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IBS

Irritable bowel syndrome (IBS) is a common condition of the digestive system. It can cause bouts of stomach cramps, bloating, diarrhoea and constipation.

Irritable bowel syndrome (IBS) is a common condition of the digestive system. It can cause bouts of stomach cramps, bloating, diarrhoea and constipation.

The symptoms of IBS usually appear for the first time when a person is between 20 and 30 years of age. They tend to come and go in bouts, often during times of stress or after eating certain foods.

Symptoms vary between individuals and affect some people more severely than others. However, most people have either diarrhoea, constipation, or bouts of both. You may also have mucus in your stools.

You may find the painful stomach cramps of IBS ease after going to the toilet and opening your bowels.

What causes IBS?

The exact cause of IBS is unknown, but most experts agree it's related to an increased sensitivity of the entire gut, which can occasionally be linked to a prior food-related illness.

This may be caused by a change in your body's ability to move food through your digestive system, or may be due to you becoming more sensitive to pain from your gut.

Psychological factors such as stress may also play a part in IBS.

Read more about the causes of IBS.

When to see your GP

Visit your GP if you think you have IBS. They will want to rule out other illnesses, such as an infection, coeliac disease (a digestive condition where a person has an adverse reaction to gluten) or chronic inflammation of the gut.

They will ask about your symptoms and whether there is a pattern to them for example, if they tend to come on when you are under more stress than usual or after eating certain foods. Your GP may suggest you keep a food diary to see whether your diet affects your symptoms.

Further tests will only be needed if you have certain "red flag" symptoms that indicate you may have another serious condition. These symptoms include:

  • unexplained weight loss
  • a swelling or lump in your abdomen or back passage (bottom) 
  • anaemia (a lack of red blood cells)

Read more about how IBS is diagnosed.

Treating IBS

There is no cure for IBS, but the symptoms can be managed by making changes to your diet and lifestyle.

Medication is sometimes prescribed for IBS. In many cases, being reassured by your GP can often help control IBS symptoms.

Although the symptoms of IBS can be troublesome, the condition does not pose a serious threat to your health. For example, it will not increase your chances of developing cancer or other bowel-related conditions.

IBS is unpredictable. You may go for many months without any symptoms and then have a sudden flare-up. It can also take many months for your symptoms to settle down.

IBS can be painful and debilitating, and can have a negative impact on your quality of life. However, with appropriate treatment you should be able to live a normal, full and active life.

Read more about treating IBS.

Living with IBS

The pain, discomfort and inconvenience of IBS can sometimes affect a person psychologically.

It is estimated that three out of four people with IBS will have at least one bout of depression, and just over half will develop generalised anxiety disorder (a condition that can cause overwhelming feelings of anxiety, fear and dread).

Speak to your GP if you have feelings of depression or anxiety and they are affecting your daily life.

These types of conditions rarely improve without treatment, and your GP will be able to recommend treatments such as antidepressants or cognitive behavioural therapy (CBT).

Read more about the psychological effects of IBS.

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IBS

The symptoms of IBS are usually worse after eating and tend to come and go in bouts.

The symptoms of IBS are usually worse after eating and tend to come and go in bouts.

Most people have a flare-up of symptoms that lasts two to four days. After this time, the symptoms usually improve but do not disappear completely.

The most common symptoms of IBS are:

  • abdominal pain and cramping - often relieved by emptying your bowels
  • a change in your bowel habits - such as diarrhoeaconstipation, or sometimes both
  • bloating and swelling of your abdomen
  • excessive wind (flatulence)
  • an urgent need to go to the toilet
  • a feeling that you need to open your bowels even if you have just been to the toilet
  • a feeling you have not fully emptied your bowels
  • passing mucus from your bottom 

Due to the embarrassment, pain and discomfort of IBS, many people with the condition also have feelings of depression and anxiety.

Bowel symptoms

There are three main patterns of bowel symptoms in IBS. They are:

  • IBS with diarrhoea - when you have repeated bouts of diarrhoea
  • IBS with constipation - when you have repeated bouts of constipation
  • IBS mixed - when you have repeated bouts of diarrhoea and constipation

These patterns are not set in stone. You can switch from one to another and go for long periods with few or no symptoms at all.

Find out about the foods and drinks that can trigger the symptoms of IBS.

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IBS

The exact cause of irritable bowel syndrome (IBS) is unknown, but most experts agree that it is related to an increased sensitivity of the entire gut.

The exact cause of irritable bowel syndrome (IBS) is unknown, but most experts agree it is related to an increased sensitivity of the entire gut.

