IBS (irritable bowel syndrome)

About irritable bowel syndrome

IBS is one of the most common problems of the digestive system – about two in 10 people in the UK have IBS and it’s twice as common in women than men.

IBS can develop at any age, but most people have their first symptoms between the ages of 20 and 35.

Symptoms of irritable bowel syndrome

Most people with IBS find their symptoms an occasional nuisance but don't need to see a doctor. However, for some people, the condition seriously affects their quality of life. If you find it difficult to cope with your symptoms, see your GP.

Symptoms of IBS include the following.

  • Pain or discomfort in your abdomen is the most common symptom of IBS and it’s often in your lower abdomen on the left-hand side. You may also get stomach cramps. The pain may be mild or severe and may ease if you open your bowels. It can often get worse if you eat. You may feel pain at a particular time of day, often in the evening. Women often find the pain relates to their menstrual cycle.
  • A change in bowel habit is another common symptom. Your faeces may vary in consistency and may alternate between constipation and diarrhoea. Alternatively, you may just pass small amounts of mucus. At times, you may feel an urgent need to open your bowels or this may feel strained. Afterwards, you may feel that your bowels haven't been completely emptied.
  • Your abdomen may feel bloated and may look swollen. This is more common in women.

These symptoms may come and go – you may not have any symptoms for months and then have a sudden flare-up.

Other symptoms you may get if you have IBS include:

  • feeling sick
  • indigestion
  • a headache
  • backache
  • tiredness
  • problems with your bladder, such as needing to urinate more frequently
  • problems with your sex life, such as pain during or after having sex, or a lack of interest in sex
  • anxiety
  • depression

These symptoms may be caused by problems other than IBS. If you have any of these symptoms, see your GP for advice.

Causes of irritable bowel syndrome

The exact reasons why you may develop IBS aren’t fully understood at present. It may be a combination of:

  • more frequent or stronger squeezing (contractions) of the muscles in the wall of your bowel – this can happen if the signals that travel from your brain to your gut when food passes through your digestive system are disrupted in some way
  • increased sensitivity to pain from inside your bowel
  • inflammation of your bowel, for example an infection such as gastroenteritis
  • your genetic make-up – you may inherit IBS

You may find that psychological factors, such as stress, may trigger your symptoms. Your symptoms may also get worse after eating certain foods, for example fatty foods.

Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (eg Nurofen) and diclofenac (eg Voltarol), can also make your symptoms worse.

Diagnosis of irritable bowel syndrome

Your GP will ask about your symptoms and examine you. He or she will also ask about your medical history.

Your GP will ask you about your pain, when it comes on and what makes it better or worse. He or she will also ask about your bowel movements, such as how often you open your bowels, how easy it is to go, what your faeces look like and if it has blood or mucus in it. There is no single test to confirm IBS therefore your GP may ask you to have some further tests, such as blood tests, to rule out other conditions.

If you have typical IBS symptoms, it's unlikely you will need further tests. However, your GP may refer you for further tests if your symptoms may be linked to more serious bowel conditions. These symptoms may include:

  • weight loss
  • blood or mucus in your faeces
  • bowel problems that first develop after age 50
  • a family history of bowel problems
  • diarrhoea that lasts longer than six weeks
  • anaemia

If your GP thinks that your IBS may be caused by an infection, you will be asked to give a sample of your faeces – also called a stool sample. This will be sent to a laboratory for testing.

Treatment of irritable bowel syndrome

Although there is no cure for IBS, there are treatments that can help to improve your symptoms. These include making changes to your lifestyle, taking medicines and psychological treatments. With the help of your GP, you can decide which is best for you.

Self-help

For most people with IBS, making some lifestyle changes is the best way to improve your symptoms.

Diet advice

The following general advice about your diet may help.

  • Eat regular meals.
  • Drink enough fluids but try to limit caffeinated drinks, such as tea and coffee, to a maximum of three cups a day and also limit alcoholic and fizzy drinks.
  • Cut down on foods that are rich in insoluble fibre, such as wholemeal bread, wholegrain rice and cereals that contain bran when your symptoms get worse.
  • Eat no more than three portions of fruit a day.
  • Limit processed foods. These may contain 'resistant starch' that is difficult for your body to digest.
  • If you have diarrhoea, cut out artificial sweeteners such as sorbitol. This is used in some sugar-free sweets, drinks and diet products.
  • If you feel bloated, try eating oats, which are found in some cereals and porridge, and a tablespoon of linseeds each day.

