Irritable bowel syndrome

If you have, or think you might have IBS, keeping track of certain things can help you and your doctor understand what’s happening.

Use this diary for two to four weeks and then share your completed diary with your doctor. Together, you can find out what’s going on and decide a treatment plan that’s right for you.

Click on the icon below to download the diary. 

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

To make a diagnosis, your GP will ask about your pain, when it comes on and what makes it better or worse. He or she may also ask about your bowel movements. They may ask how often you open your bowels, how easy it is to go and what your faeces look like. Your GP may also ask you to have some blood tests.

If you have typical IBS symptoms and are under 50, it's unlikely you will need further tests. Your GP may refer you for further tests if your symptoms may be linked to more serious bowel conditions. These include:

• weight loss
• blood in your faeces
• symptoms first developing after age 60
• a family history of bowel problems
• diarrhoea without other symptoms
• anaemia

Your GP may refer you for a sigmoidoscopy or colonoscopy. This involves using an endoscope, a flexible, tube-like instrument, to look inside your bowel. He or she may take a biopsy (a small piece of tissue) from your bowel lining for examination in a laboratory. This test helps to rule out more serious conditions such as ulcerative colitis. 

Other tests

If your GP thinks that your IBS may be caused by an infection, you will be asked to give a sample of your faeces. This will be sent to a laboratory for tests. You may also need an X-ray of your abdomen such as a barium enema. In this test, a liquid containing a small amount of barium, a type of metal, is passed through a tube into your back passage where it enters the large intestine. The barium allows inflamed or ulcerated areas of the colon to show up clearly on X-ray images. 

It’s still not clear why some people develop IBS and others don’t. But it’s thought that IBS may be caused by a combination of:

• increased squeezing of the muscles in the wall of your bowel
• increased sensitivity to pain from inside your bowel
• inflammation of your bowel, for example after an infection, such as gastroenteritis
• your genes – you may inherit IBS

You may find your symptoms get worse:

• during times of stress
• after eating certain foods, for example fatty foods
• when you’re taking certain antibiotics

Self-help

Diet advice

• Eat regular meals and give yourself plenty of time to eat them.
• Make sure you drink at least eight cups of fluid every day, especially water and drinks that don’t contain caffeine. Try to drink no more than three cups of caffeinated drinks, such as tea and coffee, each day. Don’t drink too much alcohol or fizzy drinks.
• Depending on your symptoms and the type of IBS you have, it may help to either reduce or increase the amount of fiber you eat. If your doctor suggests increasing how much fiber you eat, try to eat soluble rather than insoluble fibers. Soluble fibers include things like oats, or fruits like bananas or apples. If you need to adjust the amount of fiber you eat, your doctor will talk to you about this.
• Try to limit the amount of processed foods you eat. These may contain 'resistant starch' that’s difficult for your body to digest.
• If you have diarrhoea, you may wish to cut out artificial sweeteners, such as sorbitol. This is used in some sugar-free sweets, chewing gum and drinks.
• If you have wind and feel bloated, try eating oats which are found in some cereals and porridge. You may also find that eating one tablespoon of linseeds each day helps.
• Probiotics contain helpful bacteria and yeasts, and are found in some yogurts and food supplements. It’s thought that certain probiotics can help to ease IBS symptoms, but more research is needed to make sure they definitely do. If you decide to try probiotic supplements, stick to one brand and take them at the recommended dose for at least four weeks.
• Reducing the amount of certain sugars in your diet may help your symptoms. This is known as a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet. Your doctor or a dietitian can give you more information.

 You may find it helpful to keep a food diary to see if certain foods trigger your symptoms, especially if you’re prone to diarrhoea. These foods may include dairy products, citrus fruits, caffeine, alcohol, tomatoes and eggs. Your GP can refer you to a dietitian for advice on changing your diet if necessary. Speak to your GP or a dietitian before making major changes to your diet, or if you’re pregnant or have another medical condition.

