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Irritable bowel syndrome (IBS)

Published by Bupa's health information team, December 2007.

This factsheet is for people with irritable bowel syndrome, or who would like information about it.

Irritable bowel syndrome (IBS) is a long-term condition that causes re-occurring pain or discomfort in the abdomen (tummy) and an altered bowel habit. IBS can develop at any age, but most people have their first symptoms between the ages of 15 and 40. Women are more likely to get IBS and to have more severe symptoms.

• About irritable bowel syndrome
• Symptoms
• Causes
• Diagnosis
• Treatment
• Further information
• Questions and answers
• Related topics
• Sources

About irritable bowel syndrome

IBS is now one of the most common problems of the digestive system: about one in six people in the UK have occasional symptoms. It causes pain in the abdomen and an altered bowel habit.

Symptoms

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. Most people with IBS continue to get symptoms from time to time. The symptoms include the following.

Pain

The most common symptom of IBS is pain or discomfort in the abdomen. The pain may be mild to severe, and may be made either better or worse by opening the bowels, passing wind or eating.

Pain may occur at a particular time of day, often in the evening. Women may find the ups and downs of pain relates to their menstrual cycle.

Change in bowel habits

With IBS, your faeces may vary in consistency from hard and pellet-like to loose and watery. Alternatively, you may just pass small amounts of mucus. You may find that your bowel habit alternates between constipation and diarrhoea. Afterwards, you may feel that your bowels haven't been completely emptied.

IBS usually causes one symptom more than the others - either pain, constipation or chronic diarrhoea.

Other symptoms

These include a bloated abdomen, passing excess wind, feeling sick and indigestion. Some people also experience a sense of fullness.

These symptoms may be caused by problems other than IBS. You should visit your GP for advice.

Causes

The exact cause of IBS isn't known. It's probably a combination of different factors, including more frequent or stronger squeezing (contractions) of the muscular walls of your bowel, increased sensitivity to the amount of gas in your bowel, and your genetic make-up. Psychological factors also have a role in triggering the symptoms.

Your symptoms may be worse after you have eaten or if you are under stress. Stress may result from work anxieties, relationship difficulties or life events such as divorce or bereavement. Specific foods such as tea or coffee or fatty foods may trigger the symptoms. Antibiotics and non-steroidal anti-inflammatory medicines (eg ibuprofen and diclofenac) can also make symptoms worse.

Diagnosis

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

To make a diagnosis, your doctor will ask you about your pain, when it comes on and what makes it better or worse. He or she may also ask about your bowel movements, with questions about how often you open your bowels and what your faeces look like. Your doctor may also ask you to have some blood tests.

If you have typical IBS symptoms and are under 50, you probably won't need further tests. However, if you have unusual symptoms, such as losing weight or passing blood in your faeces, you may need other tests.

Your doctor may refer you to the hospital for further tests if you have a family history of bowel problems, are over 50 and have recently developed IBS for the first time, or if you have the diarrhoea-only type of IBS. This is because all of these can be linked to more serious underlying bowel conditions.

Your doctor may use an endoscope, a flexible, tube-like instrument, to look inside your bowel. This is called a sigmoidoscopy or colonoscopy, depending on the part of your bowel that your doctor needs to look at.

During these tests, a biopsy can be taken. This involves removing a small piece of tissue from the bowel lining for examination in a laboratory. This test helps to rule out more serious conditions such as ulcerative colitis.

Other tests

If your doctor thinks that your IBS is caused by an infection, you will be asked to give a sample of your faeces. This will be sent to a laboratory for tests.

You may also need an X-ray of your abdomen such as a barium enema. In this test, a liquid containing a small amount of barium is passed through a tube into your back passage where it enters the large intestine. The barium allows inflamed or ulcerated areas of the colon to show up clearly in X-ray images.

Treatment

Although there is no simple cure for IBS, there are treatments that can help reduce the symptoms.

Self-help

For most people with IBS, a healthy lifestyle is the best way to improve symptoms. This can include the following.

• If your main symptom is diarrhoea, you should try not to have tea, coffee, alcohol, spicy food and the artificial sweetener sorbitol, as these can increase your symptoms.
• If you have constipation, you should try gradually introducing more fibre-rich foods, such as bran, fruit and vegetables, into your diet.
• If bloating or wind is a problem, cutting out gas-producing foods, such as beans and green vegetables (eg cabbage and broccoli), may help.
• Some people find that certain foods regularly bring on symptoms, but this isn't always easy to discover. It's best not to miss out one food after another from your diet to see if it's causing your symptoms, as you may not be getting all the nutrients you need in your diet. Advice from a dietitian can be useful.
• If stress triggers your IBS, learning stress management or relaxation techniques may be useful. You may also find keeping a diary to compare your symptoms with life events helpful. If certain events are identified as triggers, it may be easier to deal with the stress of them.
• Taking regular exercise helps to keep your bowel movements regular and reduce stress.
• If you need to use painkillers, paracetamol is less likely than ibuprofen or aspirin to make your IBS worse.

If self-help treatments aren't working, see your doctor for advice. He or she can also help you identify factors that are making your IBS worse, and offer suggestions about changes you could consider making.

Medicines

Over-the-counter medicines

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

• Anti-diarrhoea medicines, such as loperamide (eg Imodium) may help but you should only take them as you need them, not on a regular basis.
• Laxatives, such as bran or ispaghula husk (eg Fybogel), can be helpful. These are bulk-forming laxatives. However, some people find that bran makes their symptoms worse. Lactulose is an alternative to bulk-forming agents. It increases the amount of water absorbed in your large bowel but can cause wind. If you need to use the stronger, bowel-stimulating form of laxatives, such as senna, you should get advice from your doctor before using them routinely.
• Antispasmodic medicines, such as mebeverine hydrochloride (eg Colofac) and peppermint oil capsules, may help with pain and wind.
• Probiotic are harmless bacteria that are sometimes contained in yoghurts. There is some scientific evidence that certain strains can be helpful for IBS symptoms, but this isn't conclusive.

Prescription medicines

Your doctor may also prescribe medicines for IBS. These include prescription-only versions of the medicines mentioned above. Low-dose antidepressants have been shown to be helpful, even if you are not depressed.

Because psychological factors such as stress can trigger IBS, talking treatments such as cognitive behavioural therapy or psychotherapy can be helpful for IBS symptoms, especially for people who have personal difficulties to deal with. Your doctor can refer you to a suitable therapist.

Further information

• Core (working name of the Digestive Disorders Foundation)
  020 7486 0341
  www.corecharity.org.uk

Related topics

• Anti-depressants
• Colonoscopy
• Cognitive behavioural therapy
• Healthy eating
• Laxatives
• Physical activity
• Stress
• Stress at work

Sources

• Dyspepsia - symptoms. NHS Library for Health. Clinical Knowledge Summaries
  www.cks.library.nhs.uk
  accessed 9 August 2007
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2006: 460-469
• Horowitz B, Fisher R. Current concepts: Irritable bowel syndrome. N Engl J Med 2001; 349: 2316
• Agrawal A, Whorwell PJ. 2006. Irritable bowel syndrome: diagnosis and management. BMJ 2006; 332: 280
• Mertz HR. Drug therapy: Irritable bowel syndrome. N Engl J Med 2003; 349: 2136

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: December 2007