You may find it helpful to keep a food diary for two to four weeks to see if certain foods cause your symptoms. Always speak to your GP before changing your diet as advice may differ depending on your symptoms. If certain foods still seem to bring on your symptoms after trying this diet advice, it may help to see a dietitian.

Lifestyle advice

Regular exercise is a good way to help reduce your symptoms. It helps keep your bowel movements regular and reduces stress. Aim to do a minimum of 30 minutes of moderate exercise a day, at least five times a week.

If your symptoms are noticeably triggered by stress, try learning stress management or relaxation techniques.

If these self-help treatments don't work, see your GP for advice. He or she can help you identify factors that may be making your IBS worse, and suggest other treatments.

Medicines

There are several over-the-counter medicines available from your pharmacist that can relieve some of your symptoms of IBS.

  • Antidiarrhoea medicines, such as loperamide (eg Imodium), may help. However, only take them as and when you need them and not on a regular basis.
  • Laxatives, such as ispaghula husk (eg Fybogel), can help if you have constipation. These are bulk-forming laxatives. Stronger laxatives called bowel-stimulating laxatives, such as senna, may also help. However, if you find you need to take them quite often it’s important to speak to your GP.
  • Antispasmodic medicines, such as mebeverine hydrochloride (eg Colofac), alverine citrate and peppermint oil capsules, may help with stomach cramps and wind. Again speak to your GP if you find you need to use these often.
  • Probiotics contain helpful bacteria and yeasts and are contained in some yoghurts. There is some evidence that certain strains can be helpful for IBS symptoms, but this isn't conclusive. See our frequently asked questions for more information.
  • If you need pain relief, you can take over-the-counter painkillers such as paracetamol. Don’t take ibuprofen (eg Nurofen) or aspirin as they may make your symptoms worse.

Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Your GP may prescribe you medicines for IBS. These include prescription-only versions of the medicines mentioned above. Your GP may also prescribe you a low-dose antidepressant as this can reduce the pain of IBS, even if you're not depressed.

Talking therapies

If your symptoms don't improve after a year of treatment, your GP may consider referring you for psychological treatment.

Talking treatments, such as cognitive behavioural therapy (CBT), hypnotherapy or psychotherapy can help relieve the symptoms of IBS. These are often useful for people who have personal difficulties to deal with. Your GP can refer you to a suitable therapist.

What are probiotics and how can they help with symptoms of irritable bowel syndrome?

Answer

Probiotics are a food supplement. They contain live bacteria and yeasts that can be helpful in restoring the balance of bacteria in your gut. Some people with irritable bowel syndrome (IBS) find them helpful in controlling their symptoms.

Explanation

Probiotics are food supplements that contain live bacteria and yeasts. People often think of bacteria as harmful but there are many good bacteria that live in and on your body that help keep you healthy. This is especially so in your gut. Good bacteria in your gastrointestinal tract may prevent harmful organisms from growing in your bowel or entering your body through your intestine. Some people think that taking probiotics helps to keep the amounts of ‘good bacteria’ in your gut even and keep it working efficiently.

You can buy probiotics as food supplements (capsules or tablets) from your pharmacist or health food shops. Always read the patient information leaflet that comes with your supplements and follow the recommended dosage. You can also buy probiotics as yogurts or drinks (eg Danone, Activa or Actimel).

Research into the effectiveness of probiotics in treating IBS has produced conflicting results. Some studies have found that they do help relieve symptoms of IBS, whereas others have found that they don't. Take probiotics for a trial period of four weeks to see if they help with your symptoms. If they make no difference to your symptoms after this time, either stop taking them or try a different brand. There is no evidence that they can do any harm.

If you have any questions or concerns about probiotics or IBS, talk to your GP.

I've heard that a bout of food poisoning can cause irritable bowel syndrome. Is this true?

Answer

Yes, after a bout of food poisoning (gastroenteritis) there is a risk of developing IBS, particularly if it’s caused by certain bacteria.

