Overview
Irritable bowel syndrome (IBS) is a common, long-term condition of the digestive system. The bowel looks normal on tests, but it is oversensitive and does not move food along smoothly, which leads to pain and changes in bowel habit.
It comes and goes, with flare-ups and calmer spells. It can be painful and tiresome, but it does not damage the bowel. Some people mostly have diarrhoea, some mostly constipation, and some have both.
Symptoms
The main symptoms are:
- Tummy pain or cramps, often worse after eating and easing after passing stools
- Bloating and a swollen tummy
- Diarrhoea, sometimes with sudden urgency
- Constipation, with straining and a feeling of incomplete emptying
- Wind, and sometimes white mucus in the stools
Tiredness, nausea, back pain and passing urine more often can also occur.
When to see a doctor
See a doctor if tummy symptoms last more than four weeks, or sooner if you notice blood in your stools, weight loss without trying, a hard lump in the tummy, or tiredness with a pale look, which can mean anaemia. Also see one if diet changes are not helping.
Causes
The exact cause is not known and probably differs from person to person. IBS is seen as a problem in how the gut and brain communicate, which may change how fast food moves through the gut and how strongly pain is felt.
Flare-ups can be set off by certain foods and drinks, such as alcohol, caffeine, and spicy or fatty foods, by stress and anxiety, and sometimes by .
Risk factors
- Being a woman, and starting in younger adult life
- A past infection of the gut
- Stress, anxiety or depression
- Stressful or difficult events earlier in life
- Food intolerances
- Genes
Complications
IBS does not damage the bowel or lead to other health problems. Its effect is on daily life: unpredictable symptoms can affect work, travel and social plans.
Anxiety and depression are more common in people with IBS, so talking therapies are sometimes part of treatment. Coeliac disease and inflammatory bowel disease can cause similar symptoms, which is why doctors check for them.
Prevention
IBS cannot be reliably prevented, but flare-ups can often be reduced:
- Keep a diary of foods, drinks and symptoms to find your own triggers
- Eat regular meals, eat slowly, and do not skip meals
- Cut back on alcohol, caffeine and fizzy drinks, and on fatty, spicy or processed foods
- Drink enough water
- Be physically active and find ways to relax
Diagnosis
There is no single test for IBS. A doctor asks about your symptoms, what sets them off, your diet, medicines and family history, and examines your tummy. A written note of your symptoms helps.
Tests are used to rule out other conditions rather than to prove IBS. They may include:
- Blood tests, for anaemia, infection and coeliac disease
- Stool tests, for blood, infection and inflammatory bowel disease
- A or , if symptoms or earlier results suggest another cause
Treatment
No single diet or medicine works for everyone, so treatment is tried step by step with a doctor. Options include:
- Diet changes, such as regular meals, more soluble fibre (for example oats), less of your trigger foods, and for some people a low FODMAP plan with a dietitian's help
- Medicines that relax the gut and ease cramps and pain, including coated peppermint oil capsules
- Medicines for diarrhoea, or fibre supplements and laxatives for constipation
- Probiotics, though research on them is still going on
- Talking therapies such as cognitive behavioural therapy, gut-directed hypnotherapy and relaxation training
IBS is usually long-term, so the aim is to keep symptoms under control. Take medicines only as a doctor or pharmacist advises.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“IBS is all in the mind, and there is nothing really wrong.”What is true?
Fact
IBS is a real condition. Experts think it involves the way the gut and brain communicate, which can change how fast food moves through the gut and how strongly pain is felt. Stress and worry can set off or worsen symptoms, but they are not the whole story.
Myth“IBS damages the bowel and can turn into bowel cancer or another serious disease.”What is true?
Fact
IBS does not damage the digestive tract or lead to other health problems. Blood in the stools, black stools, weight loss without trying and anaemia are different matters. They are not part of IBS and need to be checked by a doctor.
Myth“One special diet, such as giving up wheat or milk completely, will cure IBS for everyone.”What is true?
Fact
No single diet or medicine works for everyone, because triggers differ from person to person. A food and symptom diary helps find your own. If you find you need to avoid many foods, ask a doctor, who may refer you to a dietitian.
Myth“IBS cannot be treated, so you simply have to live with it.”What is true?
Fact
IBS is usually long-term, but symptoms can be eased. Changes in diet and daily habits, medicines for pain, diarrhoea or constipation, probiotics, relaxation and talking therapies are all used. You may need to try more than one approach to find what suits you.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Is IBS the same as inflammatory bowel disease?
No. In inflammatory bowel disease the gut is inflamed, and this can be seen on tests. In IBS the bowel looks normal. The symptoms can overlap, which is why a doctor may do stool tests or a scope to tell them apart.
Can stress cause IBS?
Stress and anxiety can set off or worsen symptoms, but they are not the only cause. IBS is a real gut condition. Learning to relax, getting regular activity and enough sleep, and talking therapies can help.
Will IBS go away?
IBS is usually a long-term condition, with symptoms that come and go. Most people can keep it under control with changes to diet and daily habits and, when needed, medicines.
Should I take probiotics for IBS?
Probiotics are live bacteria similar to those normally found in the gut. They are one option, but research on them is still going on, so talk to a doctor first about which to use and for how long.
