Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder describing a group of symptoms including abdominal pain and discomfort, and changes in the pattern of bowel movements without any evidence of underlying damage to the gut.
These symptoms are often present for months or years, and it is thought that 10-20% of the population suffer, but up to half of patients do not seek medical advice despite impacting daily life.
There is no gold standard definition of IBS, but pain and/or changes in bowel movements are likely at least 3 days per month, for 6 months or more. Women and younger adults under 30 are more likely to suffer, and there is some genetic tendency for IBS to run in families. Co-morbid conditions such as chronic fatigue syndrome, back or pelvic pain, headaches, anxiety, and depression are common, but IBS is distinct from IBD – Inflammatory Bowel Disease, where there is damage to bowel, and you may be given and IBS diagnosis once IBD has been ruled out.
Common symptoms
Pain and Cramping - Abdominal pain is the most common symptom, usually in the lower abdomen and typically decreases following a bowel movement or passage of wind. Bloating and general discomfort are common, nausea and loss of appetite may also be present.
Diarrhoea - One of the most common symptoms of IBS is diarrhoea. Accelerated bowel transit in IBS can also result in a sudden, immediate urge to have a bowel movement.
Constipation - IBS can also cause constipation as well as diarrhoea. Constipation-predominant IBS is the most common type, affecting 50% of people with IBS. Constipation in IBS includes abdominal pain that eases with bowel movements.
Alternating Constipation and Diarrhoea - Mixed or alternating constipation and diarrhoea affects about 20% of patients with IBS.
Medications
Typical medications dispensed to help symptoms include antispasmodics to relieve abdominal pain or discomfort, particularly if the symptoms occur soon after eating. Anti-diarrheal agents can be effective in preventing and relieving symptoms, but may not be as helpful for the pain. Laxatives can help treat symptoms of constipation but not necessarily the pain, and should be used under medical supervision. Anti-anxiety medications can be helpful for some people with IBS, particularly those with psychological distress.
Food and Lifestyle
Sugar, sweeteners, refined and processed foods, a lack of natural fibre and inadequate hydration may contribute to symptoms. Regular exercise can also improve transit time, thereby reducing bloating, flatulence, and pain.
Insoluble fibre found for example in grains, nuts, potatoes, and cauliflower provides bulk and helps speed up the rate of intestinal transit, thereby helping to ensure regular bowel movements and the avoidance of constipation. However, a gradual change to the diet is essential, introducing foods which are easier to digest and in small portions.
Soluble fibre is often easier on the gut and good sources include fruit, vegetables, pulses and oats. Introducing these foods, cooked initially, may increase tolerance and support motility. A gradual increase in both variety and quantity of fibrous foods is recommended.
Chewing our food thoroughly, slowing down our mealtimes, and a 12 hour overnight fast may also support healthy digestion. Keeping a food diary to understand potential trigger foods, but also stress and lifestyle factors can help understand the triggers, to avoid symptoms worsening.
For more information and support for IBS, please see www.theibsnetwork.org, a UK Charity specialising in advice and guidance and more tips for self-management.
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