Lifestyle advice

Regular exercise is a good way to help reduce your symptoms. It helps keep your bowel movements regular and reduces stress.

If your symptoms are noticeably triggered by stress, try learning stress management or relaxation techniques. Keeping a diary to compare your symptoms with life events may also be helpful.

Medicines

As well as diet and lifestyle changes, you may also wish to try medicines and talking therapies. The treatments you’re offered will depend on your symptoms and what’s causing them. Your GP will help you decide which treatments are best for you.

Several over-the-counter medicines may relieve some of your irritable bowel syndrome (IBS) symptoms. You may need to take a combination of different medicines to control your symptoms. Speak to your pharmacist if you’d like more information about the medicines available.

• Laxatives, such as ispaghula (eg Fybogel), can help if you have constipation. These are known as bulk-forming laxatives. Bowel-stimulating laxatives (such as senna) may also help, but should only be used for a short while. Speak to your GP if you find you need to use laxatives regularly.
• Antispasmodic medicines, such as mebeverine hydrochloride (eg Colofac) and peppermint oil capsules may help your abdominal pain and wind. Again, speak to your GP if you find you need to use these regularly.
• Antidiarrhoea medicines, such as loperamide (eg Imodium), may help. But don’t take them for more than five days in a row without your doctor’s advice.

• Probiotics contain helpful bacteria and yeasts and are contained in some yoghurts. There is some scientific evidence that certain strains can be helpful for IBS symptoms, but this isn't conclusive.
• If you need to use painkillers, ibuprofen (eg Nurofen) or aspirin may make your symptoms worse. Try to use paracetamol.

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

If these treatments don’t ease your symptoms, your GP may also offer you a low-dose  antidepressant (eg amitriptyline). This can reduce the pain of IBS, even if you're not depressed.

Talking therapies

If your symptoms don't improve, your GP may recommend psychological treatments.

Talking treatments, such as  cognitive behavioural therapy (CBT), hypnotherapy or psychotherapy, may help to relieve your IBS symptoms. But research is still ongoing.

If you would like to try a talking therapy, your GP may be able to suggest a suitable therapist. You can also look for a therapist yourself. If you do this, make sure you check they’re fully qualified and registered with a relevant professional organisation.

1. What are probiotics and how can they help with symptoms of irritable bowel syndrome?

Answer

Probiotics are a food supplement. They contain live bacteria and yeasts that can be helpful in restoring the balance of bacteria in your gut. Some people with irritable bowel syndrome (IBS) find them helpful in controlling their symptoms.

Explanation

Probiotics are food supplements containing live bacteria and yeasts that help restore the balance of bacteria in your gut. Bacteria are often thought of as harmful and causing ill-health, but there are many good bacteria that live in and on your body that help keep you healthy. This is especially so in your gut. Good bacteria in your gastrointestinal tract may prevent harmful organisms from growing in your bowel or entering your body through your intestine. Some people think that taking probiotics helps to keep the levels of bacteria in your gut even, keeping it working efficiently.

You can buy probiotics as food supplements (capsules or tablets) from your pharmacist or health food shops. Always read the patient information leaflet that comes with your supplements and follow the recommended dosage. Probiotics can also be bought as yogurts or drinks (eg Danone, Activa or Actimel).

Research into the effectiveness of probiotics in treating IBS has produced conflicting results. Some studies have found that they do help relieve symptoms of IBS, whereas others have found that they don't. It's recommended that people with IBS take probiotics for a trial period of four weeks to see how they find them. If they have made no difference to your symptoms after this time, either stop taking them or try a different brand.

If you have any questions or concerns about probiotics or IBS, talk to your GP.

2. I've heard that a bout of food poisoning can cause irritable bowel syndrome. Is this true?

Answer

Yes, after a bout of food poisoning (gastroenteritis) there is a risk of developing irritable bowel syndrome (IBS), particularly when it is caused by certain bacteria.

