What is Irritable Bowel Syndrome?
IBS is a long-term disorder of the gut that causes recurrent abdominal pain along with changes in bowel habits, such as diarrhoea, constipation, or both. With IBS, there are symptoms but no visible damage to the digestive tract.
Symptoms of IBS
The most common symptoms are abdominal pain, often related to bowel movements, and a change in how often you go to the toilet or what your stool looks like. Many people also experience bloating.
Other IBS Experiences
Some people feel like they have not fully emptied their bowels, or notice mucus in the stool. Symptoms can come and go over time, and some people notice flares during stressful periods or around menstrual periods.
Diagnosing IBS
Doctors usually diagnose IBS based on your symptoms, medical history, and a physical examination. In many cases, extra tests are only used to rule out other conditions.
- Medical History
Your doctor will ask about your symptom pattern, how long symptoms have been present, your diet, medicines, recent infections, stress around symptom onset, and any family history of conditions such as celiac disease, colon cancer, or inflammatory bowel disease. - Physical Examination
A physical exam may include checking for bloating, listening to the abdomen, and checking for tenderness or pain. - Investigative Testing
Many people do not need extensive testing. When needed, doctors may use blood tests, stool tests, or tests such as a breath test, endoscopy, or colonoscopy to rule out other causes of symptoms.
Possible Causes of IBS
The exact cause of IBS is not fully known. Experts think it may involve problems with brain-gut interaction, changes in how quickly food moves through the gut, increased gut sensitivity, past infections, changes in gut bacteria, food sensitivities, genetics, and sometimes anxiety, depression, or earlier life stress.
Management of IBS
IBS is usually managed with a combination of diet and lifestyle changes, medications, and sometimes probiotics or mental health therapies. Treatment is individual, and it may take time to find what works best.
Dietary and Lifestyle Modifications
Helpful steps may include eating regular meals, not skipping meals, drinking enough water, reducing caffeine, alcohol, and fizzy drinks, and increasing physical activity. Some people also benefit from a low FODMAP diet or other diet changes recommended by their doctor or dietitian.
Fibre
Fibre can help some people with IBS, but the type of fibre matters. Insoluble fibre such as bran can make symptoms worse, while soluble fibre such as oats or ispaghula is often better tolerated.
Stress
Stress does not necessarily cause IBS on its own, but it can make symptoms worse for many people. Stress management, relaxation training, cognitive behavioural therapy, or gut-directed hypnotherapy may help some patients.
Physiotherapy
Some patients, especially those with bowel urgency, difficulty with bowel control, or problems emptying the bowels, may benefit from pelvic health physiotherapy. This can include exercises and training to improve pelvic floor and sphincter muscle control.
Medications
Medicines are chosen based on symptoms. They may include treatments for diarrhoea, constipation, or abdominal cramping and pain, such as laxatives, antispasmodics, or other prescription medicines.
Antibiotics
For some patients with IBS with diarrhoea, a doctor may prescribe rifaximin, an antibiotic that can help in selected cases. This is not needed for everyone with IBS
Probiotics
Some doctors may suggest trying probiotics. Research is still ongoing, so they may help some people more than others, and it is best to use them with guidance from your doctor.