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Irritable bowel syndrome (IBS)

IBS is a long-term condition that causes pain or discomfort in your abdomen (tummy) and a change in your bowel habit.

IBS is a common condition which affects your digestive system. About two in 10 people in the UK have IBS. Women are twice as likely to get it as men.

IBS can develop at any age, but people usually have their first symptoms between the ages of 20 and 30.

Details

  • Symptoms Symptoms of irritable bowel syndrome

    Most people with IBS find their symptoms an occasional nuisance but don't feel the need to see a doctor. However, you may find that the condition affects your quality of life. If you find it difficult to cope with your symptoms, speak to your GP.

    Symptoms of IBS include the following.

    • Pain or discomfort in your abdomen. This is the most common symptom of IBS. It’s often in your lower abdomen on the left-hand side. You may also get cramps. This pain may ease if you go to the toilet and may get worse after eating.
    • Changes in bowel habit. Your faeces may vary in consistency and can alternate between constipation and diarrhoea. Alternatively, you may just pass small amounts of mucus. At times, you may have an urgent need to open your bowels or this may feel strained. Afterwards, your bowels may feel like they haven't been completely emptied.
    • Your abdomen may look and feel bloated.

    These symptoms can come and go – you may not have any symptoms for months and then have a sudden flare-up.

    Other symptoms you may get if you have IBS include:

    • feeling tired
    • indigestion
    • feeling sick
    • backache
    • tiredness
    • problems with your bladder, such as needing to urinate more frequently

    These symptoms may be caused by problems other than IBS. However, if you have any of them, speak to your GP for advice.

    As well as the physical symptoms it causes, for some people IBS can be linked to other problems. For example, you may lose interest in sex or find it painful. It’s also common for IBS to be associated with feelings of anxiety or depression.

    You may feel embarrassed about your symptoms and talking about them, but try not to. It’s important to remember that your mental wellbeing is as important as your physical health. Your GP can give you advice about how to manage any feelings of anxiety or depression you may have.

  • Diagnosis Diagnosis of irritable bowel syndrome

    Your GP will ask about your symptoms and may ask to examine you. He or she will also ask about your medical history.

    Your GP will ask you about your pain, when it comes on and what makes it better or worse. He or she will also ask you about your bowel movements. This may include questions about how often you go to the toilet, how easy it is to go, and what your faeces look like. There is no single test to confirm IBS. Therefore, to rule out any other conditions, your GP may also recommend that you have some blood tests.

    If you have typical IBS symptoms, it's unlikely you will be offered any other tests. However, if your symptoms could be linked to other bowel conditions, your GP may suggest that you have some further tests.

    Symptoms that are linked to other bowel conditions include:

    • unexplained weight loss
    • blood or mucus in your faeces
    • bowel problems that first develop after the age of 60
    • diarrhoea that lasts longer than six weeks
    • anaemia

    You may also be advised to have further tests if you’re over 40 and have a family history of bowel or ovarian cancer.

    If your GP thinks that your symptoms could be caused by an infection, he or she may ask you for a sample of your faeces. If you have this test, your sample will be sent to a laboratory for testing. This is also known as a stool sample.

  • Treatment Treatment options for irritable bowel syndrome

    There are a number of treatment options for irritable bowel syndrome. These are described below. Which treatments you are offered will depend on your personal circumstances. Your doctor will discuss these with you to help you make a decision that’s right for you. Your decision will be based on your doctor’s expert opinion and your own personal values and preferences.

    Although there is no cure for IBS, there are many self-help measures and lifestyle changes you can make that may help to improve your symptoms. You may also wish to try medicines and psychological treatments. With the help of your GP, you can decide which is best for you. However, if your symptoms don’t cause you too much trouble or stop you from doing things, you may wish to have no treatment at all.

    Self-help

    Making lifestyle changes may help to ease your symptoms of IBS.

    Diet advice

    The following general advice about your diet may help.