This can be caused by:

  • a change in your body's ability to move food through your digestive system
  • becoming more sensitive to pain from your gut 
  • psychological factors
  • an episode of food poisoning

Digestion process

Your body usually moves food through your digestive system by squeezing and relaxing the muscles of the intestines in a rhythmic way.

However, in IBS it is thought this process is altered, resulting in food moving through your digestive system either too quickly or too slowly. Either way, there will be discomfort within the abdomen.

If food moves through your digestive system too quickly, you will have diarrhoea because your digestive system does not have enough time to absorb water from the food.

If food moves through your digestive system too slowly, you will have constipation because too much water is absorbed, making your stools hard and difficult to pass.

It may be that food does not pass through the digestive systems of people with IBS properly because the signals that travel back and forth from the brain to the gut, controlling the nerves, are disrupted in some way.

An increase in levels of a chemical called 5-hydroxytryptamine (5-HT), which can occur after eating certain foods or during times of stress, is also thought to affect the normal functioning of the gut.

Increased sensitivity

Many sensations in the body come from your digestive system. For example, nerves in your digestive system relay signals to your brain to let you know if you are hungry or full, or if you need to go to the toilet.

Some experts think that people with IBS may be oversensitive to the digestive nerve signals. This means mild indigestion that is barely noticeable in most people becomes distressing abdominal pain in those with IBS.

Psychological factors

There is a fair amount of evidence to suggest psychological factors play an important role in IBS.

However, this does not mean that IBS is "all in the mind", because symptoms are very real. Intense emotional states such as stress and anxiety can trigger chemical changes that interfere with the normal workings of the digestive system.

This does not just happen in people with IBS. Many people who have never had IBS before can have a sudden change in bowel habits when faced with a stressful situation, such as an important exam or job interview.

It has also been discovered that many people with IBS have experienced a traumatic event, usually during their childhood, such as abuse, neglect, a serious childhood illness or bereavement.

It is possible that these types of difficult experiences in your past may make you more sensitive to stress and the symptoms of pain and discomfort.

IBS triggers

Certain foods and drinks can trigger the symptoms of IBS. Triggers vary from person to person, but the most common ones include:

  • alcohol 
  • fizzy drinks
  • chocolate
  • drinks that contain caffeine, such as tea, coffee or cola
  • processed snacks, such as crisps and biscuits
  • fatty food
  • fried food

Keeping a food diary may be a useful way of identifying possible triggers in your diet.

Stress is another common trigger of IBS symptoms. Therefore, finding ways to manage stressful situations is an important part of treating IBS.

Read more about treating IBS.

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IBS

There are no specific tests for IBS, as it does not cause any obvious detectable abnormalities in your digestive system.

There are no specific tests for IBS, as it does not cause any obvious detectable abnormalities in your digestive system.

If you have the symptoms of IBS, your GP will not always need to order blood tests to help diagnose you.

However, in a few cases they may recommend blood tests to rule out other conditions that cause similar symptoms, such as an infection or coeliac disease (a stomach condition caused by gluten intolerance).

IBS is usually diagnosed by carrying out a physical examination and checking whether your symptoms match those typical of the condition.

Your GP will suspect you have IBS if one of the following criteria applies to you.

  • you have abdominal pain or bloating that is relieved when you pass a stool
  • you have abdominal pain or bloating associated with episodes of diarrhoea or constipation
  • you are passing stools more frequently than normal

If you have at least two of the following symptoms, a diagnosis of IBS will be confirmed:

  • a change in how you pass stools, such as needing to strain, feeling a sense of urgency or feeling you have not emptied your bowels properly
  • bloating, hardness or tension in your abdomen
  • your symptoms get worse after eating
  • you pass mucus from your back passage

Further tests

Further tests are usually only needed when you have certain "red flag" symptoms that indicate you may have another serious condition. These symptoms include:

  • unexplained weight loss
  • a swelling or lump in your abdomen or back passage
  • bleeding from your back passage
  • anaemia (a lack of red blood cells)

Further testing may also be recommended if you have a family history of bowel cancer or ovarian cancer, or if you are over 60 years of age and you have had a change in your bowel habits that has lasted for more than six weeks.

Tests you may have include:

  • sigmoidoscopy  where a sigmoidoscope (a thin, flexible tube with a small camera and light at one end) is used to examine your back passage and the lower section of your bowel
  • colonoscopy  where a device similar to a sigmoidoscope, called a colonoscope, is used to examine your entire bowel
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IBS

The symptoms of irritable bowel syndrome (IBS) can often be reduced by changing your diet and lifestyle. Medication or psychological treatments may also be helpful.

