Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome, or IBS as it is often called is a chronic (long term) disorder that affects the digestive system and can sometimes come and go. It is described as abdominal pain, cramping or discomfort that may be associated with opening your bowels and/or accompanied by a change in bowel habit. People with IBS can have constipation, diarrhoea or a mixture of both and many describe erratic and unpredictable bowel movements. There is no cure for IBS, but diet and lifestyle changes along with medication, can often help control the symptoms.

Around 10-20% of people in England have IBS and it is twice as common in women than in men. Most people are diagnosed with IBS in their twenties to thirties, but IBS is now being diagnosed in a lot of older people too.

Diagnosis

The word syndrome means ‘a group of symptoms which consistently occur together’ and your healthcare professional will take a detailed history of your symptoms and how they are affecting you. A diagnosis of IBS may be made if in the past six months you have experienced:

1. Abdominal pain/discomfort
2. Bloating
3. Change in bowel habit

IBS is only considered if the pain and discomfort is either relieved by a bowel movement or associated with an altered bowel frequency or stool (poo) form, plus at least two of the following symptoms:

• Altered stool (poo) passage such as straining, urgency or feelings of incomplete evacuation
• Abdominal bloating, tension or hardness
• Your symptoms are made worse by eating
• Passage of mucous in your poo

Some people also experience tiredness, nausea (feeling sick), back ache, wind, difficulty controlling their poo (incontinence) or bladder problems.

There is no formal ‘test’ that is used to diagnose IBS, but your GP may carry out some blood tests or a test on your poo, to exclude any other conditions that may be causing your symptoms.

Managing IBS Symptoms

There are a lot of self-help strategies that can help you to manage your IBS symptoms and your healthcare professional can help guide you with these.

• Dietary adjustments
• Lifestyle adjustments
• Managing stress and anxiety
• Medications

Diet:

You could try keeping a diary of your food intake and make a note of how certain foods affect your symptoms or bowel movements. The current advice from the NHS on managing IBS symptoms includes:

• Having regular meals and taking your time to eat.
• Avoid missing meals or leaving long gaps between eating.
• Drinking at least 8 cups of fluid per day, especially water or other non‑caffeinated drinks, for example herbal teas.
• Restricting tea and coffee to 3 cups per day.
• Reducing your intake of alcohol and fizzy drinks.
• It may be helpful to limit intake of high‑fibre food (such as wholemeal or high‑fibre flour and breads, cereals high in bran, and whole grains such as brown rice).
• Reducing your intake of ‘resistant starch’ (starch that resists digestion in the small intestine and reaches the colon intact), which is often found in processed or re‑cooked foods.
• Limit eating fresh fruit to 3 portions per day
• People with diarrhoea should avoid sorbitol, an artificial sweetener found in sugar‑free sweets (including chewing gum) and drinks, and in some diabetic and slimming products.
• People with wind and bloating may find it helpful to eat oats (such as oat‑based breakfast cereal or porridge) and linseeds (up to 1 tablespoon per day).
• You could try Probiotics – these can take up to 4 weeks to work

If you are struggling to identify foods that are affecting your symptoms, or are finding that you have to restrict your diet significantly, your GP may refer you to a Registered Dietician for more help.

Lifestyle Adjustments:

Keeping fit and healthy can help with your IBS symptoms. Simple exercise like walking is good for both physical and mental health. Maintaining a healthy weight can also help with your symptoms, particularly if you suffer with issues such as accidental bowel leakage (faecal incontinence).

Managing Stress and Anxiety:

Many people with IBS find that their moods affect their symptoms. It is well known that stress, anxiety and our overall mental health can have a huge impact on how our bowels work. Try to take some time each day to relax. Techniques such as mindfulness and meditation can be really helpful. If you feel your mental health is contributing to your IBS symptoms, speak with your GP who can refer you for further support such as counselling, hypnotherapy, cognitive behavioural therapy or clinical psychology. 

Medications:

Medications can help with the symptoms of IBS. There are various medications available and would be prescribed by your doctor depending on your symptoms and response to other strategies. Medications are usually used as part of a combination approach and may include:

• Antispasmodics to help with pain and cramping
• Laxatives to help with constipation
• Anti-motility medication to help with diarrhoea
• Antidepressants
• Medications to help with wind