    • Eat regular meals and give yourself plenty of time to eat them.
    • Make sure you drink enough fluids. Try to limit your intake of caffeinated drinks, such as tea and coffee, to a maximum of three cups a day. Don’t drink too much alcohol or fizzy drinks.
    • Try to reduce the amount of fibre in your diet. Aim to eat no more than three portions of fruit a day.
    • You may also find it helpful to cut down on foods that are rich in insoluble fibre. These include wholemeal bread, wholegrain rice and cereals that contain bran.
    • Try to limit your intake of processed foods. These may contain 'resistant starch' that is difficult for your body to digest.
    • If you have diarrhoea, you may wish to cut out artificial sweeteners, such as sorbitol. This is used in some sugar-free sweets, drinks and diet products.
    • If you have wind and feel bloated, try eating oats, which are found in some cereals and porridge. You may also find that eating one tablespoon of linseeds each day helps.
    • Probiotics contain helpful bacteria and yeasts and are found in some yoghurts. There is some evidence that certain strains can be helpful for IBS symptoms, but this isn't conclusive.
    • Some studies suggest that a diet low in certain sugars may help. This is known as a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet. It involves reducing the amount of sugar you eat from milk products and certain fruits such as mangos. Research into how well a low-FODMAP diet works is still ongoing. Speak to your GP or a dietitian for more information.

    You may find it helpful to keep a food diary to see if certain foods cause your symptoms. Speak to your GP or a dietitian before making major changes to your diet, or if you’re pregnant or have another medical condition.

    Lifestyle advice

    Regular exercise is a good way to help reduce your symptoms. Aim to do a minimum of 30 minutes of moderate exercise a day, at least five times a week.

    If your symptoms are noticeably triggered by stress, you could try learning a relaxation technique to help you deal with your stress.

    You may find it helpful to talk to other people who are in a similar situation to you. You can find details about self-help groups from charities that support people with IBS – some of these will have websites with contact details. Don’t forget, you can also speak to your GP about this. He or she may also be able to give you information about local self-help groups.

    If these self-help treatments don't work, see your GP for advice. He or she can help you identify factors that may be making your IBS worse, and suggest other treatments.

    Medicines

    If your symptoms don’t improve with lifestyle changes, you may wish to try medicines. There are several over-the-counter medicines that may relieve some of your symptoms. Speak to your pharmacist if you’d like more information about your treatment options.

    • Laxatives, such as ispaghula (eg Fybogel), can help if you have constipation. These are known as bulk-forming laxatives. Bowel-stimulating laxatives, such as senna, may also help. However, if you need to take them for more than two weeks, it’s important to speak to your GP.
    • Antispasmodic medicines, such as mebeverine hydrochloride (eg Colofac) and peppermint oil capsules may help with abdominal pain wind. Again, speak to your GP if you find the need to use these often.
    • Antidiarrhoea medicines, such as loperamide (eg Imodium), may help. However, only take them as and when you need them and not on a regular basis.

    Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    If these treatments don’t ease your symptoms, your GP may also offer you a low-dose antidepressant. This can reduce the pain of IBS, even if you're not depressed.

    Talking therapies

    If your symptoms don't improve, your GP may recommend psychological treatment.

    Talking treatments, such as cognitive behavioural therapy (CBT), hypnotherapy or psychotherapy may help to relieve the symptoms of IBS. These may help you cope with your condition. Some studies suggest that psychological therapies like these may be helpful in improving the symptoms of IBS, although research is still ongoing. More research is needed to look into how well these treatments work, especially in the long term.

    If you would like to try this kind of therapy, ask your GP if he or she can suggest a suitable therapist. You can also look for a therapist yourself. If you do this, make sure you check that they are fully qualified and registered with a relevant professional organisation.

  • Bowel treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including bowel treatment.

