Irritable Bowel Syndrome (IBS)

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Irritable bowel syndrome is a common intestinal upset that can be distressing. Dr Felix supplies all UK available treatments for IBS.


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Virginia Chachati

Reviewed by Virginia Chachati MPharm
(2013, University College London)
GPhC Registration number: 2087654

Information last reviewed 10/03/21

About

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IBS) is a common condition affecting the digestive system. It can cause symptoms such as abdominal pain, cramps, bloating, gas, diarrhoea or constipation, and mucus in the stool. While the exact cause of IBS is unknown, it is thought to be linked to diet, the sensitivity of the gut, hormones and stress.

Which foods trigger IBS?

The direct cause of IBS is unknown, but it can be triggered by certain foods in some individuals. These include spicy foods, fatty foods, chocolate, alcohol and caffeine. If you frequently have constipation, you might want to avoid:

  • Refined grains (rather than whole grains)
  • Processed foods
  • Coffee, fizzy drinks and alcohol
  • High-protein foods

If your IBS triggers frequent diarrhoea, consider cutting down on:

  • Too much fibre
  • Chocolate, alcohol, caffeine, fructose or sorbitol
  • Fizzy drinks
  • Large portions at mealtimes
  • Fried or fatty foods
  • Dairy products if you are lactose intolerant
  • Foods containing wheat if you are gluten intolerant or have coeliac disease

What causes IBS?

While the exact cause of IBS is unknown, there are factors that may contribute. The muscle wall of your intestine contracts to help move food through the digestive tract. Changes in these muscle contractions can cause symptoms of IBS. Stronger contractions can cause bloating, gas build up and diarrhoea. Weaker contractions can cause a build up of stools that become hard and dry, leading to constipation. This may be due to poor nerve signalling between the brain and the intestines. If nerves in the digestive system are oversensitive, the feeling of discomfort caused by gas or digestion may be exaggerated and the intestine may overreact, resulting in either constipation or diarrhoea. Changes in the bacterial environment in the gut can also cause IBS. This may occur after an infection, such as food poisoning, resulting in a change in the balance of bacteria in your gut.

How to deal with IBS?

If you think you might have IBS, make an appointment with your GP to discuss your symptoms. You can then rule out other conditions that have similar symptoms and discuss possible treatments. When diagnosed with IBS, it can help to be open about your condition and seek support from family and friends. Don’t be embarrassed - IBS is a common condition which many people deal with daily. Adjusting your diet and lifestyle can have a positive impact on your condition, especially if you make an effort to work out what triggers your IBS flare ups.

Symptoms

What are the symptoms of IBS?

Common symptoms of IBS include stomach pain, intestinal muscle cramps or spasms, nausea, feeling tired, bloating, constipation, diarrhoea, trapped gas, flatulence and clear or white mucous in your stools.

What are the first signs of IBS?

IBS can be difficult to identify, as everyone experiences digestive problems every once in a while. However, if you are experiencing abdominal pain, constipation, excessive gas or diarrhoea frequently, speak to a doctor to discuss your symptoms.

How is IBS diagnosed?

IBS cannot be diagnosed with a single test. Your doctor will discuss your symptoms, conduct a physical exam and ask about your family medical history. They may suggest some tests to rule out other causes of your symptoms. These tests include an X-ray, CT scan, a colonoscopy or flexible sigmoidoscopy.

Treatment

Lifestyle changes to help with IBS

There are lifestyle changes you can make to help you deal with IBS. Keeping a food and wellness diary may help you identify triggers to avoid future flare ups. Common triggers include caffeine, alcohol, spicy food and stress. Drinking plenty of water helps reduce the likelihood of constipation. Exercising regularly and maintaining a healthy, balanced diet can help reduce flare ups. You may want to try eating small meals throughout the day rather than large meals.

