What is Irritable Bowel Syndrome (IBS)?
IBS is the name given to a chronic (longstanding) condition that affects the digestive system. Symptoms include constipation, diarrhoea (or both), abdominal discomfort and bloating. These symptoms can come and go and last for days, weeks or months at a time.
IBS is an illness that has no specific cause and no single effective treatment. It does not increase your risk of having other bowel related diseases such as Ulcerative Colitis, Crohn’s disease or bowel cancer. It is not life threatening but can be frustrating to live with and can impact on all aspects of your everyday life.
It is estimated that IBS affects up to 13 million people in the UK. It affects almost twice as many women as men, tends to start in teenage years or twenties and may persist on and off throughout life, often depending on what is happening.
What are the symptoms?
- Abdominal pain or discomfort – which can be worse after eating and improves when you go to the toilet
- Bloating – your abdomen feels swollen, ‘tight’ or full
- Constipation – straining to pass stools, feeling like you haven’t finished, stools are hard and dry. This is known as constipation predominant IBS or IBS-C
- Diarrhoea – loose or watery stools and a sudden urge to go. This is known as diarrhoea predominant IBS or IBS-D
You may experience both constipation and diarrhoea; this is known as mixed IBS (IBS-M).
Other symptoms linked to IBS:
- Increased wind (flatulence)
- Passing mucus from your bottom
- Tiredness/lack of energy
- Nausea (feeling sick)
- Heartburn and indegestion
- Aches and pains (head, back, muscles)
- Bladder problems – going more often, sudden urges, not getting there in time
- Incontinence – being unable to control your bowel, having accidents
- Sexual problems
Symptoms vary from person to person and will be better on some days than on others. They may be triggered by certain foods, stress or lifestyle changes. This doesn’t mean IBS is caused by diet or stress or that you can cure it completely by managing your diet or stress.
How do I know if my symptoms are serious?
See your GP if you think you have IBS. Ask for an urgent appointment if you have:
- A change in bowel habit
- Lost weight for no reason
- Passed blood from your bottom or have diarrhoea with blood in it
What causes IBS?
The causes of IBS are poorly understood for several reasons:
- We can X-ray the bowel and see its structure but can’t visualise how the bowel moves in an easy way
- The bowel is erratic, we can’t predict when it will move, so assessment would have to be over many hours and this is rarely possible
- IBS is not just one disease, it is a set of symptoms which may be caused by several factors interacting
- It is not possible to study the muscle and nerves in the bowel without a full thickness biopsy which is invasive and painful and risks complications
Whilst there is no specific cause for IBS, common risk factors could include:
- An attack of gastroenteritis
- A traumatic or upsetting event
- Courses of powerful antibiotics
All of these seem to reset the gut to a state of hypersensitivity:
- stimulating the gut immune system
- inducing a mild inflammation
- altering the colonic bacteria
- making the gut sensitive
Most people with IBS have a sensitive gut and symptoms can be triggered by diet, stress or life changes.
What should I eat?
Sometimes simple dietary changes are all that are needed. Monitor your progress by keeping a food and symptom diary. Only avoid foods if you experience similar symptoms on more than one occasion otherwise your diet becomes very restricted, after an interval, test these foods again to see what happens.
Remember any food can make you feel worse just because it’s making your gut work. When your gut is hypersensitive any food can trigger a response. If you excluded a food every time you felt unwell with it you could quickly end up on a very restricted diet. Dietary restriction does work for some, but not for everyone.
Visit https://www.bda.uk.com/foodfacts/irritable_bowel_syndrome for further information.
Or – the above link has the info below in it:
- Keep a diary of what you eat and any symptoms you get – try to avoid things that trigger your IBS.
- Have regular meals
- Avoid missing meals or leaving long gaps between eating
- Drink at least 8 cups of fluid per day, especially water or other non‑caffeinated drinks, for example herbal teas.
- Cook homemade meals using fresh ingredients when you can – avoid spicy, fatty or processed foods
- Adjust your fibre intake (usually reducing it).Try soluble fibre (e.g. oats) rather than insoluble fibre (e.g. wholemeal bread, bran)
- Delay or skip meals
- Eat too quickly
- Eat lots of fatty, spicy or processed foods
- Eat more than 3 portions of fresh fruit a day (a portion is 80g)
- Drink more than 3 cups of tea or coffee a day
- Drink lots of alcohol or fizzy drinks
How can I reduce bloating?
Bloating is a feeling of fullness which typically occurs after eating. Here are some tips you can try:
- Eat oats (such as porridge) daily
- Try eating 1 tablespoon of linseeds daily
- Limit fresh fruit to 3 portions per day
- Avoid fizzy drinks and alcohol
- Avoid foods that are hard to digest like cabbage, broccoli, onions, brussel sprouts, beans, onions and dried fruit
- Avoid products containing sorbitol, an artificial sweetener
- Move more – exercise is good for you
- Ask your Pharmacist about using an antispasmodic
Should I take probiotics?
