Irritable Bowel Syndrome (IBS)

The main symptoms of IBS are:

• Stomach pain and/or cramps – This is usually worse after eating and better after relieving yourself on the toilet
• Bloating – Your tummy may feel uncomfortably full and swollen.
• Diarrhoea – You may have watery faeces and sometimes need to use the toilet urgently
• Constipation – You may strain when defecating and feel as though you can’t empty your bowels fully.
• Alternating diarrhoea and constipation.
• Flatulence
• Passing mucus from your anus

Although many people have only gut symptoms, people with IBS are more likely than other people to experience other disturbances of bodily function, for example:

• Tiredness
• Indigestion/ acid reflux
• Urinary frequency or urgency
• Backache and other chronic pains
• Feeling of a lump/tightness in the throat
• Sense of difficulty taking a deep or normal breath

IBS flare-ups can happen for no obvious reason. Here are a few triggers below:

• Alcohol
• Caffeine
• Certain foods i.e. spicy or fatty foods.
• Stress and anxiety

IBS is not the same as inflammatory bowel disease (IBD). Inflammatory bowel disease is a term used to describe two conditions: Ulcerative colitis and Crohn’s disease. Unlike IBS, ulcerative colitis and Crohn’s disease both involve inflammation of the gut.

If you think you have IBS you should book an appointment with your GP. Your GP can check for IBS and do some tests to rule out other problems.

You should see your GP urgently if you have:

• Lost weight for no reason
• Bleeding from your anus or have bloody diarrhoea
• A hard lump or swelling in your tummy
• First onset of IBS symptoms over 35 years of age
• Regular vomiting
• Food getting stuck in your gullet on swallowing
• Shortness of breath, noticeable heart palpitations and pale skin

These could be signs of something more serious and your GP will want to discuss them with you

Your GP will ask you some questions regarding your symptoms and how long you have had them. Your GP may also feel your tummy to check for lumps or swelling.

There are no diagnostic tests for IBS, but you might need some tests to rule out other possible causes of your symptoms. Your GP may arrange a blood test to check for problems like coeliac disease and may also ask for a sample of your stool to test for infections and Inflammatory Bowel Disease (IBD). There is no evidence that IBS leads to Inflammatory Bowel Disease or cancer.

You will not need further tests in hospital unless your GP is unsure what the problem is. In particular, you do not need a camera test of the bowel (colonoscopy) to diagnose IBS.

If your GP thinks you have IBS, they’ll talk to you about what it is and what the treatment options are. If you’re unsure about something afterwards, write down any questions you have and make another appointment to go over them.

IBS is a ‘functional illness’: it is a disorder of how your bowel functions rather than a ‘structural’ problem. This means that blood tests, scans, and camera tests of the gut (endoscopies) are all normal and there are no visible signs of inflamed or damaged gut tissue. Instead, IBS is a problem with the mechanisms which control the gut’s function and activity.

Mood, IBS and the gut– brain axis: It is very understandable that the unpleasant symptoms associated with IBS impact on our emotions. We are learning more and more about communication between the gut and the brain and think that this can play a significant role in IBS e.g. when we are anxious, our body conserves energy so that we can escape (real or imagined) danger. It does this by slowing digestion and even getting rid of things that we are yet to digest or have digested. Our bowel motility can speed up or slowdown in this process, which can lead to diarrhoea (speeding up) or constipation (slowing down). Some people feel sick or actually vomit when they are anxious. Our gut constantly communicates with the brain and lets it know what is going on in the body. It has a strong influence on the parts of our brain associated with emotions. When our gut is happy, our brain is happy, and vice versa.

It is sometimes difficult to talk about symptoms associated with IBS, but it can be helpful to share your experiences with people you trust so they have a better idea of what you are going through. People differ in how much they are able to talk about their struggles, whether these are associated with physical symptoms or emotional wellbeing. Sometimes it helps to write about how we feel. It can also be helpful to notice any links between our thoughts, feelings, behaviour and bowel symptoms, in particular, noting the effect of periods of stress and anxiety as well as more positive emotions. Recording symptoms, behaviours and mood can be helpful to see the impact of any changes we might make.

About 1 in 3 patients with IBS also have a co-existing mood problem such as anxiety and depression. Addressing these issues can significantly improve your IBS symptoms and quality of life. Your GP may ask you a few questions to help identify low mood and anxiety.

Stress: A lot of evidence points to the fact that stress (past or present) causes very real changes in the systems which control gut function. This can set up a vicious circle where stress causes unpleasant IBS symptoms, which in turn causes us difficulty fulfilling our usual duties like work or caring duties, or stops us enjoying our usual leisure activities like sports, which leads to us feeling more stressed, which leads to worse IBS symptoms etc.

You can also visit the Guts UK who have online information you may find useful, as well as TALKWORKS who offers an online workshop and provides information and advice for living with IBS.

The following interventions have scientific evidence of benefit:

• Dietary changes
• Psychological help to adjust and reduce stress responses
• Medication

Not every treatment works for every person. It is often a combination of treatments that works best and about 3 in every 4 patients with IBS feel better after adopting some or all of these measures.

There is no diet or medicine that works for everyone with IBS. But there are lots of things that can help if you’ve been diagnosed with IBS.

Here are some general tips below to help relieve IBS symptoms.

Click here to access some great IBS dietary videos.

