Irritable Bowel Syndrome

What is Irritable Bowel Syndrome?

Irritable Bowel Syndrome (IBS) is a common condition that affects the digestive system, particularly the large intestine (colon). It is a long-term, often life-long disorder that causes a combination of abdominal pain, bloating, and changes in bowel habits such as diarrhoea, constipation, or both. IBS is considered a functional gastrointestinal disorder, which means there is no visible damage or inflammation in the bowel, but the gut doesn’t function as it should.


IBS is not contagious, cancerous, or life-threatening, but it can significantly affect a person’s quality of life. Symptoms may come and go and can be triggered by various factors, including stress and certain foods. The severity of symptoms varies from person to person.

Impact of Irritable Bowel Syndrome on Anatomy and Health

IBS does not cause any visible damage to the digestive organs. When you look at the intestines of someone with IBS through medical imaging or tests like a colonoscopy, everything often appears normal. However, when the gut's movement and communication with the brain become disrupted, it results in a Disorder of the Gut-Brain Interactions (DGBI).


In IBS, the muscles in the bowel may contract too strongly or too weakly, leading to symptoms such as cramps, diarrhoea, or constipation. Some people also experience a heightened sensitivity in their gut nerves, meaning normal digestion can feel painful or uncomfortable.


The condition affects more than just the gut:

  • Digestive discomfort: Pain, bloating, and irregular bowel movements can cause daily discomfort.
  • Mental health: IBS is closely linked with stress, anxiety, and depression. The gut and brain are closely connected through what’s known as the gut-brain axis.
  • Nutrition: Some people avoid certain foods due to fear of symptoms, resulting in poor nutrition or unbalanced diets.
  • Social life and work: The unpredictability of symptoms may lead to missed social events, work absences, or a reduced quality of life.


Causes and Risk Factors for Irritable Bowel Syndrome

The exact cause of IBS is not fully understood, but researchers believe it involves a mix of physical, emotional, and environmental factors. These include:

  • Abnormal gut movement: The intestines may contract too much (causing diarrhoea) or too little (causing constipation).
  • Increased gut sensitivity: The nerves in the digestive system may be more sensitive than usual, leading to pain or discomfort.
  • Imbalance of gut microbiome: An imbalance in the natural bacteria that live in the gut may affect digestion.
  • Gut-brain miscommunication: The gut (enteric) nervous system may not communicate properly with the brain (central nervous system), making digestion irregular.
  • Food intolerances: Some people with IBS are sensitive to certain foods, including high-FODMAP foods (fermentable carbohydrates).
  • Stress and mental health: Emotional stress, trauma, or anxiety can worsen IBS symptoms or even trigger them.
  • Hormonal changes: Many women notice their symptoms worsen during menstruation, suggesting hormones may play a role.


Symptoms of Irritable Bowel Syndrome

Common symptoms include:

  • Abdominal pain or cramping: Usually felt in the lower belly and often relieved after a bowel movement.
  • Bloating and gas: A feeling of fullness or swelling in the abdomen.
  • Changes in bowel habits: These include:
  • Diarrhoea: Frequent loose or watery stools.
  • Constipation: Hard, infrequent stools that are difficult to pass.
  • Alternating diarrhoea and constipation.
  • Mucus in the stool: Some people may notice a whitish mucus in their stool.
  • A feeling of incomplete emptying: You may feel like you haven’t fully emptied your bowels even after going to the toilet.

Other associated symptoms may include:

  • Fatigue
  • Nausea
  • Difficulty sleeping
  • Headaches
  • Anxiety or depression

Prevention of Irritable Bowel Syndrome

There is no guaranteed way to prevent IBS, but adopting certain habits can reduce your risk or help manage symptoms if you’re already diagnosed.


To help prevent IBS or reduce flare-ups:

  • Eat a balanced, regular diet: Avoid skipping meals and try to eat at the same time each day.
  • Limit trigger foods: Common triggers include caffeine, alcohol, fatty foods, spicy foods, dairy products, and high-FODMAP foods such as onions, garlic, beans, and wheat.
  • Increase fibre gradually: Fibre helps with bowel movements, but should be increased slowly to avoid gas and bloating.
  • Stay hydrated: Drink plenty of water to help digestion.
  • Manage stress: Practice relaxation techniques like yoga, deep breathing, mindfulness, or regular exercise. Cognitive Behavioural Therapy (CBT) has also been shown to help.
  • Regular physical activity: Exercise helps stimulate bowel movement and improve mood.
  • Sleep well: Good sleep supports digestion and reduces stress-related symptoms.
  • Avoid overuse of laxatives or anti-diarrhoeal medicines: These can make symptoms worse over time if not used properly.
  • Probiotics: Some people find relief from taking probiotic supplements or eating probiotic-rich foods like yoghurt and kefir.