Probiotics are dietary supplements that boost the friendly bacteria in the gut, to help restore the natural balance that has been disrupted. There is little scientific evidence to prove probiotics help IBS, but they can relieve some symptoms. If you wish to try these, it is recommended to take the product for 4 weeks, at the dose recommended by the manufacturer, to see if they help.
Is stress making my IBS worse?
The part of our brain which controls our bowel becomes more active if we feel stressed or anxious. This means our bowel symptoms can become worse. Be aware of how you are feeling and create time to relax. Identify and make the most of your leisure time, do more of the things you enjoy. Practising mindfulness or yoga can aid relaxation.
Moderate physical exercise promotes physical and mental health and well- being. Exercise can relieve bloating. Think about how you can increase your activity level. Simple steps include walking up the stairs instead of using the lift, take a break at lunchtime and go for a walk.
What medication can I take to help with IBS?
There are lots of medications which your doctor may prescribe to improve your symptoms (constipation, diarrhoea, cramps). It is important to tell your doctor whether or not it is working and do share any concerns you may have about taking it. Each person will react differently so you may need to adopt a trial and error approach to work out which medicines will help you.
Tips for managing Diarrhoea predominant IBS (IBS-D)
- Reduce your intake of high fibre foods such as wholemeal bread, brown rice, bran-based cereals, nuts and seeds
- Avoid products containing sorbitol, an artificial sweetener found in chewing gum and in some diabetic and slimming foods
- Reduce your intake of alcohol
- Caffeine stimulates your bowel so limit your intake of tea and coffee
- Ask your Pharmacist about medication that can help (Loperamide)
- If you keep getting diarrhoea drink extra water to avoid dehydration
Tips for managing Constipation predominant IBS (IBS-C)
- Make sure you drink 8 cups of fluid daily
- Eat more soluble fibre – this is found in oats, pulses, carrots, peeled potatoes and linseeds
- Ask your Pharmacist about medication that can help (laxatives)
- Check your positioning on the toilet
Should I take laxatives?
Yes. If you are constipated you will need to take laxatives. It is important to take these regularly and to be able to adjust the dose according to your response i.e. if your stool remains hard and dry increase your dose, if it becomes too loose, reduce or stop your dose. Try to take them at the correct dose for as long as needed. There are a range of types available so talk to your GP if it’s not working. Remember it’s usual to adopt a trial and error approach.
Are laxatives safe to take in the long term?
Yes. It is common for people to worry about taking laxatives long term in case their bowel becomes dependant on them or they damage the bowel, making it even slower. There is no research evidence that long term use of laxatives damages the bowel or increases dependency.
Sometimes the laxative you have used for a while no longer seems to be effective. This may be because your symptoms have become worse. Also, many laxatives rely on your gut bacteria to be able to work. Over time your gut bacteria may change so the response to that particular laxative will change. It is usual to alter the dose of what you have been taking or to try an alternative laxative.
Will laxatives increase my risk of bowel cancer?
No. There is no research evidence to suggest that using laxatives will increase your risk of bowel cancer.
Is it safe to use a mix of laxatives?
Yes. If one type of laxative on its own is ineffective, your Health Care Professional may advise combining different types of laxatives. For example, if your stool is hard and dry and the frequency of bowel movements has reduced you might use a softener (such as Docusate Sodium) alongside a stimulant laxative (such as Bisacodyl). Your Doctor, Nurse or Pharmacist will advise you.
What about research into IBS?
Clinical research can provide information about:
- The cause of a disease i.e. what goes wrong in the body
- The links between a disease and other diseases or lifestyle choices
- How to best diagnose diseases
- How to care for populations of patients with a certain illness
- How to develop pathways of care
- How to treat, reduce or even cure symptoms or a disease
- How to prevent an illness
In 2018, there were 392 research publications into IBS. This is a big increase but there is still a long way to go. For example there were nearly ten times that number (2,899) on inflammatory bowel disease and over 5,000 on colorectal cancer.
How can I be involved in research?
Research will develop better treatments for IBS. You can help by being involved. This could be by raising funds for a research charity, but the most important way is volunteering for trials.
Remember that if you volunteer for a clinical trial you might get access to a new, more effective treatment but you could end up on the placebo; and even if you are on an active treatment which works, that treatment will stop when the trial is over. But by participating you are helping medical science move forward, bringing the chance of a licensed treatment closer.
You can make an impact on research by signing up to ContactME-IBS. This is an NHS-owned national database of IBS patients wishing to know about research that they can volunteer for. Register here https://www.contactme-ibs.co.uk/
Where can I get further information about IBS?
Talk IBS is a support and information hub on the TalkHealth website. There is a discussion forum where you can talk to others living with IBS and also online clinics where you can speak to experts. http://www.talkhealthpartnership.com/
Other sources of Information:
The IBS Network provides information, support and advice for people living with IBS. They have established patient support groups in many areas across the UK. Visit: https://www.theibsnetwork.org/ for more information including diet and medications for IBS.
Guts UK – is committed to fighting all digestive disorders. For more information about IBS visit: https://gutscharity.org.uk/advice-and-information/conditions/irritable-bowel-syndrome/
For information related to diet visit: https://www.bda.uk.com/foodfacts/irritable_bowel_syndrome