Irritable bowel syndrome

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, visit your GP. People with IBS often continue to get symptoms from time to time.

Pain

The most common symptom of IBS is pain or discomfort in the abdomen. This may be associated with stomach cramps. The pain ranges from mild to severe, and may be made better by opening the bowels or passing wind. It is often made worse by eating.

Pain may occur at a particular time of day, often in the evening. Women often find the ups and downs of pain relates to their menstrual cycle.

Change in bowel habit

Your faeces may vary in consistency from hard and pellet-like to loose and watery. Alternatively, you may just pass small amounts of mucus. Your bowel movements may alternate between constipation and diarrhoea. 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.

IBS usually causes one symptom more than the others - either pain, constipation or chronic diarrhoea.

Other symptoms

Other symptoms that are sometimes present in IBS include:

• excess wind
• feeling sick
• indigestion
• backache
• tiredness
• fullness
• bladder problems

These symptoms may be caused by problems other than IBS. You should visit your GP for advice. 

The exact cause of IBS is unknown. It's likely a combination of:

• more frequent or stronger squeezing (contractions) of the muscles lining your bowel
• increased sensitivity to the gas inside your bowel
• your genetic make-up

Psychological factors, such as stress, may trigger your symptoms. Stress may result from work anxieties, exams, relationship difficulties, or life events such as divorce or bereavement.

Your symptoms may get worse after eating. Specific foods, such as tea, coffee and fatty foods, can also trigger symptoms.

Antibiotics and non-steroidal anti-inflammatory drugs, such as ibuprofen (eg Nurofen) and diclofenac (eg Voltarol), can make symptoms worse. 

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. 

Although there is no simple cure for IBS, there are treatments that can help reduce the symptoms. These include changes to your lifestyle, medicines and psychological treatments. With the help of your GP, you can decide which is most suited to you.

Self-help

Diet advice

For most people with IBS, a healthy lifestyle is the best way to improve symptoms. The following general advice about diet may help.

• Eat regular meals.
• Drink enough fluids. Limit caffeinated drinks, such as tea and coffee, alcohol and soft drinks.
• Cut down on foods rich in insoluble fibre, such as wholemeal bread, wholegrain rice and cereals containing bran.
• Eat no more than three portions of fruit a day.
• Avoid processed foods. These may contain 'resistant starch' which is difficult for your body to digest.
• If you have diarrhoea, cut out the artificial sweetener sorbitol. This is used in some sugar-free sweets and drinks, and diet products.
• Try the supplement ispaghula powder to help relieve constipation.
• Bloating symptoms may be improved by eating oats, which are found in some cereals and porridge, and a tablespoon of linseeds each day.

Other 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.

If you recognise that certain events trigger your symptoms, it may be easier to deal with the problem that is causing the symptoms. If these self-help treatments don't work, see your GP for advice. He or she can help you identify factors that may be making your IBS worse, and suggest other treatments. If certain foods still seem to bring on your symptoms after trying this diet advice, seeing a dietitian may be helpful.

Medicines

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

• Anti-diarrhoea medicines, such as loperamide (eg Imodium) may help. You should only take them as needed, not on a regular basis.
• Certain laxatives, such as ispaghula husk (eg Fybogel), can help if you have constipation. These are bulk-forming laxatives. Stronger laxatives called bowel-stimulating laxatives, such as senna, may help. However, you should speak to your GP before using them routinely.
• Antispasmodic medicines, such as mebeverine hydrochloride (eg Colofac), alverine citrate and peppermint oil capsules, may help with stomach cramps and wind.
• 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.

Your GP may prescribe medicines for IBS. These include prescription-only versions of the medicines mentioned above. Low-dose antidepressants can reduce the pain of IBS, even if you're not depressed.

Talking treatments such as cognitive behavioural therapy, hypnotherapy or psychotherapy can help relieve the symptoms. These may be most useful for people who have personal difficulties to deal with. Your GP may refer you to a suitable therapist. 

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.

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.

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

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.

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. 

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

Sources

• Ruepert L, Quartero AO, de Wit NJ, et al. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews 2011, Issue 8. doi:10.1002/14651858.CD003460.pub3
• Irritable bowel syndrome (IBS). Map of Medicine. www.mapofmedicine.com, published 17 January 2012
• Irritable bowel syndrome. Prodigy. www.prodigy.clarity.co.uk, published August 2008
• Irritable bowel syndrome. eMedicine. www.emedicine.medscape.com, published 13 January 2012
• What is IBS. The IS Network. www.theibsnetwork.org, accessed December 2011
• Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care. National Institute for Health and Clinical Excellence (NICE), February 2008. www.nice.org.uk
• Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc 2009; 109(7):1204–14. doi:10.1016/j.jada.2009.04.012
• Start active, stay active: a report on physical activity for health from the four home countries’ Chief Medical Officers. Department of Health, 2011. www.dh.gov.uk
• Joint Formulary Committee. British National Formulary. 62nd ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2011
• Moayyedi P, Ford AC, Talley NJ, et al. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut 2010; 59:325–32. doi:10.1136/gut.2008.167270
• Ernst E, Pittler MH, Wider B, et al. Oxford handbook of complementary medicine. Oxford: Oxford University Press; 2008: 226–27
• Probiotics. National Center for Complementary and Alternative Medicine. www.nccam.nih.gov/health, published 1 December 2011
• Gastroenteritis. Prodigy. www.prodigy.clarity.co.uk, published September 2009
• Pediatric irritable bowel syndrome. eMedicine. www.emedicine.medscape.com, published 22 December 2010
• Irritable bowel syndrome in children. National Digestive Diseases Information Clearinghouse (NDDIC). www.digestive.niddk.nih.gov, published November 2008
• Inflammatory bowel disease. eMedicine. www.emedicine.medscape.com, published 26 October 2011
• Crohn's disease. Map of Medicine. www.mapofmedicine.com, published 30 August 2011
• Crohn disease. eMedicine. www.emedicine.medscape.com, published 16 June 2011
• Ulcerative colitis. eMedicine. www.emedicine.medscape.com, published 23 December 2011
• Managing bloating and wind. National Association for Colitis and Crohn’s Disease. www.nacc.org.uk, accessed 1 December 2011