Fibre explained

Dietary fibre supplementation can have a significant benefit on symptoms. However, not all types of fibre are the same. Fibre can be ‘soluble’ or ‘insoluble’ and the right balance of each is important.

Insoluble fibre – undergoes very little change as it passes through the bowels, bulking poo and increasing poo water content.

Soluble fibre – dissolves in water forming a gel that interacts with gut bacteria, resulting in production of chemicals which may help stimulate the bowels and play a good role in the bowel’s immune system. Soluble fibre can be found in the form of oats, so porridge is a good source, as well as linseeds, which can be bought quite cheaply from most supermarkets. However, it is also worth trying a soluble fibre supplement from your pharmacist or GP called “ispaghula”.

Remember it can take up to 6-weeks for changes in fibre to have an effect and you should change things gradually to avoid worsening bloating.

How to ease bloating, cramps and flatulence

• Eat oats regularly – for example, try porridge for breakfast
• Eat up to 1 tablespoon of linseeds a day – scatter on your food
• Try to avoid foods that are hard to digest – like cabbage, broccoli, cauliflower, Brussel sprouts, beans, onions and dried fruit
• Avoid products containing a sweetener called sorbitol
• If limiting these foods makes no difference to your symptoms, add them back in.

How to reduce diarrhoea

• Cut down on high fibre food, like wholegrain foods (such as brown bread, bran and brown rice), nuts and seeds. If limiting these foods makes no difference to your symptoms, add them back in.
• Avoid products with a sweetener called sorbitol.
• Ask a pharmacist about medicines that can help, like Imodium.

If you keep getting diarrhoea, be sure to drink plenty of water to avoid dehydration.

How to relieve constipation

• Drink plenty of water to help make your stool softer
• Increase how much soluble fibre you eat – good foods include oats, pulses, carrots, peeled potatoes and linseeds.
• You can ask your pharmacist about taking laxatives.

For more on diet you can check out the IBS Network.

Low FODMAP diet

Your GP may be able to refer you to an NHS dietician if diet tips and other changes aren’t helping. The dietician may recommend a diet called a low FODMAP diet. This involves avoiding foods that your digestive system can’t easily breakdown such as:

• Some types of fruit & vegetables
• Milk
• Some wheat products

Tips on lactose

Some patients, particularly those with diarrhoea predominant symptoms and patients whose IBS was set off by a bout of food poisoning, benefit from reducing or avoiding lactose to see if their symptoms improve. Lactose intolerance is also more common in patients with Black Asian Minority Ethnicity background.

• Lactose is the sugar contained within cow’s milk
• Often IBS patients can reduce lactose and don’t have to eliminate it from their diet completely to improve their symptoms
• Start with a 2-week trial of swapping normal milk and yoghurt with lactose free alternatives
• If your symptoms improve then try adding a little milk and yoghurt back in to see how much you can get away with. If there is no improvement, then reintroduce milk and yoghurt in your diet.
• A lactose-free diet is not the same as a dairy-free diet. A dairy-free diet aims to eliminate all products which contain cow’s milk protein. A dairy free diet is not necessary for patient with IBS.

Probiotics

• These are ‘friendly bacteria’ and other organisms which can be found in some foods and supplements. They can be found as single strains or as a mixture of several strains.
• There is no current evidence to suggest that any single or mixture of strains of bacteria is effective at treating IBS symptoms.
• It is reasonable or patients who wish to try a probiotic to take one product for up to 4 weeks, but only consider continuing if your symptoms improve. Don’t do this at the same time as making dietary changes above otherwise you won’t know what is helping and what makes you worse – just do one thing at a time. Unfortunately, these products can be expensive and are not available on the NHS.
• Two commonly used probiotics include VSL#3 and Symprove

Healthy mind

Simple strategies for reducing stress probably help IBS symptoms – relaxation is often left behind with our busy lives and you should explore different ways to relax, even if only for a short time each day. Consider diaphragmatic breathing, yoga, mindfulness, connecting with friends and family, and doing activities which are meaningful and enjoyable to you – these activities sometimes get left out by patients with troublesome IBS. It can also be helpful to exercise – however you like to do this – on a regular basis.

If you find you’ve had IBS for a long time and other treatments aren’t helping, your GP may refer you for therapy such as cognitive behavioural therapy (CBT). This can help if stress or anxiety is triggering your symptoms. It can also help you cope with your condition better. You can find out about local services in your area here.

Your pharmacist can advise on over-the-counter medicines available to help with abdominal cramps or diarrhoea.

If pharmacy medicines aren’t helping, your GP may prescribe a stronger medicine such as:

• Anti-spasmodic medication
• Anti-diarrhoeal medication
• Laxatives
• Neuromodulator medication

Neuromodulators are a group of drugs which are also used in different doses to treat low mood – however, they have been shown to be very effective in IBS as well. The one medication with the best evidence in IBS is called Amitriptyline, although several other similar medications are also effective.

Your GP may refer you to a specialist if you have severe symptoms and other medicines haven’t helped. If your symptoms remain troublesome despite treatment by your GP, please let them know.

Videos about IBS

What is irritable bowel syndrome (IBS)? | https://patient.info

Patient Platform Ltd | published on 19 February 2018

Living well with IBS | 

The IBS Network | published on 27 November 2014

Irritable Bowel Syndrome Overview | http://www.badgut.org/

GI Society | Published on 29 Oct 2015

Other online resources

• Dietary Advice from the British Association of Dieticians
• Guts Charity
• NHS IBS: IBS diet advice