Irritable Bowel Syndrome (IBS)

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Irritable bowel syndrome (IBS) is a form of digestive problem. It is defined as a collection of symptoms that affect the digestive system.

IBS overview

IBS symptoms are numerous due to the size and complexity of the digestive system but can include constipation, diarrhoea. abdominal pain and excessive wind among many others.

IBS is the most common digestive disorder and 1 in 10 people will suffer from it at some point in their life1.

Although often disruptive to life, IBS is not life threatening. According to research, there are no links between IBS and other, more severe conditions (such as bowel cancer). IBS symptoms can usually be relieved with treatment. 

IBS causes

There are a number of speculated causes of IBS, although the exact cause currently remains unknown.

1)   Disrupted functioning of gut movement 

The body propels food through the digestive system via a process called peristalsis.

Peristalsis is a complex system of muscle contractions and propulsions that work to squeeze and release food rhythmically through the body.

These movements transport the food from organ to organ and are absolutely vital for the process of digestion. 
Many experts have concluded that IBS is a symptom of malfunctioning peristalsis.

Somehow messages passing between the brain and the gut have been disrupted. This means that the rhythmic muscle contractions that work to push food around are occurring either too quickly or too slowly.

Constipation is caused as a result of the movements occurring too slowly and diarrhoea is caused as a result of the movements occurring too quickly. 

2)   Extra sensitive nerves

The digestive system is controlled and monitored by signals sent to and from the brain via the autonomic nervous system. 

The autonomic nervous system carries involuntary nerve impulses from the brain to other parts of the body.

Different parts of the nervous system control different aspects of digestion. Nerve impulses send a variety of important messages to the brain, such as when we are too full, when we are hungry or when we need to use the toilet.

Many experts believe that people with IBS are extra sensitive to these nerve impulses.

The bowel often responds to stimuli with violent contractions that would usually pass unnoticed. IBS sufferers, with their extra sensitive nerves, would be more likely to feel these contractions. 

Research has shown that people who have had food poisoning or gut infections are more likely to develop IBS1.

This suggests that the changes within the gut caused by infection have somehow increased nerve sensitivity and caused IBS.

 3)   Psychological factors

Psychological factors such as trauma, stress and anxiety have been found to induce IBS.

The digestive system is heavily controlled not only by nerve impulses but also by hormones and chemicals. There are a number of hormones designed to control specific parts of the digestive system, such as the regulation and release of digestive fluids in the stomach and from the liver and pancreas.

It is thought that the hormones released during particularly stressful times can somehow interfere with the natural functioning of the digestive hormone regulators. 

People with IBS might notice that their symptoms flare up during nerve-racking situations such as public speaking.

IBS diagnosis

Because IBS is a syndrome, and not a diagnosable infection or disease, there is no standard biological procedure for ‘diagnosing’ IBS.

If an individual experiences one or more of the symptoms, they may choose to visit the GP for an assessment. The GP will take 4 steps to assess the severity of the condition:

1)   A GP will check for what are known as ‘red flag symptoms’. These include:

  • significant change in bowel function
  • unexplained weight loss
  • difficulty swallowing
  • increase in heart burn and stomach pain
  • bleeding from back passage.

2)  A GP will assess the individual’s nutritional and dietary habits. Patients may want to discuss their problems and symptoms with a nutritionist. For more information on how a nutritionist can help you, or a list of nutritionists from your area, please visit our helpful directory.  

3)  A GP will assess the individual’s physical activity levels.

4)  A GP will assess the individual’s lifestyle and psychological health.

Depending on the outcome of the assessment, a GP may request that the patient have a colonoscopy (though unlikely).

A colonoscopy tests for more serious conditions such as ulcerative colitis (a long-term condition affecting the colon). The process involves the insertion of a hose-like instrument (called an endoscope) into the bowel.

The doctor will usually take a biopsy (a small sample of flesh) for further examination in a laboratory.

If the GP believes the patient’s IBS was caused by an infection, then they are likely to request a sample of the patient’s faeces for inspection.

IBS is rarely indicative of a serious problem. The GP will simply advise IBS patients on ways in which they can reduce the symptoms.

IBS facts and statistics2

1) Most people notice their first symptoms of IBS between the ages of 15 and 40

2) 1/3 of people with IBS only suffer from diarrhea, 1/3 of people only suffer from constipation and the unfortunate remaining 1/3 suffer from a combination of both.

3) More women suffer from IBS than men.

4) 3 out of 4 people who suffer from IBS will experience a bout of depression sometime in their lives.

5) Over half of IBS suffers will develop generalized anxiety disorder (GAD), which is the prolonged and overwhelming feeling of dread, anxiety or fear

IBS symptoms

Symptoms of IBS are numerous and can vary in severity according to a number of extraneous factors. The most common symptoms include:

  • Abdominal pain- this is the most common symptom of IBS. It can feel like a dull stabbing or twisting sensation low down in the abdomen. The pain can be alleviated using a hot water bottle or lightly rubbing the area in order to help move trapped air.
    Many people find that the pain increases or decreases in severity or occurrence depending on foods eaten. 
  • Diarrhoea-1 out of 3 people with IBS will experience frequent bouts of diarrhea. Diarrhea usually goes away by itself within a few days but can often be disconcerting for the sufferer. Diarrhea can also lead to dehydration. Visit our page on diarrhea for more information on how to prevent and treat dehydration1.
  • Constipation- constipation is the passing of particularly dry or compact stools. Constipation can be very painful for the sufferer. It can cause abdominal pain and a general feeling of bloating and discomfort in day-to-day life. The large, hard stools can additionally cause tears and bleeding when passing through the anus. Visit our page on constipation for more information on the causes, symptoms and the treatments available.

