Irritable bowel syndrome (IBS): symptoms, tests and self-care

Irritable bowel syndrome, usually shortened to IBS, is a common condition of the digestive system. This article explains what IBS is, how it shows itself, how it is diagnosed and what everyday steps can help, using information from the NHS, the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and MedlinePlus.

1. Introduction

IBS is a set of symptoms that appear together, mainly repeated belly pain and changes in bowel habits such as diarrhoea, constipation or both. Doctors find no visible damage or disease in the digestive tract ^[4]. MedlinePlus notes that although IBS can cause a great deal of discomfort, it does not harm the intestines ^[5].

IBS is called a functional gut disorder, which means the gut looks normal but does not work as smoothly as it should. Doctors now often describe this as a disorder of gut-brain interaction ^[4]. Older names include spastic colon and nervous colon ^[4].

The NHS says diet and lifestyle changes can help improve IBS symptoms or stop them getting worse ^[3]. IBS affects up to twice as many women as men ^{[4, 5]}, and it is more likely to develop in people under 50 ^[4].

2. Causes and risk factors

The exact cause is not known ^[5]. NIDDK explains that the gut and brain may not work well together, which can make the gut more sensitive and change how the bowel muscles squeeze. That can lead to diarrhoea, constipation, or both ^[4].

Factors linked with a higher chance of IBS include ^[4]:

• A family member who has IBS
• Stressful or difficult experiences in childhood
• A severe infection of the digestive tract
• Being female, and being younger than 50

IBS often exists alongside other conditions, such as long-term pain conditions, acid reflux, anxiety and low mood ^[4].

3. Signs and symptoms

Symptoms come and go, with better days and flare-ups. The NHS lists these main symptoms ^[1]:

• Stomach pain or cramps, often worse after eating and easing after a bowel movement
• Bloating, with a swollen or uncomfortably full tummy
• Diarrhoea, which may be watery and may come with sudden urges to go
• Constipation, with straining and a feeling that the bowel has not emptied fully

Other possible symptoms include wind, mucus in the stool, tiredness, nausea, backache, bladder problems and pelvic pain ^[1].

Doctors describe three common patterns: IBS with constipation (IBS-C), IBS with diarrhoea (IBS-D) and mixed IBS (IBS-M). Many people have normal bowel movements on some days and abnormal ones on others, so the pattern can shift ^[4].

Common triggers

Some people notice that symptoms are set off by alcohol, caffeine, spicy or fatty meals, stress and anxiety, or regular antibiotic use. Sometimes a flare-up has no clear cause ^[1].

4. Diagnosis and tests

There is no single test that confirms IBS. Doctors base the diagnosis on your symptoms after other possible causes have been ruled out ^{[2, 5]}. Your doctor will ask how often symptoms happen, how long you have had them, whether they come and go and what seems to trigger them. They may also feel your tummy for lumps or swelling ^[2].

Tests are used mainly to rule out other conditions ^{[2, 5]}:

• A blood test, which can check for coeliac disease, an immune reaction to gluten
• A stool sample, which can check for infection and for inflammatory bowel disease (IBD), a group of conditions that cause swelling in the gut
• In some cases, other tests such as a colonoscopy, a camera test of the large bowel, if the doctor is unsure what is causing the problem ^{[2, 5]}

Writing down your symptoms before the visit can help your doctor ^[2].

5. Treatment and self-care

The NHS says there is no single diet or medicine that works for everyone with IBS ^[3]. Your doctor will suggest a plan that fits you.

Diet and drinks

The NHS suggests that people with IBS ^[3]:

• Eat regular meals, do not skip them, and eat slowly
• Keep a food and symptom diary to spot personal triggers
• Drink plenty of fluids, roughly 1.5 litres a day, mostly water or caffeine-free drinks
• Cut back on fatty, spicy and processed foods, alcohol and fizzy drinks, and limit caffeine
• For bloating and wind, try oats, and avoid foods that are hard to digest and products sweetened with sorbitol
• For diarrhoea, reduce high-fibre foods such as wholegrain bread, nuts and seeds
• For constipation, add soluble fibre such as oats, pulses and carrots

MedlinePlus mentions a special eating plan called a low FODMAP diet among the diet options for IBS ^[5]. The NHS advises seeing a doctor if you need to avoid many different foods to control your symptoms ^[3].

Stress and activity

Finding ways to relax and getting regular exercise are part of the NHS advice ^[3]. MedlinePlus mentions stress management, relaxation techniques, hypnosis and psychological treatments among the options people use ^[5].

Medicines

A pharmacist or doctor can advise on products that target a particular symptom, such as medicines that ease gut cramps, slow diarrhoea or soften stools. The NHS says probiotics may also be tried for a month ^[3]. If diet changes and pharmacy products are not helping, the NHS advises seeing a doctor, who may refer you to a dietitian or a specialist ^[3]. Always tell your doctor about any supplement or herbal product you use.

6. When to see a doctor

The NHS advises seeing a doctor if you think you may have IBS and your symptoms have lasted more than 4 weeks, so that other conditions can be checked ^[1].

Get urgent medical advice if you have any of these, because they can point to something more serious ^[1]:

• Weight loss with no clear reason
• Bleeding from the back passage or bloody diarrhoea
• A hard lump or swelling in the tummy
• Shortness of breath, a racing heartbeat or unusually pale skin

In an emergency, call your local emergency number (112 in India, 911 in the United States).

7. Conclusion

IBS is a common gut condition that causes pain, bloating and changes in bowel habits without harming the intestines. Most people can manage their symptoms with diet, stress management, probiotics and medicine. Diagnosis relies on symptoms and on ruling out other conditions. Regular meals, enough fluids, exercise, stress management and trigger awareness help many people, and a doctor can guide further steps. Do not ignore warning signs such as bleeding or unexplained weight loss.