A comprehensive overview of irritable bowel syndrome (IBS)
Written by:
Gastroenterologist
Published: 04/04/2023
Edited by: Aoife Maguire
What is IBS?
Irritable bowel syndrome (IBS) is a common condition which affects the gastrointestinal tract and leads to symptoms of abdominal cramps, bloating and changes in bowel habits with either constipation or diarrhoea. These symptoms tend to come and go over time but sometimes they can last days, weeks or even months at a time.
It is a condition which affects patient’s quality of life, with symptoms which are absolutely genuine but in the absence of a detectional disease process. It is regarded as a functional problem of the gastrointestinal tract which doctors poorly understand.
How do you know if you have IBS?
Patients will IBS will present with a variety of symptoms; abdominal cramps, bloating, loose stools or constipation. Sometimes they will have a combination of all of these things at different times.
The way in which doctors diagnose IBS is to apply the Rome IV Criteria, which states that patients will have gastrointestinal symptoms for approximately 6 months, including 3 months of continuous symptoms but in the absence of another detectable disease process.
Some testing is required, including checking a full blood count, inflammatory markers. Women with bloating are tested for ovarian pathologies known as a CA 125.
There is also a new stool test known as calprotectin which looks for evidence of inflammation. If all of these things are negative and the patient fits the Roam IV criteria and they do not have any red flag symptoms, such as blood in the stool or weight loss, then doctors can confidently make that diagnosis.
What foods usually trigger IBS?
IBS can present with gradual onset symptoms, however in some indivudals there is an insighting event. For example, after an episode of gastroenteritis, some patients suffer from a post infectious problem regarding the gut functions.
At other times, this condition tends to occur in times of stress and is more common in patients with a background of anxiety and depression.
Sometimes doctors do not understand what contributes to the formation of the condition in the first place and it is likely that there is a number of underlying conditions contributing to IBS as opposed to one.
How is IBS treated?
As with many conditions, treatment for IBS is multifactorial.
Treatment may include changes to lifestyle. For example, cooking home made meals, using fresh ingredients and keeping a diary of what you eat can sometimes help to identify why certain foods triggers. Other factors such as finding ways to relax, getting plenty of exercise and probiotics can be beneficial.
There can be certain behaviours which may help to reduce IBS, such as skipping or delaying meals, eating too qucikly and eating too much fatty, spicy or processed foods. In addition, eating too much fruit may be harmful because fruit sometimes may ferment in the gut. Due to this, doctors advise no more than 3 portions of fresh fruit every day.
Sometimes, patients may drink too much caffeine in the form of tea or coffee and fizzy drinks. These can contribute to these symptoms because caffeine is a gastrointestinal stimulant. Additionally, reducing alcohol can sometimes be helpful to symptoms.
How should people manage their IBS symptoms?
Some testing is required, including checking a full blood count, inflammatory markers and coeliac serology. In women with bloating, excluding ovarian pathology using a blood test known as Ca-125 is recommended.
Alongside the conservative intervention of lifestyle changes, doctors may recommend use of anti spasmodic medicines to help with abdominal cramps such as buscopan, mebeverine, colpermin or alverine citrate.
There is some anecdotal support for the use of probiotics. These are interventions which cannot be prescribed but are widely available across the internet and various health food shops.
Reassuring the patient that there is nothing more serious happening regarding their health is important. A confident diagnonsis of IBS is helpful to the patient.
Additionally, it is essential to treat patients holistically, focusing on the global health of the patient and as part of that it is important to see if there is any mental health issues such as anxiety. Intervention such as cognitive behavioural therapy (CBT) can sometimes be useful.
For patients with ongoing symptoms, doctors sometimes use neuromodulators, which reduce sensitivty from the gut. In this case, neuromodulators are used to desensitise the gut because they work on a lot of the neuroreceptors that are in the gastrointestinal tract.
If you are suffering from IBS and would like to book an appointment with Dr Blaker, you can do so by visiting his Top Doctors profile today.