Irritable Bowel Syndrome (IBS)

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Irritable bowel syndrome is a common intestinal upset, affecting up to 20% of the adult population. It’s not a medical problem, but it can be distressing. Dr Felix supplies all UK available treatments for IBS.


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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, sensitivity of the gut, hormones and stress.

Which foods trigger IBS?

The direct cause of IBS in unknown, but some foods are thought to trigger bouts of the condition in some individuals. Trigger foods different between patients, but often include spicy foods, fatty foods, chocolate, alcohol and caffeine. If you frequent constipation, you may wish to try avoiding:

  • Refined grains (rather than whole grains)
  • Processed foods
  • Coffee, carbonated beverages and alcohol
  • High-protein foods
  • Dairy products

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

  • Excessive fibre. Try eating no more than 3 portions of fresh fruit per day
  • Chocolate, alcohol, caffeine, fructose or sorbitol
  • Carbonated beverages
  • Large portions at mealtimes
  • Fried or fatty foods
  • Dairy products, particularly if you are lactose intolerant
  • Foods containing wheat, particularly if you are gluten intolerant or coliac

What causes IBS?

While the exact cause of IBS is unknown, there are several factors which are thought to contribute. The muscle wall of the intestines are responsible for moving food through the digestive tract, and changes in muscle contractions can cause the symptoms of IBS. Stronger contractions can cause boating, gas and diarrhoea, while weaker contractions can cause a build up stools that become hard, dry and difficult to shift. One suggestion is that this is due to poor coordination in the signals between the brain and the intestines. If the nerves in the digestive system are oversensitive, the feeling of discomfort caused by gas or digestion is disproportionate 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 a bout of infection, such as diarrhoea, resulting in a change of gut activity.

How to deal with IBS

If you think you might have IBS it is worth making an appointment with your GP to discuss your symptoms. This way, you can 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 day to day. Adjusting your diet and lifestyle can have a positive impact on your condition, especially if you make an effort to work out what triggers flare ups and make adjustments to your routine accordingly.


What are the symptoms of IBS?

Common symptoms of IBS include bloating, constipation and/or diarrhoea, excessive or trapped gas, and clear or white mucus in the stool.

What are the first signs of IBS?

IBS can be difficult to identify, as everyone experiences digestive problems once in a while. However, if you are experiencing abdominal pain, constipation, excessive gas or diarrhoea frequently, it is worth consulting a doctor to discuss whether IBS treatment could help you.

How is IBS diagnosed?

IBS cannot be diagnosed with a straightforward test. Your doctor will want to ask you about your symptoms, conduct a physical exam and ask about your family medical history. They may also suggest some tests to rule out other, more serious causes of your symptoms, such as an X-ray or CT scan, a colonoscopy or a flexible sigmoidoscopy. 


Lifestyle changes to help with IBS

There are a few lifestyle changes you can make to help you deal with IBS. Identifying your triggers can help you to avoid bouts of symptoms, and keeping a food diary may help with this. Common triggers include dairy products, caffeine, alcohol and spicy food, as well as stress and anxiety. Drinking plenty of water helps with healthy digestion, as does exercising,  eating fibre-rich foods and generally maintaining a healthy and balanced diet. You may wish to try eating smaller meals more regularly to relieve stress on your digestive system.

Dietary changes to help with IBS

Trigger foods of IBS differ between patients. Some general dietary tips for dealing with IBS include:

  • Keep a diary of food which trigger symptoms and try to avoid them
  • Cook homemade meals and use fresh ingredients where possible
  • Try eating probiotics, such as yoghurt and kefir, to promote a healthy bacterial environment in the gut
  • Don’t delay or skip meals
  • Don’t rush your food
  • Avoid eating too much spicy, fatty or processed foods
  • Limit your intake of fresh fruit to 3 portions per day
  • Do not drink more than 3 cups of coffee or tea per day
  • Avoid drinking too much alcohol or carbonated beverages
  • To relieve bloating, cramps or gas, try increasing your intake of oats and linseed, and avoiding foods which are difficult to digest, such as cauliflower, broccoli, brussel sprouts, beans, onions, and foods containing sorbitol
  • To relieve diarrhoea, cut down on high-fibre foods, nuts and seeds and avoid products containing sorbitol
  • To relieve constipation, drink plenty of water to help keep stools soft, increase your intake of fibre by eating foods like oats, pulses, potatoes and linseeds and carrots.