The symptoms of irritable bowel syndrome (IBS) can often be reduced by changing your diet and lifestyle, and understanding the nature of the condition.

In some cases, medication or psychological treatments may also be helpful.

IBS-friendly diet

Changing your diet will play an important part in controlling your symptoms of IBS. However, there is no "one size fits all" diet for people with IBS. The diet that will work best for you will depend on your symptoms and how you react to different foods.

It may be helpful to keep a food diary and record whether certain foods make your symptoms better or worse. You can then avoid foods that trigger your symptoms. But it is important to remember these foods do not need to be avoided for life.

Fibre

People with IBS are often advised to modify the amount of fibre in their diet. There are two main types of fibre:

  • soluble fibre  which the body can digest
  • insoluble fibre  which the body cannot digest

Foods that contain soluble fibre include:

  • oats
  • barley
  • rye
  • fruit, such as bananas and apples
  • root vegetables, such as carrots and potatoes
  • golden linseeds

Foods that contain insoluble fibre include:

  • wholegrain bread
  • bran
  • cereals
  • nuts and seeds (except golden linseeds)

If you have IBS with diarrhoea, you may find it helps to cut down on the insoluble fibre you eat. It may also help to avoid the skin, pith and pips from fruit and vegetables.

If you have IBS with constipation, increasing the amount of soluble fibre in your diet and the amount of water you drink can help.

Your GP will be able to advise you what your recommended fibre intake should be.

The National Institute for Health and Clinical Excellence (NICE) provides more detailed advice about IBS and diet (PDF, 39kb).

Eating tips

Your IBS symptoms may improve by following the advice below:

  • have regular meals and take your time when eating
  • avoid missing meals or leaving long gaps between eating
  • drink at least eight cups of fluid a day, particularly water and other non-caffeinated drinks such as herbal tea
  • restrict your tea and coffee intake to a maximum of three cups a day
  • lower the amount of alcohol and fizzy drinks you drink
  • reduce your intake of resistant starch, starch that resists digestion in the small intestine and reaches the large intestine intact  it is often found in processed or re-cooked foods
  • limit fresh fruit to three portions a day a suitable portion would be half a grapefruit or an apple
  • if you have diarrhoea, avoid sorbitol, an artificial sweetener found in sugar-free sweets, including chewing gum and drinks, and in some diabetic and slimming products
  • if you have wind and bloating, consider stopping all cereals for six weeks or increasing your intake of linseeds (up to one tablespoon a day)

Avoid exclusion diets (where you do not eat a certain food groups, such as dairy products or red meat) unless you are being supervised by a professional dietitian.

Exercise

Most people find exercise helps relieve the symptoms of IBS. Your GP will be able to advise you about the type of exercise that is suitable for you.

Aim to do a minimum of 30 minutes vigorous exercise a day, at least three times a week. The exercise should be strenuous enough to increase your heart and breathing rates. Brisk walking and walking uphill are both examples of vigorous exercise.

Read more about the benefits of exercise and the different types of fitness activities you can try.

Probiotics

Probiotics are dietary supplements that product manufacturers claim can help improve digestive health. They contain so-called "friendly bacteria" that supposedly destroy "bad bacteria", helping to keep your gut and digestive system healthy.

Some people find taking probiotics regularly helps relieve the symptoms of IBS. However, there is no scientific evidence to prove that probiotics work and have beneficial health effects.

If you decide to try probiotics, make sure you follow the manufacturer's instructions and recommendations regarding dosage.

Reducing stress

Reducing the amount of stress in your life may help lower the frequency and severity of your IBS symptoms. Some ways to help relieve stress include:

  • relaxation techniques, such as meditation or breathing exercises
  • physical activities, such as yogapilates or tai chi  (where deep breathing and relaxation is combined with slow and gentle movements)
  • regular exercise, such as walkingrunning or swimming

If you are particularly stressed, you may benefit from a talking therapy, such as stress counselling or cognitive behavioural therapy (CBT).

Read more about how to manage stress.

Medication

A number of different medications are used to help treat IBS, including:

  • antispasmodic medicines (antispasmodics)  which help reduce abdominal pain and cramping
  • laxatives  used to treat the symptoms of constipation
  • antimotility medicines  used to treat the symptoms of diarrhoea
  • antidepressants  originally designed to treat depression, but can also help reduce abdominal pain and cramping

These medications are discussed in more detail below. 