Other symptoms include:

  • bloating and flatulence
  • feeling that bowels have not been entirely emptied
  • needing the toilet urgently
  • passing mucus through the back-passage
  • change in bowel movement during stressful times.

Living with IBS

IBS is not a life threatening condition. For this reason the syndrome can be misunderstood and too-readily dismissed. Many people living with IBS find they can easily deal with the symptoms and get on with their lives normally. In some other cases however, the symptoms of IBS can be debilitating and can often affect sufferers both physically and emotionally. People with serious symptoms such as unpredictable bowel movements or severe abdominal pain can struggle to function at work and will often experience a decline in emotional wellbeing.  The difficulty is that IBS is a vicious cycle when it comes to emotional wellbeing; additional stress can worsen symptoms and the symptoms themselves can cause additional stress. Emotional complications that arise when living with IBS include:

  • Depression- research shows that 3 out of 4 IBS patients will suffer from a bout of depression at some point in their lives.

The constant discomfort of constipation, abdominal pains or trapped wind can induce a feeling of despair and may prevent an individual from wanting to enjoy a social life or even go out in public. Pain itself can be very isolating. It is sometimes hard for others to understand or empathise with people experiencing pain and this may increase the sufferer’s feeling of isolation, possibly leading to depression1.

  • Anxiety- Over half of IBS suffers will develop generalized anxiety disorder (GAD), which is the prolonged and overwhelming feeling of dread, anxiety or fear. If you are suffering from anxiety and would like to discuss your problems, please feel free to visit our counselling directory1. 

Treating IBS

Improve your lifestyle

It is important for IBS sufferers to try to reduce their stress levels. An improved state of emotional wellbeing can improve symptoms of IBS. An improved lifestyle can be achieved in a number of different ways. You may wish to try: 

1. Relaxation- having a busy life with a stressful job or a family to look after can severely limit time spent relaxing. Reclining with a hot drink and a hot water bottle can soothe the physical pain of IBS because heat can relax cramping muscles. Lying down will release any tension in the joints and ease the blood flow around the body, thus relieving the physical symptoms of stress (tense shoulders etc.).

2. Exercise- physical activity releases ‘feel-good’ hormones such as adrenaline and endorphins, both of which offer a natural high. Joining a gym class or sports team is additionally a great way to meet new people and it can also offer a retreat from the source of stress itself. Exercise will also keep IBS sufferers physically healthy and reduces the possible development of high blood pressure, high cholesterol and heart disease. Choosing an activity such as yoga will incorporate both relaxation and exercise.

3. Diet- food is thought to play a role in how we feel. According to the mental health charity ‘mind’, middle-aged people who regularly eat a high quantity of processed food are more likely to suffer from depression2. There are certain chemicals in the brain that fuel human behavior and emotion. These chemicals are known as neurotransmitters (including serotonin, dopamine and acetylcholine) and are thought to be affected by the chemicals in the food we consume.
It is generally advisable to eat natural products such as vegetables, fish and meat as opposed to processed foods such as take-away, confectionary and ready-meals that can contain a high amount of additives and are often loaded with calories. You can also try eating meals at regular times throughout the day. This could help encourage regular bowel movements.

You may also try the following quick tips from Bupa:

  • Avoid sweeteners as these can induce diarrhea.
  • Drink fluid to prevent dehydration caused by constipation.
  • Avoid caffeinated drinks such as tea, coffee or energy drinks.
  • Avoid processed food as they often contain ‘resistant starch’, which the body finds hard to digest.
  • If you suffer from constipation, try the supplement ‘ispaghula’, a form of fibre.
  • Oats can cure bloating so try to eat cereals and porridge.
  • Only eat 3 portions of fruit every day. 

4. Medication- There a number of medications available for IBS, and these can be purchased over the counter at a chemist. Depending on your symptoms, you may want to consider any of the following:

  • For diarrhea- try anti-diarrhea medication such as loperamide, although it is inadvisable to take this on a regular basis- only when necessary.

  • For constipation- try bulk-forming laxatives such as ispaglaula husk, which can help constipation, as can stronger bowel-stimulating laxatives such as senna.

  • For cramps and trapped wind- try antispasmodic medicines such as meberverine hydrochloride or alverine citrate. Alternatively take peppermint oil or capsules.

  • Painkillers- it is inadvisable to take ibuprofen or aspirin because these can make symptoms worse. Instead, you may like to choose paracetamol.

If you are experiencing symptoms of IBS, it is advisable to see your GP to discuss possible treatments and medication.

How can a nutritionist help IBS?

People with IBS know that a single meal choice can completely ruin a day by inducing painful abdominal pains or inconvenient bowel problems. A nutritionist understands this relationship between food and mood. They can keep the symptoms of IBS at bay by applying their expert knowledge to the sufferer’s dietary habits. There is much conflicting data in the media regarding food and diets. A particular diet advocated one day can be condemned the next. Nutritionists understand that this can be confusing and frustrating for people experiencing symptoms of IBS and so aim to give advice based on evidence rather than speculation. With personalised meal plans tailored to individual tastes and requirements, hiring a nutritionist could greatly improve the day-to-day life of an individual suffering from IBS.

Further Help

References 

1NHS, Irritable Bowel Syndrome 2The British Journal of Psychiatry, Dietary pattern and depressive symptoms in middle age 3Bupa, Irritable Bowel Syndrome


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