IBS

What do we mean by IBS?

Irritable bowel syndrome (IBS) is a term used to describe a diverse range of symptoms including abdominal pain, cramps, spasms, bloating, gas, constipation and diarrhoea. The symptoms vary and they tend to come and go without warning. They can be quite mild, but some people feel severe pain in parts of their abdomen. People who get IBS may also get ‘reflux indigestion’ symptoms (heartburn, or acid reflux with burning feelings in middle of the chest, also known as GORD or gastro-oesophageal reflux disease).

How can we be sure that IBS is the problem?

IBS is usually diagnosed by its symptoms, after your doctor has ruled out other causes. It’s normal occasionally to experience indigestion, bloating or wind, and constipation or diarrhoea. These problems could be the result of a change of diet, hurried meals or a shift in routine. But if symptoms like this continue or worsen, or if you develop any gut symptoms you have not had before, you should check with your doctor in case the problem is due to a different digestive disorder that needs treatment. If inflammatory or other detectable diseases are ruled out the doctor may conclude that the condition is ‘IBS’. By definition there is nothing to see, only a troublesome combination of symptoms.

Is it curable?

Most people can control and live with the symptoms of IBS. This may involve rigorously checking to see if a food or food type is upsetting your gut, or looking to other additons to your diet like spices or herbs (perhaps as hot teas). Increasingly research suggests that what you eat can have an important effect on IBS, so making some simple dietary changes may help. The gut is very sensitive to stress, and people often find that stress makes their IBS symptoms worse. In many cases, reducing stress can help to relieve some of the symptoms. There are also various prescription and over-the-counter medicines that may relieve the symptoms: laxatives, anti-diarrhoea medicines, antispasmodics, or tricyclic drugs.

Is it dangerous?

IBS does not damage the intestines or lead to cancer. Nor, even though some of the symptoms are similar, is it related to inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis.

What causes it?

IBS is one of the most common digestive problems: in England 10-20% of people have IBS at some time in their lives, and twice as many women get it as men. This may be due to the menstrual cycle and other hormonal factors as the bowels are sensitive to hormone changes. 

Something else that plays a part in IBS is called ‘visceral hyper-sensitivity’. Air and other gases collect in the gut (produced by digestion, possibly by the gut bacteria – the microbome –  but also through air-swallowing). If this stretches the intestine, this stretching may be felt as pain. Researchers have recently discovered that about half the people who get IBS feel this discomfort sooner than would be expected. This means their bowel reacts to things that might not bother other people, such as stress, big meals, wind (gas), some medicines, certain foods, caffeine or alcohol This ‘stretch-sensitivity’ is often very specific to the gut –  many IBS patients seem to have a greater than usual tolerance of pain in other parts of their bodies.

A number of small studies have indicated that people who have experienced early trauma are more likely to develop IBS (it was more common in adults who were evacuated form their homes as young children in the Second World War). In the early years of childhood, after potty training, the ‘rules of behaviour’ that govern our bowel habits are laid down. What should be a settled relationship between unconscious bowel activity and central nervous controls – for example agreeing when is the best time to go to the toilet – can be disrupted in the long term by childhood traumas.

IBS is also linked to several other health problems that involve increased sensitivity to internal sensations. For instance, people who get IBS are more likely to get migraine, chronic fatigue, period pains and restless leg syndrome. A 2006 study, involving 125,000 people, some who had IBS and some who didn’t, found that IBS sufferers were 60% more likely to have migraine, 40% more likely to experience depression, and 80% more likely to suffer from fibromyalgia.

IBS and Periods

Many women get constipation and/or diarrhoea just before their period comes on. Women who get IBS are more likely to be bothered in this way. Yet sometimes even severe IBS goes away during pregnancy. It isn’t clear why: possibly because of hormonal changes, or because during pregnancy the body has to become less sensitive to things stretching inside.

Self-help Techniques:

Here are some simple tips that may ease your IBS:

• Take regular exercise to improve your circulation and make you feel more relaxed.
• Raise the head of your bed by 15 cm (6 inches) so that gravity can help keep digestive acids in your stomach.
• Consider trying herb or spice teas or visiting a medical herbalist – cardamon, fennel, caraway seeds or peppermint tea or oil may help.
• A nutritionist may help you identify problem foods and recommend a simple treatment, such as a course of probiotics.
• Eat regular, small meals and follow a healthy, fibre-rich diet.
• Keep a food diary if you suspect that you are sensitive to certain foods.
• Avoid rich or fatty foods and some people also react badly to highly spiced meals.
• Steam, grill or bake rather than fry.
• Avoid raw foods and acidic foods such as vinegar and pickles.
• Cut down on tobacco and alcohol, which increase stomach acidity; strong coffee, which irritates the stomach lining; and sodas, which cause gas.
• Avoid eating just before going to bed.
• Eat at a table sitting upright, rather than slumped in front of the TV.
• Consider talking to your doctor about cognitive-behavioural therapy (CBT).
• Keep a symptom-and-stress-trigger diary.
• Practise relaxation and breathing techniques to help you deal with stress and anxiety. You may wish to buy a relaxation CD. Relax before and during meals and chew your food thoroughly.
• Consider having hypnotherapy.
• Consider visiting an acupuncturist.

What other information might be helpful

• If you think that you might be suffering from stress or anxiety (feeling nervous or having worrying thoughts that are making you feel very tense) that are causing symptoms of IBS, you might like to see the information on STRESS AND ANXIETY first.
• If you have general feelings of pain in several places in your body, see the information on SORE MUSCLES. If you are female and the pain in your stomach seems linked to your periods, see the information on PERIOD PROBLEMS

For more information see the NHS Website