Antispasmodic medicines

Antispasmodics work by helping relax the muscles in your digestive system. Examples of antispasmodic medicines include mebeverine and therapeutic peppermint oil.

Side effects associated with antispasmodics are rare. However, people taking peppermint oil may have occasional heartburn and irritation on the skin around their anus (bottom).

Antispasmodics are not recommended for pregnant women.

Laxatives

Bulk-forming laxatives are usually recommended for people with IBS-related constipation. They make your stools denser and softer, which means they are easier to pass.

It is important you drink plenty of fluids while using a bulk-forming laxative. This will help prevent the laxative from causing an obstruction in your digestive system.

Start on a low dose and then, if necessary, increase it every few days until one or two soft stools are produced every one or two days. Do not take a bulk-forming laxative just before you go to bed.

Side effects associated with taking laxatives can include bloating and wind. However, if you increase your dose gradually, you should have few, if any, side effects.

Antimotility medicines

The antimotility medicine loperamide is usually recommended for IBS-related diarrhoea.

Loperamide works by slowing contractions of muscles in the bowel, which slows down the speed at which food passes through your digestive system. This allows more time for your stools to harden and solidify.

Side effects of loperamide include:

  • abdominal cramps and bloating
  • dizziness
  • drowsiness
  • skin rashes

Loperamide is not recommended for pregnant women.

Antidepressants

Two types of antidepressants are used to treat IBS tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).

TCAs are usually recommended when antispasmodic medicines have not been able to control the symptoms of pain and cramping. They work by relaxing the muscles in your digestive system.

However, TCAs will only provide relief after three to four weeks, as your body starts to get used to the medication. They should be taken consistently.

Possible side effects of TCAs include:

  • dry mouth
  • constipation
  • blurred vision
  • drowsiness

These side effects should improve within a few days of starting the medication. Tell your GP if the side effects become a problem  they may prescribe another type of antidepressant.

Amitriptyline is the most widely used TCA.

Selective serotonin reuptake inhibitors (SSRIs) are an alternative antidepressant. Examples of SSRIs that are used to treat IBS include:

Common side effects of SSRIs include blurred vision, diarrhoea or constipation and dizziness.

Read more about selective serotonin reuptake inhibitors (SSRIs).

Psychological treatments

If your IBS symptoms are still causing problems after 12 months of treatment, your GP may refer you for a type of therapy known as a psychological intervention.

There are several different types of psychological therapy. They all work by teaching you techniques to help you control your condition better. The availability of psychological interventions on the NHS may vary from region to region.

Hypnotherapy

Hypnotherapy has been shown to help some people with IBS reduce their symptoms of pain and discomfort.

Hypnosis is used to change your unconscious mind's attitude towards your symptoms.

You can have hypnotherapy as an outpatient in some NHS hospital pain clinics, or you can learn self-hypnosis techniques to do at home.

Psychodynamic interpersonal therapy (PIT)

Psychodynamic interpersonal therapy (PIT) is a type of talking treatment that has had some success in helping people with IBS.

It is a form of psychotherapy based on the principle that your unconscious thoughts, beliefs and attitudes can influence how you think, act and feel.

Your therapist will help you to explore how your past might have unconsciously affected you. They will also help you to confront unhelpful beliefs, attitudes and behaviours in order to try to change them.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is another type of talking treatment that can help with IBS.

CBT is based on the principle that the way you feel depends partly on the way you think.

Studies have shown that if you train yourself to react differently to IBS by using relaxation techniques and staying positive, you should see a decrease in your pain levels.

CBT may also help you to cope better with stress, anxiety and depression.

Complementary therapies

Some people claim therapies such as acupuncture and reflexology can help people with IBS. However, there is no medical evidence to suggest they are effective and they are not recommended.

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IBS

As irritable bowel syndrome (IBS) is not life-threatening, people who do not understand the condition are sometimes quick to trivialise it.

As irritable bowel syndrome (IBS) is not life-threatening, people who do not understand the condition are sometimes quick to trivialise it.

However, the symptoms of IBS often have a significant impact on a person's day-to-day life. The pain, discomfort and inconvenience of IBS is very real and can have a deep psychological effect.

For example, it is estimated that three out of four people with IBS will have at least one episode of depression, and just over half will develop generalised anxiety disorder (GAD). This is a long-term condition that can cause feelings of unease, worry or fear.

You should visit your GP if you are feeling anxious or depressed. These conditions rarely improve without treatment and they could make your IBS symptoms worse.

