Irritable bowel syndrome (IBS)
Irritable bowel syndrome (IBS) is a common, long-term condition affecting the functioning of the digestive system. It can cause abdominal discomfort, bloating and a change in bowel habit (constipation and/or diarrhoea).
It's a condition that has no specific cause and, whilst there are many treatment options available, there is no one single effective treatment - what works for one person may not necessarily work for you. Symptoms may change over time and can last from a couple of days to a few months at a time, depending on how they are managed.
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Who gets IBS?
Research suggests that IBS affects up to one in five people in the UK at some stage of their life. It is twice as common in women, and usually first develops when a person is between 20 and 30 years of age. But, as with many conditions, there isn’t a rule of thumb - there are many reasons why it may occur, and you could develop the condition at any stage in life.
Although IBS is typically a lifelong condition, the condition may persist on and off throughout life, often depending on what is happening in a person’s life. It is also possible that the condition may improve over time, with changes in diet and lifestyle behaviours.
Symptoms of IBS
The symptoms vary between individuals and affect some people more severely than others. In some people, the symptoms seem to be triggered by something they have had to eat or drink, stressful periods, or food poisoning. You may find some of the symptoms of IBS ease after going to the toilet and opening your bowels.
Flare-ups of symptoms can last a few days, but, after this time, symptoms will usually improve. Whilst symptoms can come and go in episodes, they may not disappear completely.
The most common symptoms of IBS include:
- Abdominal (stomach) pain or discomfort. This pain typically occurs on the left-hand side of your lower abdomen. This pain can get worse after eating and may ease after using the toilet.
- A change in bowel habits - this can alternate from constipation to diarrhoea. The consistency of your faeces may also vary, and you might pass limited amounts of mucus.
- Experiencing an urgent need to go to the toilet. Or, after the movement, your bowels might not feel entirely empty.
- Your abdomen may feel and look bloated.
- Gastrointestinal problems can also be a side effect of some medications. In some cases, you may not experience any symptoms for months then all of a sudden they flare up.
- excessive wind (flatulence)
- feeling sick
- bladder problems
- painful sex
While some people with IBS may experience a number of these problems, symptoms may not be directly linked to irritable bowel syndrome. If you are experiencing any of them, you should book an appointment with your GP.
The symptoms of IBS can have a psychological impact on a person, as a result of the impact on day-to-day life. As a result, you may experience other symptoms such as anxiety and depression. If you think this might be the case, it is important to seek help; your mental health is just as important as your physical health. Your GP will be able to supply you with advice to manage your depression or anxiety.
What causes IBS
While the causes of IBS are unknown, many experts believe it to be related to digestive problems and increased gut sensitivity.
According to the IBS Network, while there is no known cause for irritable bowel syndrome, common risk factors include:
- gastroenteritis (vomiting and diarrhoea)
- experiencing traumatic or upsetting event
- certain courses of antibiotics
Problems with digestion
To move food through our digestive systems, our body will move with rhythm, squeezing and relaxing the intestines to promote movement. In someone with IBS however, it is thought that this process is different. The food is either passed through the gut too quickly, or too slowly.
When food passes through the gut too quickly, the digestive system can’t keep up. If it doesn’t have enough time to absorb the water from the food, it can result in diarrhoea. If food is moving through the digestive system too slowly, however, the body absorbs too much water. Your stools become hard and difficult to pass, resulting in constipation.
A common belief is that people with IBS experience problems with digestion because the signals going from brain to gut are being disrupted.
The digestive system is responsible for many different sensations in the body. For example, it’s your digestive system sending signals to your brain if you are hungry, full, or need the toilet. Some experts believe people with IBS are overly sensitive to these signals. So, for example, where mild indigestion is barely noticeable in some people, for those with IBS, this can become an intense, distressing pain.
There is evidence to suggest that certain lifestyle habits and psychological factors play a role in IBS, such as experiencing a traumatic event during childhood, such as abuse, illness or bereavement, or when under stress.
This doesn’t mean that IBS is a condition of the mind however, and the physical symptoms are very real. Heightened emotions, such as stress or anxiety can trigger chemical change in the body, which can interfere with the regular functionality of the bowels.
Even if you don’t have IBS, you can still show the effects of this chemical change. You may have experienced a sudden change in bowel habits when under stress, such as sitting an important exam or a presentation at work.
It’s possible that difficult experiences in childhood have made you more sensitive to stress, and so symptoms can flare up when under pressure or in a traumatic situation.
Diet and digestive health go hand in hand, and certain foods are thought to trigger symptoms of IBS. While this isn’t the case for everyone, common dietary triggers include:
- fizzy drinks
- alcoholic drinks
- processed snacks, such as biscuits, crisps and cakes
- caffeinated drinks, such as tea and coffee
- fatty foods
Learn more about the effects of diet and IBS, and how a nutrition professional can help.