Dietary changes to help with IBS

Foods that trigger IBS symptoms vary between patients. Here are some dietary tips to help reduce the likelihood of triggers:

  • Keeping a food and wellbeing diary to see which foods or emotions trigger symptoms
  • Cooking homemade meals and using fresh ingredients where possible
  • Avoid delaying or skipping meals
  • Taking the time to savour your food and enjoy your meals
  • Avoid overeating spicy, fatty or processed foods
  • Try to limit yourself to three cups of coffee or tea per day or choose decaffeinated drinks
  • Avoid drinking too much alcohol or carbonated beverages
  • To relieve bloating, cramps or gas, avoid foods such as cauliflower, broccoli, brussel sprouts, beans and onions
  • To relieve diarrhoea, cut down on high-fibre foods and avoid foods containing sorbitol
  • To relieve constipation, drink plenty of water to help keep stools soft and increase your intake of fibre by eating foods like oats, pulses and potatoes

How is IBS treated?

While there is no cure for IBS, there are treatments that can help relieve your symptoms. IBS symptoms can come up randomly and these are known as flare ups. Treatments aim to help clear up symptoms within two weeks. Colofac tablets and Colofac MR capsules contain the active ingredient mebeverine, an antispasmodic, which works by relaxing the intestine’s muscle wall. This prevents irregular spasms and relieves cramps, bloating, diarrhoea and constipation. Fybogel Mebeverine dispersible sachets contain mebeverine and work in the same way, but also contain ispaghula husk which acts as a mild laxative. Alternatively, Colpermin capsules contain peppermint oil, which is an antispasmodic. If your symptoms last longer than two weeks, you should speak to your doctor for advice.

How to live with IBS?

Knowing your triggers is a good way to avoid IBS flare ups disrupting your daily routine. Similarly, making an effort to reduce stress in your life can help prevent IBS flare ups. Being open about your condition with your family and friends can help you build a support network and remove some of the stigma or embarrassment you may feel about having IBS. Finally, seeking professional advice from a doctor can help you prepare for situations when your IBS symptoms flare up. Make sure you know where the bathroom is when attending events, or check out the menu for a restaurant beforehand so you can enjoy your meal without worrying about what you will be able to eat.

Side Effects

What are the risks of IBS?

While IBS can disrupt your daily life, it can be managed by making changes to your diet and lifestyle, or with treatment after consulting your doctor. Health complications can occur, although they are not usually serious or life-threatening. If you have frequent diarrhoea, you can become dehydrated, so it is important to drink plenty of water and use rehydration sachets to replace lost salts. If IBS makes you feel constipated, stools can accumulate and harden in your colon. This can be painful and you may experience symptoms such as cramps, headache and nausea. Experiencing frequent constipation or diarrhoea can lead to haemorrhoids which may bleed and become painful. In all of these cases, you should speak to your doctor for advice.

What are the complications of IBS?

IBS is not usually dangerous but it can lead to health complications. These include dehydration from regular diarrhoea, a build up of stools that compact in the bowel from constipation, or haemorrhoids. Speak to your doctor if you are suffering from any health complications of IBS.

What is the link between IBS and depression?

The unpredictable nature of IBS can make you feel more anxious or stressed, further aggravating the condition. This is because the digestive tract is partly controlled by the nervous system that responds to stress and can result in symptoms such as pain, cramps, diarrhoea or constipation. Depression can occur if IBS symptoms cause daily disruption to your life and you feel you can’t live normally. Speak to your doctor for advice if you are worried about the effects of IBS on your quality of life.

Q&A

Is IBS stress related?

IBS is stress related because the digestive tract is partly controlled by the nervous system which responds directly to stress. Finding ways to reduce the impact of stress on your daily life can help reduce the severity of your IBS.

Are IBS and mental health related?

Evidence suggests that IBS and mental health are closely related. High levels of stress, anxiety or depression can cause more frequent or severe flare ups of IBS. The nervous system is partly responsible for controlling the digestive tract and responds to triggers, like stress, that can lead to IBS symptoms.

Does IBS run in the family?

It is thought that a family history of IBS can increase your chances of having IBS. Whether IBS is hereditary is still unknown, but shared factors in a family’s environment and genetics may influence the severity of IBS symptoms you may experience.

What else has similar symptoms to IBS?

IBS can be difficult to diagnose correctly as it shares symptoms with other medical conditions and relies heavily on a patient’s ability to describe their symptoms. Conditions that are similar to IBS include:

  • Lactose intolerance
  • Coeliac disease
  • Irritable bowel disease (IBD), including ulcerative colitis, microscopic colitis and Crohn’s disease
  • Diverticulitis
  • Stress, anxiety or depression
  • Gallstones
  • Pancreatitis

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