Your GP will be able to recommend an effective treatment programme for you, such as antidepressants or cognitive behavioural therapy (CBT), or a combination of the two.

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IBS

After having irritable bowel syndrome (IBS) for more than 20 years, Ansar Ahmed Ullah is learning to live with the condition.

After having IBS for more than 20 years, Ansar Ahmed Ullah is learning to live with the condition.

"I think my IBS came from too many curries!" says Ansar Ahmed Ullah. He first came to London in the early 1980s. Living in shared accommodation, he relied on spicy takeaways for his main meal in the evening. "We'd also go to the community centre at lunchtime, where they served curry and rice," he remembers.

In the mid-1980s, Ansar started to suffer from frequent constipation, bloating, occasional diarrhoea and stomach pain. On one occasion, the pain was so bad that he was rushed to hospital. "I was there for a week," he remembers. "The doctors gave me all kinds of tests. They thought I might have a stomach ulcer, but they didn't find anything."

Eventually, Ansar spoke to his GP, who diagnosed IBS. He was prescribed painkillers and a muscle relaxant drug to ease his constipation. Unfortunately, neither drug was effective. Ansar decided to try to treat himself.

He joined the IBS Network to learn about his condition. He had several food allergy tests and discovered that he was sensitive to wheat, spicy food and dairy products.

"Luckily, I'm still able to eat chicken and fish," he says. "Avoiding dairy and wheat is very difficult. I love milk in my tea. I've never been able to stand the taste of soya, and I love bread and biscuits. I've found the wheat-free ranges at the supermarkets very helpful, though."

Ansar says he's tried every IBS remedy on the market. "I've more or less resigned myself to the fact that I'm not going to be cured of IBS," he says. "But it can be very difficult.

"The mornings are the worst. When I was employed, I was constantly late because I had to spend so long in the toilet with constipation. There's not a lot of awareness of IBS, particularly among young people, so it's hard for people to understand what you're going through."

Ansar says IBS also affects his relationship with his partner. "She does sometimes get annoyed when she needs to go somewhere in a hurry and I'm still in the toilet. It's also very awkward when you're out and about and you need to use a loo suddenly or for a long period of time. The IBS is in the back of my mind all the time. I have to consider it when I go anywhere or do anything."

However, Ansar tries not to let his IBS get him down. "I do my best to stick to my wheat-free diet and I make sure I eat plenty of fruit. I've found that really helps the constipation. I'm also planning to take more exercise. I already go to Pilates classes and I've got a bike, which I should really use more! I think I'm learning to live with my IBS."

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IBS

Geoff Lyon, 57, has had severe IBS since early childhood. He tells us his story.

Geoff Lyon, 57, has had severe IBS since early childhood. He tells us his story.

"It all started when I was about eight years old. I was getting a lot of unexplained diarrhoea and feeling sick. I couldn't go anywhere without wanting to go to the toilet. My parents didn't understand what was wrong with me.

"As I grew up, it didn't get any better. I was still suffering diarrhoea and nausea, as well as constipation, headaches and feeling tired all the time. Sometimes it would wake me up at night and I'd sit for a couple of hours on the toilet sweating, with a severe cramping pain in my gut. I wouldn't be able to go, then suddenly I'd have a gush of diarrhoea. I would be exhausted the next day.

"It wasn't until 1980, when I was 29, that I was referred to hospital to have a barium enema (when the colon is filled with a liquid that shows up on X-ray) and a blood test. They couldn't find anything seriously wrong and eventually diagnosed irritable bowel syndrome (IBS). I was relieved to finally have a diagnosis.

"I was given an antispasmodic drug to take two to three times a day, which slows the contractions in your gut. I now control my IBS with codeine phosphate, an antidiarrhoeal drug.

"Not only has the treatment helped, but also cutting dairy products from my diet. About nine years ago my doctor suggested I try a non-dairy diet. It seems to help. I've always loved milk and cream, so it was difficult switching from them to soya products, but it's worth it. One Christmas I gave in and had some cream trifle. Within half an hour I was on the toilet, which proves it isn't good for me.

"At the moment I still get attacks quite frequently, but they're not as bad and I'm more in control of them. I know when I'm going to have an attack, as I become really lethargic and my stomach distends the night before, like I'm six months pregnant.

"I've noticed that if I'm stressed, my IBS kicks in a couple of days later, so I try to relax and remove any stress from my life.

"I run a self-help group for the IBS Network, which I'd recommend joining. You get lots of factsheets and a 'Can't Wait Card' that you can show to hotels or shops if you desperately need to use their toilet facilities."

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