Managing irritable bowel syndrome

Irritable bowel syndrome (IBS) is a long-term condition that causes reoccurring pain or discomfort in your abdomen and an altered bowel habit.

IBS is one of the most common problems of the digestive system – about 1 in 10 people worldwide have IBS and it’s nearly twice as common in women than in men.

IBS can develop at any age, but most people have their first symptoms between the ages of 20 and 35.

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. If you find it difficult to cope with your symptoms, see a doctor.

Symptoms of IBS include:

• Pain or discomfort in your abdomen is the most common symptom of IBS and it’s often in your lower abdomen on the left-hand side. You may also get stomach cramps. The pain may be mild or severe and may ease if you open your bowels. It can often get worse if you eat. You may feel pain at a particular time of day, often in the evening. Women often find the pain relates to their menstrual cycle.
• A change in bowel habit is another common symptom. Your faeces may vary in consistency and may alternate between constipation and diarrhoea. Alternatively, you may just pass small amounts of mucus. At times, you may feel an urgent need to open your bowels or this may feel strained. Afterwards, you may feel that your bowels haven't been completely emptied.
• Your abdomen may feel bloated and may look swollen. This is more common in women.

These symptoms may come and go – you may not have any symptoms for months and then have a sudden flare-up.

Other symptoms you may get if you have IBS include:

• feeling sick
• indigestion
• a headache
• backache
• tiredness
• problems with your bladder, such as needing to urinate more frequently
• problems with your sex life, such as pain during or after having sex, or a lack of interest in sex
• anxiety
• depression

These symptoms may be caused by problems other than IBS. If you have any of these symptoms, see your doctor for advice.

Causes of irritable bowel syndrome

The exact reasons why you may develop IBS aren’t fully understood at present. It may be a combination of:

• more frequent or stronger squeezing (contractions) of the muscles in the wall of your bowel – this can happen if the signals that travel from your brain to your gut when food passes through your digestive system are disrupted in some way
• increased sensitivity to pain from inside your bowel
• inflammation of your bowel, for example an infection such as gastroenteritis
• your genetic make-up – you may inherit IBS

You may find that psychological factors, such as stress, may trigger your symptoms. Your symptoms may also get worse after eating certain foods, for example fatty foods.

Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and diclofenac, can also make your symptoms worse.

Diagnosis

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

Your doctor will ask you about your pain, when it comes on and what makes it better or worse. He or she will also ask about your bowel movements, such as how often you open your bowels, how easy it is to go, what your faeces look like and if it has blood or mucus in it. There is no single test to confirm IBS therefore your doctor may ask you to have some further tests, such as blood tests, to rule out other conditions.

If you have typical IBS symptoms, it's unlikely you will need further tests. However, your doctor may refer you for further tests if your symptoms may be linked to more serious bowel conditions. These symptoms may include:

• weight loss
• blood or mucus in your faeces
• bowel problems that first develop after age 50
• a family history of bowel problems
• diarrhoea that lasts longer than six weeks
• anaemia

If your doctor thinks that your symptoms may be caused by an infection, you will be asked to give a sample of your faeces – also called a stool sample.

This will be sent to a laboratory for testing.

Treatment

Although there is no cure for IBS, there are treatments that can help to improve your symptoms. These include making changes to your lifestyle, taking medicines and psychological treatments. With the help of your doctor, you can decide which is best for you.

Self-help

For most people with IBS, making some lifestyle changes is the best way to improve your symptoms.

Diet advice

The following general advice about your diet may help.

• Eat regular meals.
• Drink enough fluids but try to limit caffeinated drinks, such as tea and coffee, to a maximum of three cups a day and also limit alcoholic and fizzy drinks.
• Cut down on foods that are rich in insoluble fibre, such as wholemeal bread, wholegrain rice and cereals that contain bran when your symptoms get worse.
• Eat no more than three portions of fruit a day.
• Limit processed foods. These may contain 'resistant starch' that is difficult for your body to digest.
• If you have diarrhoea, cut out artificial sweeteners such as sorbitol. This is used in some sugar-free sweets, drinks and diet products.
• If you feel bloated, try eating oats, which are found in some cereals and porridge, and a tablespoon of linseeds each day.

You may find it helpful to keep a food diary for two to four weeks to see if certain foods cause your symptoms. Always speak to your doctor before changing your diet as advice may differ depending on your symptoms. If certain foods still seem to bring on your symptoms after trying this diet advice, it may help to see a dietitian.

Lifestyle advice

Regular exercise is a good way to help reduce your symptoms. It helps keep your bowel movements regular and reduces stress. The World Health Organization recommends doing 150 minutes (two and a half hours) of moderate exercise over a week. You can do this by carrying out 30 minutes at least five times a week.

If your symptoms are noticeably triggered by stress, try learning stress management or relaxation techniques.

If these self-help treatments don't work, see your doctor for advice. He or she can help you identify factors that may be making your IBS worse, and suggest other treatments.

Medicines

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

• Antidiarrhoea medicines, such as loperamide, may help. However, only take them as and when you need them and not on a regular basis.

• Laxatives, such as ispaghula husk, can help if you have constipation. These are bulk-forming laxatives. Stronger laxatives called bowel-stimulating laxatives, such as senna, may also help. However, if you find you need to take them quite often it’s important to speak to your doctor.

• Antispasmodic medicines, such as mebeverine hydrochloride, alverine citrate and peppermint oil capsules, may help with stomach cramps and wind. Again speak to your doctor if you find you need to use these often.

• Probiotics contain helpful bacteria and yeasts and are contained in some yoghurts. There is some evidence that certain strains can be helpful for IBS symptoms, but this isn't conclusive.

• If you need pain relief, you can take over-the-counter painkillers such as paracetamol (acetaminophen). Don’t take ibuprofen or aspirin (acetylsalicylic acid) as they may make your symptoms worse.

Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Your doctor may prescribe you medicines for IBS. These include prescription-only versions of the medicines mentioned above. Your doctor may also prescribe you a low-dose antidepressant as this can reduce the pain of IBS, even if you're not depressed.

Talking therapies

Your doctor may consider referring you for psychological treatment.

Talking treatments, such as cognitive behavioural therapy (CBT), hypnotherapy or psychotherapy can help relieve the symptoms of IBS. These are often useful for people who have personal difficulties to deal with. Your doctor can refer you to a suitable therapist.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.