Explanation

Gastroenteritis is inflammation of your stomach and intestines, which is caused by an infection. In the UK, about two in 10 people get gastroenteritis each year.

There are several different types of infection that cause gastroenteritis, for example viruses, bacteria or parasites. It's thought that bacterial gastroenteritis, in particular, puts you at risk of developing IBS. The most common cause of bacterial gastroenteritis is food poisoning, specifically:

  • salmonella – often from dairy, eggs and poultry
  • campylobacter – often from dairy, meats and poultry
  • bacillus – from reheated rice
  • vibrio – often from seafood
  • Escherichia coli (E. coli) – often from minced beef

Around two in 10 people have symptoms of IBS for the first time after having gastroenteritis.

If you have any question or concerns about IBS or gastroenteritis, talk to your GP.

Are there any complementary medicines I can try to help with my irritable bowel syndrome symptoms?

Answer

Complementary medicines aren't recommended to treat symptoms of IBS.

Explanation

Some research has suggested that complementary therapies, such as relaxation techniques, biofeedback and herbal medicines, may be helpful in controlling symptoms. However, the evidence is limited and more research is needed to be certain of their effectiveness, although the same could be said of many approaches to the treatment of IBS.

If you have any questions or concerns about complementary therapies and IBS, talk to your GP.

My son has irritable bowel syndrome and it interferes with his school life. What can I do to help him?

Answer

Children with IBS do sometimes find that their symptoms can interfere with school. However, by keeping your child's teachers informed about his or her condition and how it affects them, you may be able to keep this disruption to a minimum.

Explanation

Having a child with IBS can be difficult, especially if his or her symptoms are bad enough to interfere with school. However, there are things you can do as a parent to make things easier for your child.

It's important to let your child's school know about their condition, and to make sure this information filters down to the teachers. This will make it easier for your child to leave classes in a hurry if he or she needs to do so without drawing unnecessary attention. Also, it will help if the school nurse is aware of the situation so your child can get medicines (if needed) without having to explain every time and feel embarrassed.

Some children may need to take time off school if their symptoms are particularly bad. If this happens, it's useful to set up a system whereby your child can receive school work on a regular basis to do at home. This will stop him or her falling behind and make their return to the classroom easier.

It's also important to ensure that during your child's time away from school, he or she maintains contact with friends. This will help to keep some normality in your child's life and may help take their mind off the symptoms.

If you have any questions or concerns about your child's IBS, talk to your GP.

What is the difference between irritable bowel syndrome and inflammatory bowel disease?

Answer

IBS is a different condition to inflammatory bowel disease but some of the symptoms are similar. Inflammatory bowel disease is usually more serious than IBS and the treatment is often different.

Explanation

Inflammatory bowel disease is an umbrella term for conditions that cause inflammation in the bowel – it most often refers to Crohn’s disease and ulcerative colitis.

Crohn's disease is inflammation of your digestive pathway. It can affect any part of your digestive system, from your mouth down through your stomach and bowel to your anus. However, it's most common in your small bowel or the first part of your large bowel.

In ulcerative colitis, the lining of your large bowel and back passage (rectum) becomes inflamed and develops ulcers. This means that your large bowel can't absorb as much water as usual and it leads to diarrhoea.

Common symptoms of IBS include:

  • pain or discomfort in your abdomen (tummy)
  • a change in bowel habit – your bowel movements may alternate between constipation and diarrhoea or you may just pass small amounts of mucus
  • a bloated abdomen

If you have inflammatory bowel disease, you may also have diarrhoea and a painful abdomen so sometimes it’s confusing to know which condition you have. However, if you have inflammatory bowel disease you will also have other symptoms, including:

  • weight loss
  • a fever
  • bleeding from your rectum (back passage)
  • tears, ulcers or abscesses (pus-filled areas) around your anus

If you have ulcerative colitis or Crohn’s disease you’re at greater risk of getting IBS. It’s therefore possible that you can have both inflammatory bowel disease and IBS. It’s thought this is because the inflammation that happens in inflammatory bowel disease causes short-term damage to nerve endings in your intestine. It may be, for example, that you have an attack of inflammatory bowel disease followed by IBS symptoms, such as bloating.