Types of Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is classified into different types based on the pattern of bowel movements a person experiences. Knowing your type of IBS is important because it helps guide the most effective treatment approach.


The main types of IBS include:

  • IBS with Constipation (IBS-C):
  • Most stools are hard or lumpy.
  • You may have fewer bowel movements, bloating, and straining during bowel movements.
  • IBS with Diarrhoea (IBS-D):
  • Most stools are loose or watery.
  • You may experience an urgent need to use the bathroom and discomfort after eating.
  • IBS with Mixed Bowel Habits (IBS-M):
  • You experience both diarrhoea and constipation, often alternating.
  • This type can be unpredictable and frustrating to manage.


Diagnosis of Irritable Bowel Syndrome

There is no single test that can diagnose IBS. Instead, the diagnosis is made based on your symptoms, medical history, and by ruling out other conditions.


Your doctor will usually:

  • Ask about your symptoms:
  • Duration, frequency, and type of symptoms.
  • Whether they’re linked to meals, stress, or your menstrual cycle.
  • Perform a physical examination:
  • This may include feeling the abdomen and checking for tenderness or bloating.
  • Request basic tests to rule out other conditions:
  • Blood tests to check for signs of inflammation, anaemia, or infection.
  • Stool tests to check for parasites or signs of infection.
  • Coeliac disease screening may be done, especially in people with diarrhoea.
  • Refer for further tests if needed:
  • If red flags like blood in stool, weight loss, or a family history of bowel disease are present, your doctor may suggest a colonoscopy or imaging tests.

Treatment of Irritable Bowel Syndrome

There is no cure for IBS, but the symptoms can be effectively managed. Treatment is tailored to each person’s IBS type, symptom severity, and lifestyle. A combination of diet, medication, and mental health strategies often works best.


Lifestyle and Dietary Changes

  • Identify trigger foods: A food diary can help identify problem foods.
  • Low FODMAP diet: This evidence-based diet reduces fermentable sugars that cause bloating and gas.
  • Eat smaller, regular meals: Avoid skipping meals and overeating.
  • Avoid caffeine, alcohol, spicy, and fatty foods: These can irritate the bowel.
  • Increase fibre (for IBS-C): Gradually add fibre-rich foods or use a supplement like psyllium.

Medications

  • For IBS-C (constipation): Fibre supplements, laxatives, or prescription drugs that help move the bowels.
  • For IBS-D (diarrhoea): Anti-diarrhoeal medicines like loperamide, bile acid binders, or probiotics.
  • For all types:
  • Antispasmodics to relieve cramping.
  • Peppermint oil capsules (natural antispasmodic).
  • Low-dose antidepressants (like amitriptyline) for gut pain and stress-related symptoms.

Psychological Support

  • Cognitive Behavioural Therapy (CBT): Proven to reduce symptom severity in IBS.
  • Stress management: Yoga, meditation, breathing exercises, and counselling.
  • Gut-directed hypnotherapy: Has shown benefits in some patients with chronic IBS.

Probiotics

  • May help improve the balance of gut bacteria.
  • Choose strains proven to help IBS, and take them for at least 2-4 weeks to assess effectiveness.

What if Irritable Bowel Syndrome is Untreated?

IBS is not life-threatening and does not cause long-term damage to the bowel. However, if left untreated, it can still have a significant negative impact on day-to-day life.


Possible consequences of untreated IBS include:

  • Persistent discomfort and pain: Ongoing bloating, cramps, or diarrhoea can interfere with work, sleep, and social life.
  • Mental health issues: Chronic IBS symptoms can lead to anxiety, depression, and reduced self-confidence.
  • Nutritional deficiencies: People may avoid a wide range of foods, leading to unbalanced diets or poor nutrition.
  • Reduced quality of life: Fear of symptoms or flare-ups may limit social outings, travel, and physical activity.
  • Increased healthcare use: Repeated doctor visits, tests, or unnecessary treatments may occur without a clear diagnosis or plan.


By recognising symptoms early and seeking medical advice, most people with IBS can avoid these outcomes. With the right support, many individuals can achieve long-term relief and resume their normal activities.