Irritable bowel disease (IBS)

What is IBS?

Irritable bowel syndrome (IBS) is a common functional disorder of the gut.  There is no physical, structural abnormality of the bowel; rather it functions in an abnormal way (usually an overactive bowel).  IBS causes various symptoms that include abdominal pain, bloating, variable bowel habits that can either lead to diarrhoea or constipation, and urgency to defaecate.  Additionally, people with IBS can complain of nausea, headaches, poor appetite, lethargy and muscle pains.  Up to 1 in 5 people in the UK develops IBS at some stage in their life.  IBS can affect anyone at any age, but it commonly first develops in young adults and teenagers.  IBS is twice as common in women as in men.

What causes IBS?

There are no known causes of IBS.  However, it often begins after a stressful or emotional event.  It can also follow on from an infection of the bowel.  Certain dietary factors can make symptoms worse.

What tests are needed in IBS?

IBS was traditionally a diagnosis of exclusion.  However, nowadays it can be diagnosed based on the patient’s symptoms, providing there are no alert signs of a serious underlying disease.  Most people who present with IBS symptoms will, however, undergo some tests; these might include blood tests including one to check for celiac disease, and possibly an endoscopy of the bowel.

What are the treatments for IBS?

Dietary modification can help.  Traditionally, a high-fibre diet was recommended; however, some studies have suggested fibre can make symptoms worse.  Fibre (roughage) is the part of food that is not absorbed and makes up the bulk of stools.  There appear to be two types of fibre: soluble and insoluble fibre.  Soluble fibre, found in oats, nuts, seeds and some vegetables, seems to help in IBS, whilst insoluble fibre (bran) can exacerbate symptoms and should be avoided.  Drinking at least eight cups of fluid per day, especially water, helps, as does avoiding caffeinated and carbonated drinks.

Regular exercise can help symptoms, as can avoiding stress and other trigger factors.  Antispasmodic medications are often necessary to control pain.  If diarrhoea is the predominant symptom, anti-diarrhoeal medication such as loperamide can be taken, either regularly or on an as-required basis.  On the other hand, if constipation is the main issue, bulk-forming laxatives such as fybogel can help.

Antidepressant medication can be used to alleviate symptoms.  They are especially effective when pain and diarrhoea predominate.  Taking probiotics, which are nutritional supplements that contain “good bacteria”, can also sometimes help.  There are a number of newer treatments that are currently undergoing evaluation.

What is the prognosis for people with IBS?

Most people with IBS will have long-term symptoms; these can, however, wax and wane.  Most people are able to get to a position whereby they can control their symptoms enough to allow them to lead a normal life.

If you think you might have IBS, please make an appointment to see one of our specialists who will be able to advise you on whether any tests are necessary, and what treatments are available.

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