Explanation

Gastroenteritis is an inflammation of your stomach and intestines caused by an infection. There are several different types of infection that cause gastroenteritis, for example viruses, bacteria or parasites. It's thought that bacterial gastroenteritis, in particular, puts you at risk of developing IBS. The most common cause of bacterial gastroenteritis is food poisoning, specifically:

• salmonella, often from dairy, eggs and poultry
• campylobacter, often from dairy, meats and poultry
• bacillus, from reheated rice
• vibrio, often from seafood
• Escherichia coli (E. coli), often from minced beef

Approximately one in 14 people who have had bacterial gastroenteritis will go on to develop symptoms of IBS. You are at particular risk if you are female or if you had diarrhoea for a long period of time during your bout of gastroenteritis.

If you have any question or concerns about IBS or gastroenteritis, talk to your GP.

3. Are there any complementary medicines I can try to help with my irritable bowel syndrome symptoms?

Answer

Complementary medicines aren't recommended to treat symptoms of irritable bowel syndrome (IBS).

Explanation

Some research has suggested that using relaxation techniques, biofeedback and herbal medicine may be helpful in controlling symptoms. The evidence is limited and more research is needed to be certain of their effectiveness, although the same could be said of many approaches to the treatment of IBS.

If you have any questions or concerns about complementary therapies and IBS, talk to your GP.

4. My son has irritable bowel syndrome and it interferes with his school life. What can I do to help him?

Answer

Children with irritable bowel syndrome (IBS) do sometimes find that their symptoms can interfere with school. However, by keeping your child's teachers informed about his or her condition and how it affects them, you may be able to keep this disruption to a minimum.

Explanation

Having a child with IBS can be difficult, especially if his or her symptoms are bad enough to interfere with schooling. However, there are things you can do as a parent to make things easier for your child.

It's important to let your child's school know about his or her condition, and to make sure this information filters down to the teachers. This will make it easier for your child to leave classes in a hurry if he or she needs to do so without drawing unnecessary attention. Also, it helps if the school nurse is aware of the situation so your child can get medicines (if needed) without having to explain every time and feel embarrassed.

Some children may need to take time off school if their symptoms are particularly bad. If this happens, it's useful to set up a system whereby your child can receive school work on a regular basis to do at home. This will stop him or her falling behind, making returning to the classroom easier.

It's also important to ensure that during your child's time away from school, he or she maintains contact with friends. This will help to keep some normality in your child's life and may help take his or her mind off the symptoms.

If you have any questions or concerns about your child's IBS, talk to your GP. 

What’s the difference between irritable bowel syndrome and inflammatory bowel disease?

Answer

IBS and inflammatory bowel disease are two different conditions, but they can cause some similar symptoms. Inflammatory bowel disease describes conditions that cause inflammation in your bowel. It usually refers to Crohn's disease and ulcerative colitis.

Explanation

Crohn's disease can affect any part of your digestive system from your mouth, down through your stomach and bowel to your anus. It can cause mouth ulcers, an urgent need to open your bowels, tummy pain and diarrhoea (which may be bloody).

In ulcerative colitis, the lining of your large bowel and back passage (rectum) becomes inflamed and develops ulcers. The main symptoms are bloody diarrhoea, an urgent need to go to the toilet and open your bowels and pain in your tummy.

If you have IBS, you don’t have any inflammation in your bowel. Common IBS symptoms include:

• pain or discomfort in your tummy
• constipation and/or diarrhoea (but with no blood)
• passing mucus
• a bloated abdomen

Since IBS and inflammatory bowel disease can cause similar symptoms, it can be difficult to know which condition you have. But if you have inflammatory bowel disease, you will also have other symptoms:

• weight loss
• a fever
• bleeding from your rectum (back passage)

See your GP if you have any of these symptoms. If your GP thinks you may have inflammatory bowel disease or something else wrong with your bowel, you’ll need to have some tests. It’s important to have a correct diagnosis so you can be offered the right treatment.

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• Core
  www.corecharity.org.uk
• The British Dietetic Association
  www.bda.uk.com
• The IBS Network
  0114 272 3253
  www.theibsnetwork.org

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