Irritable Bowel Syndrome

This medical checklist used by doctors to detect irritable bowel syndrome states that the condition is a ‘recurrent abdominal pain or discomfort and a marked change in bowel habit for at least six months, with symptoms experienced on at least three days of at least three months’.

In addition to this, patients need to identify with at least two of these three statements in order to be considered an IBS sufferer:

• Pain is relieved by a bowel movement
• Onset of pain is related to a change in frequency of stool
• Onset of pain is related to a change in the appearance of stool.

Irritable bowel syndrome takes different forms amongst its sufferers, and the symptoms of any two IBS sufferers can be quite different. Visit our page on IBS symptoms as well as our pages on the diagnosis of IBS to find out about which of your symptoms are most likely to be due to IBS and how doctors recommend making a diagnosis.

Causes of IBS range from post-infective to psychological, and the condition can be triggered by all sorts of other things too – see our page on triggers.

Of course, this means that there are different ways to treat irritable bowel syndrome. These include a wide range of medication as well as diet and other therapies, depending on the type and cause of the IBS. See our IBS treatment pages for more details.

• Bile salt malabsorption is the cause of diarrhoea in up to 20% of sufferers. It is, however, missed by many doctors. But it is simple to treat. The SehCAT scan is the simplest way to detect this problem.
• Small intestinal bacterial overgrowth affects a sizeable number of people with diarrhoea. It is most common in people who have had abdominal surgery in the past. Also, as more people survive cancer, we are seeing this problem more often after radiotherapy for ovarian, uterine, colon and prostate cancer in particular. The test we use to detect this is the lactulose hydrogen breath test
• A newly recognised problem is caecalmalfermentation. If you find that you run to the toilet three or four times each morning, but are fine for the rest of the day, it is quite possible you have this condition. The new Smart Pill test is a good way to diagnose this treatable problem. People with this condition often have alternating constipation and diarrhoea.
• Did you know that almost all Asians and Black Africans have lactose intolerance? But it also affects 1 in 50 white British people. It may cause no symptoms at all, but it may also cause very dramatic wind, bloating and diarrhoea. There are two ways we use to diagnose it: the lactose hydrogen breath test and a specialised analysis of duodenal biopsy samples at endoscopy. Given that it can cause so much trouble and is so easy to diagnose, it is important not to miss this particular cause.

As yet, there is no known cure for IBS, so treatments are generally aimed at relieving symptoms and will differ depending on the issues you have been experiencing. But if you have a condition that mimics IBS, it may be completely reversible. For example an overactive thyroid can cause a diarrhoea predominant IBS picture but will respond very well to specific treatment for the thyroid.

The doctor will listen to you, assess your symptoms, as well as arranging appropriate tests or consulting the results of any tests already done, and your food and/or stool diaries if you have kept them. By studying all this information in detail your doctor can tailor a treatment plan to best suit your needs.

With the new tests our world class experts at the London Gastroenterology Centre have available, we can diagnose many people as having something which is actually not IBS and which can be cured. For example, if you have diarrhoea, you might be suffering from lactose intolerance, small bowel bacterial overgrowth of caecalmalfermenation. If you have constipation, the issue could be one of disordered anorectal function.

Although we cannot tell you exactly how to cure IBS, we can almost certainly help you feel very much better.

Quite often the main problems you may experience are one or more of the following:

• Constipation and/or Diarrhoea
• Abdominal pain with or without hypersensitivity
• Hyperventilation

Your doctor will prescribe treatments aimed at combating these particular symptoms.

Treatment for IBS comes in many different forms; it may involve taking medication to alleviate your symptoms, changing your diet to avoid aggravating your IBS, or undergoing therapy to improve relaxation and combat stress, a known trigger of the disease.

Some common treatments you may encounter include:

Constipation
Treatments for constipation are designed to help you pass faeces, either by bulking up your stool, making it easier to pass, or by directly stimulating the bowel to contract.

Diarrhoea
Treatments for diarrhoea are designed to slow the passage of faeces through the intestines. Most anti-diarrhoea medications work directly on the bowel to slow its contraction.

Pain
As well as traditional painkillers, antispasmodics may be prescribed to help alleviate your IBS pain. Pain is usually somewhere in the abdomen, although sometimes it is felt in the chest or back. Antispasmodics work to reduce cramping in the bowel, which is a common source of pain in IBS.

Diet
Symptoms such as constipation can be eased by increasing fibre intake through your diet and/or with special high-fibre supplements. Some people actually do not respond well to a high fibre diet. These people need a low fibre diet together with special fibre replacement treatment. You may also be advised to follow a low FODMAP diet to ease your IBS symptoms, in addition to excluding foods that trigger your IBS.

Hypersensitivity
Many IBS sufferers feel heightened pain sensations in their abdomen and digestive system. Your doctor may want to treat this with medication and/or certain types of other therapy.

Hyperventilation
Excessive or incoordinated breathing caused by stress of anxiety can lead to an excess of air in your digestive system, worsening your symptoms. Techniques and therapy aimed at reducing anxiety can aid in preventing this problem.

Psychological treatment
Stress can be a key trigger for IBS symptoms in many patients, so ensuring you remain relaxed and minimising anxiety can be a key way in minimising your symptoms. In addition to reducing stress, there are also a variety of ways in which psychological treatment can help you to gain control over your IBS, whether it be through medication, hypnotherapy or cognitive behavioural therapy (CBT).

Probiotics
Probiotics found in certain foods and supplements are ‘good’ bacteria that can help restore balance in your digestive system. They can reduce levels of harmful, disease-causing bacteria and inflammation and have been shown to be reasonably effective in reducing some patients’ IBS symptoms.

For some, treating IBS symptoms with medicine (traditional or alternative) is the answer. For others, it’s dietary adjustments or lifestyle changes that bring about relief from the abdominal pain, bloating, constipation or diarrhoea. From probiotics to peppermint oil, there are pills, supplements and herbal remedies out there for every type of IBS.

Diet

Many sufferers of irritable bowel syndrome manage their symptoms through self-help. Managing and changing diet is probably the most common way that people deal with their symptoms themselves. With the help of a food diary, most IBS sufferers will start to see clear patterns in their symptoms, and will start to pinpoint their specific IBS triggers.

For in depth information about IBS and diet, read our article about it here

Natural remedies

There are also lots of herbs and supplements available on the high street, which can dramatically improve the various discomforts of IBS – bloating, gas and cramps as well as diarrhoea and constipation.

Peppermint is widely known for its therapeutic properties – it increases gut motility and eases abdominal cramping.
Similarly, a soothing chamomile tea can reduce gut spasms.
A handful of linseeds per day is often prescribed for its gentle laxative effects.

And this is only scratching the surface of possible alternative remedies for IBS symptoms.
Taking probiotics is another method of self-help for IBS that can be easily made part of a daily routine.

Click here to see our detailed page about natural remedies

Patients whose IBS seems to stem from stress or anxiety can also benefit from Meditation and self-hypnosis, whether in classes or from MP3s which you can download from the Internet that can help you detach from your worries and relax