How is IBS treated?

While there is no cure for IBS, treatments are available which can help relieve your symptoms. IBS usually presents symptoms in sporadic bouts, known as flare ups, and treatment is usually taken in the event of a flare up with the aim of clearing symptoms within 2 weeks. Colofac tablets contains the active ingredient mebeverine, an antispasmodic which works by relaxing the muscle wall of the intestine, preventing irregular spasms and relieving cramps, bloating, diarrhoea and constipation. Fybogel Mebeverine dispersible sachets contain the same active ingredient 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 a natural antispasmodic. For best results, each of these treatments should be taken between 30 and 60 minutes before a meal, no more than 3 times a day, in the event of an IBS flare up. If symptoms persist for longer than 2 weeks, you should consult your doctor for advice. For one-off cases of constipation or diarrhoea, an over-the-counter treatment may be sufficient for you. Laxatives containing Senna or Bisacodyl usually relieve constipation overnight, while imodium is a good option for relieving diarrhoea.

How to live with IBS

Though IBS is not dangerous or life-threatening, IBS can be annoying to live with and can interrupt your daily life. Knowing your triggers is the best way to avoid bouts of symptoms, helping you to modify your diet to avoid disruption to your routine. Similarly, making an effort to reduce stress in your life can help make flare ups of IBS less regular, as well as helping you to deal calmly with them when they do occur. Being open about your condition is important, removing some of the stigma and embarrassment that surrounds many gastrointestinal issues, as is getting help and support both from close friends and professionals. Finally, being prepared for all situations will help you feel better about continuing your routine during a flare up of symptoms. Make sure you know where the bathroom is when attending events, or check out the menu for a restaurant beforehand so you can relax during a meal out without worrying about what you will be able to eat.

Side Effects

What are the risks of IBS?

While IBS can be annoying, it is not usually dangerous and can be managed by making changes to your diet and lifestyle, or with treatment following a consultation with a doctor. Further health complications can occur, although they are not usually serious or life-threatening. If you have frequent diarrhoea, you can become dehydrated as your body is losing too much water and salt, so it is important to drink plenty of water. Your doctor may also recommend drinking sports drinks, which help boost your levels of vital salts and electrolytes and can quickly rehydrate you. If your IBS leaves you constipated for a long period of time, stool can become compacted in your colon and become painful, causing symptoms such as headache, nausea and vomiting. If this affects you, contact your doctor for advice. Furthermore, experiencing frequent constipation, diarrhoea, or both can lead to hemorrhoids which may bleed and become painful.

What are the complications of IBS?

IBS is not usually dangerous, but can have some minor health complications. These include dehydration from regular diarrhoea, a compacted bowel from constipation, or hemorrhoids around the anus. Speak to your doctor if you are suffering from health complications of IBS. 

What is the link between IBS and depression?

Often, people who suffer from IBS are also sufferers of anxiety or depression. This is because the intestinal tract is partly controlled by the nervous system, which responds to stress, and is therefore influenced by stress and worry. In addition, IBS can cause you to feel more anxious or stressed, further aggravating the condition.


Is IBS stress related?

IBS is related to stress because the intestinal tract is in part controlled by the nervous system, which responds directly to stress. Finding ways to reduce the impact of stress in 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 flare ups of IBS to become more regular and/or more severe, because the nervous system is in part responsible for control of the intestinal tract.

Does IBS run in the family?

It is thought that having a family history of IBS is a factor in its occurence. Whether the condition is hereditary is still unclear, but shared factors in a family’s environment and genetics may play a role.

What else has similar symptoms to IBS?

IBS can be hard to diagnose correctly as it shares symptoms with other medical conditions and relies heavily on a patient’s ability to describe their symptoms. Conditions which may be confused with 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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