Unlike some medical conditions that have specific tests in order to make a diagnosis, this isn’t the case with IBS. This is because the condition doesn’t cause any easily detectable abnormalities in your digestive system. Everyone is affected by the condition differently, to varying severities.
For this reason, the most important thing you can do is to share with your doctor a clear description of the symptoms you have experienced. In most cases, your GP will consider assessing you for IBS if you have been experiencing any of the typical symptoms of IBS for at least six months.
One method for diagnosis that GPs use is known as the ‘Rome criteria’ - a classification system used for all functional gastrointestinal disorders, including IBS. This criteria means that a diagnosis will be considered if you have had abdominal pain or discomfort for at least one day per week in the last three months (on average). This is in addition to two or more of the following other symptoms:
- Experiencing relief by passing stools.
- Needing to go to the toilet frequently.
- Noticing a change in the consistency of your stools.
To help with a diagnosis, it might be helpful to record a note of your symptoms in a diary. This will help to highlight the frequency of your symptoms and to note any patterns. You can use this for reference when consulting your GP.
Ruling other conditions out
Many cases of IBS can be diagnosed in this way, based on your symptoms alone. However, sometimes further tests may be needed to check for other possible causes or conditions. For example, you may have blood tests to rule out other conditions with similar symptoms, such as an infection or coeliac disease. Depending on what you are being tested for, it may also be necessary to take a sample of your stools.
Red flag symptoms
Further tests will be carried out if you present any of the following ‘red flag’ symptoms, as these could indicate you have a more serious condition:
- unexplained weight-loss
- bleeding from your rectum
- a lump or swelling in your back passage or stomach
You may also need further tests if you:
- have a family history of ovarian or bowel cancer
- are over 60 and have had a change in bowel habits that have lasted over six weeks.
In such cases, your doctor may recommend a colonoscopy. This can check for abnormalities in your gut.
The process of getting a diagnosis might be uncomfortable, but it is nothing to be embarrassed about. This is the first step towards getting you the right treatment, to help ease your symptoms.
Diet and IBS
Symptoms of IBS are often managed through dietary and lifestyle changes. Understanding what is triggering your IBS can help you know the best methods you can take to manage symptoms. In some cases, medication and/or psychological treatments are recommended.
Certain foods and habits are thought to trigger symptoms, such as alcohol and fizzy drinks, and smoking. If you’re experiencing symptoms of IBS, your first port of call should be your doctor. If no underlying health issues are found, they may refer you for nutritional support. A nutrition professional can work with you to understand what may be triggering your symptoms and guide you through any required lifestyle changes.
There is no ‘one size fits all’ approach when it comes to diet and IBS, so keeping a food diary can be beneficial. The diet that works for one person, may not work for you, so knowing how you react to different foods can help control symptoms. If one food makes symptoms worse, write it down. If a certain food appears to ease symptoms, add it to the list.
Once you have a list of potential trigger foods, you and the nutrition professional can begin devising an IBS diet plan, tailored to you and your symptoms.
Fibre can play a big part in managing symptoms of IBS. Therefore, a professional may suggest you adjust the amount of fibre in your diet.
There are two types of fibre, insoluble and soluble. Insoluble fibre cannot be digested by the body (doesn’t dissolve in water), while soluble fibre (dissolves in water) can. If you’re suffering from constipation, for example, drinking more water and increasing the amount of soluble fibre in your diet can help.
Foods containing soluble fibre include:
- golden linseeds
- root vegetables
Foods containing insoluble fibre include:
- whole grain bread
- nuts and seeds.
Low FODMAP diet
If you experience frequent or persistent bloating, your nutritionist may suggest the low FODMAP diet, thought to be effective in managing symptoms of IBS.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are types of carbohydrates that are difficult for the gut to absorb and digest, meaning they ferment quickly while in the large intestine. This fermentation process causes gases to be released, resulting in painful bloating.
Typically, a low FODMAP diet involves restricting your intake of certain foods high in FODMAPS, including some fruits, vegetables, wheat products and dairy. Because of this, if you are considering a low FODMAP diet, it is advised you seek the support of a qualified professional. Without support, this diet can be very difficult to follow and in some cases, can lead to more digestive problems or nutritional deficiencies. A qualified dietitian can ensure your diet is healthy and balanced, while monitoring your symptoms and supporting you in the journey.
Why contact a nutrition professional?
When living with IBS, a single meal choice can completely ruin your day, with uncomfortable abdominal pain, or inconvenient bowel problems. A nutrition professional understands this and knows how important the relationship between diet and health is. By applying their expert knowledge and assessing your dietary habits and symptoms, they can help you manage the condition safely.
A nutrition professional can carry out full nutrition assessments to establish any potential diet or lifestyle triggers. This can then be used to devise an appropriate plan, tailored to you and your symptoms. Remember, it’s important you visit your GP before making any dietary changes to rule out any other conditions.
