking if they smoke.)
  • Consider limiting intake of high-fibre food (but see the section above where an increase may help in some cases).
  • Limit fresh fruit to three portions (of 80 g each) per day.
  • If you have diarrhoea, avoid sorbitol, an artificial sweetener found in sugar-free sweets (including chewing gum) and in drinks, and in some diabetic and slimming products.
  • If you have a lot of wind and bloating, consider increasing your intake of oats (for example, oat-based breakfast cereal or porridge) and linseeds (up to one tablespoon per day). You can buy linseeds from health food shops.

The foods that are most commonly reported to cause IBS symptoms are: wheat (in bread and cereals), rye, barley, dairy products, coffee (and other caffeine-rich drinks such as tea and cola), and onions.

Probiotics: are nutritional supplements that contain good bacteria. That is, bacteria that normally live in the gut and seem to be beneficial. Taking probiotics may increase the good bacteria in the gut which may help to ward off bad bacteria that may have some effect on causing IBS symptoms. You can also buy foods that contain probiotic bacteria. These include certain milk drinks, yoghurts, cheeses, frozen yoghurts, and ice creams. They may be labelled as 'probiotic', 'containing bacterial cultures', or 'containing live bacteria'.

There is some evidence that taking probiotics may help to ease symptoms in some people with IBS. At present, there are various bacteria that are used in probiotic products.

Other lifestyle factors: Regular exercise may also help to ease symptoms. Stress and other emotional factors may trigger symptoms in some people. So, anything that can reduce your level of stress or emotional upset may help.

*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.