Find a nutrition professional near you.
The symptoms of IBS can have a huge impact on a person’s life. But, with careful adjustments to your diet and a few key lifestyle changes, symptoms can be minimised and easily managed.
If you suffer from IBS, it is important to learn as much as you can about the condition from your GP or a nutrition professional. They can teach you about the best ways for you to reduce your individual symptoms. In addition to specific advice, there are some more general ways to reduce the impact of symptoms on your lifestyle, such as changing your relationship with food, and making more time for relaxation and exercise.
Be more mindful with food
Food forms a huge part of our lives - we need it to survive. But, wider than that, food and drink form a large part of our lifestyles, too. Not only do we plan our days around meal times, but food often features as part of our social lives - such as eating out with friends and family.
While it can be hard to refrain from eating your favourite foods, if they are foods that cause a flare-up of IBS symptoms, it is recommended to avoid them as much as possible - to limit your discomfort. Of course, sometimes, foods that cause a flare up of symptoms either can’t be avoided, or you may actively choose to eat them. When faced with this decision it’s important to weigh up the balance of whether eating the food will be worth the symptoms you experience afterwards. Be aware of the symptoms you are likely to experience and where you will be - for instance, if you’ll be in the comfort of home.
There are some common adjustments you can make to your diet, such as:
- Restricting your coffee and tea intake to a maximum of two a day.
- Drinking alcohol within the recommended amounts (your individual tolerance may vary).
- Staying hydrated as this can help relieve constipation.
In addition to these, try to enjoy a varied diet made of wholesome, fresh foods, at regular intervals throughout the day. Ensuring you get enough fibre and nutrients could help to encourage regular bowel movements, and limit the impact that IBS has on your lifestyle.
As well as being mindful and conscious of your diet, it is also important to try to reduce your stress levels; an improved state of emotional well-being can improve your IBS symptoms. This can be achieved in a number of different ways.
Having a busy life, with a stressful job or a family to look after can limit the time you have to spend relaxing. But, did you know that stress and anxiety may be factors that are causing, or aggravating your IBS symptoms? There are many complex connections between the brain and the gut, so stress management can be effective in easing your symptoms.
Make the most of your leisure time and create time for relaxation. You could try:
- Hot non-caffeinated drinks, or a hot water bottle. This can soothe the physical pain of IBS as the heat can relax cramping muscles.
- Lying down can release tension in the joints and ease blood flow around the body.
- Ensure you get enough sleep.
- Relaxation therapies such as mindfulness or meditation.
Moving our bodies and making time for regular physical activity is so good for us, both in body and mind. We experience the release of ‘feel-good’ hormones such as adrenaline and endorphins, both of which offer a natural high. Joining a sports team or gym class can be great ways to meet new people and can also offer a retreat from the source of stress itself. Particularly if you choose an activity such as yoga, which incorporates both relaxation and exercise.
But, more than this, regular exercise can help to keep your digestive system moving, and this can be particularly helpful if constipation is one of your symptoms. In addition, exercise will keep you physically healthy and reduce the possible development of high cholesterol, high blood pressure, and heart disease.
If you don’t enjoy exercise, you could try combining it with something you do enjoy, such as spending time with friends or listening to music. If your symptoms make you hesitant to exercise in public, try exercising at home.
Remember, there is no one way to alleviate symptoms. This can be a lifelong journey, so keep an open mind and try to adapt your lifestyle as much as you can to limit your symptoms and improve your well-being in general.
While symptoms of IBS can often be managed by a change in diet and lifestyle habits, some people may benefit from further treatment.
If you’re stressed, exhausted or under pressure, your body will feel the effects. Emotional tension can make IBS worse and many people with IBS discover that their bowels act as an ‘emotional barometer’. It can give an idea of how well, or not well, you’re coping with what’s going on in your life.
Of course, if stress is triggering your IBS or making symptoms worse, it’s important you address it. This may mean speaking to your GP or a professional, like a counsellor. Lack of sleep, poor diet and anger can all put strain on your body, so it’s important you understand what is triggering your symptoms, and work to overcome them.
There are a number of different medications used to help manage symptoms of IBS. Though it is important to note that while a medicine can manage one symptom, it can make another worse. While most of the following medications can be bought over-counter, it is important you consult your doctor before taking any treatment.
- Laxatives, prescribed to relieve constipation.
- Antispasmodics, which help to reduce stomach cramping and pain.
- Antimotility medicines, prescribed to relieve diarrhoea.
If you are still experiencing symptoms after 12 months of treatment, you may be referred for psychological therapy. There are several types that may be suggested for people with IBS, all of which aim to teach you techniques to help you manage the condition. Treatments may include:
- cognitive behavioural therapy (CBT)
Hypnotherapy is a recognised as an IBS treatment by the National Institute for Health and Care Excellence (NICE). Learn more about hypnotherapy for IBS.
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