  • Causes Causes of irritable bowel syndrome

    The exact reasons why IBS develops aren’t fully understood at present. It may be a combination of:

    • increased squeezing of the muscles in the wall of your bowel
    • increased sensitivity to pain from inside your bowel
    • inflammation of your bowel, for example after an infection, such as gastroenteritis,
    • your genes – you may inherit IBS

    You may find that your symptoms get worse:

    • during times of stress
    • after eating certain foods, for example fatty foods
    • whilst taking certain antibiotics
  • FAQs FAQs

    Are there any complementary medicines I can try to help with my irritable bowel syndrome symptoms?

    Answer

    Although they do appear to help some people with IBS, there is very little evidence to show that complementary medicines are effective for treating the condition.

    Explanation

    Some research suggests that complementary therapies, including relaxation techniques and herbal remedies, may help to relieve symptoms. However, the evidence is limited and more research is needed to be certain of their effectiveness. Because of this, complementary medicines aren’t recommended to treat symptoms of IBS.

    If you have any questions or concerns about complementary therapies and IBS, talk to your GP.

    I've heard that a bout of food poisoning can cause irritable bowel syndrome. Is this true?

    Answer

    Yes, some research suggests that you may be at risk of developing IBS if you’ve had a bout of food poisoning (gastroenteritis).

    Explanation

    Gastroenteritis is a condition caused by an infection that leads to diarrhoea and vomiting. In the UK, about two in 10 people get gastroenteritis each year.

    There are several different types of infection that cause gastroenteritis, for example viruses, bacteria or parasites. It's thought that bacterial gastroenteritis, in particular, puts you at risk of developing IBS. The most common cause of bacterial gastroenteritis is food poisoning, specifically:

    • salmonella – often from meat, eggs and poultry
    • campylobacter – from milk and poultry
    • bacillus cereus – from reheated rice
    • Escherichia coli (E. coli) – beef, milk and vegetables

    You can help to prevent gastroenteritis by washing your hands after going to the toilet and thoroughly cooking and reheating food.

    If you have any questions or concerns about IBS or gastroenteritis, talk to your GP.

    My child has irritable bowel syndrome and it interferes with his school life. What can I do to help?

    Answer

    Children with IBS sometimes find that their symptoms can interfere with school. Keeping your child's teachers informed about his or her condition and its effects may help to reduce any disruption it causes.

    Explanation

    If your child has IBS, the symptoms may sometimes affect his or her school life. There are things you can do to help.

    It's a good idea to tell your child's teachers about his or her condition. Explain that your child may sometimes need to leave the classroom in a hurry to go to the toilet. It may also help if the school nurse is aware of your child’s condition so that your child can get medicines (if needed).

    Some children may need to take time off school if their symptoms flare up. You may wish to arrange for your child to receive work from his or her teachers to do at home.

    If your child needs to take time off school, try to encourage him or her to stay in touch with friends. This may help to keep some normality in your child's life and may also distract him or her from their symptoms.

    If you have any questions or concerns about your child's IBS, talk to your GP.

    What are probiotics and how can they help with the symptoms of irritable bowel syndrome?

    Answer

    Probiotics contain live bacteria and yeasts that can be beneficial for your health. Some people with irritable bowel syndrome (IBS) find them helpful in controlling their symptoms.

    Explanation

    Probiotics contain live bacteria and yeasts. People often think of bacteria as harmful, but there are many bacteria that help keep you healthy. This is especially so in your gut. Some bacteria, such as probiotics, may prevent harmful bacteria from growing in your bowel or entering your body through your intestine.

    You can buy probiotics as food supplements (capsules or tablets) from your pharmacist or health food shops. Always read the patient information leaflet that comes with your supplements and follow the recommended dosage. You can also buy probiotics as yoghurts or drinks.

    Research into the effectiveness of probiotics in treating IBS has produced conflicting results about whether or not they relieve symptoms. If you choose to take probiotics, try taking them for a trial period of four weeks to see if they help with your symptoms. For most people probiotics aren’t thought to be harmful or have serious side-effects. However, there isn’t much information about how effective or safe they are if you take them long-term or if you have an underlying health condition.

    If you have any questions or concerns about probiotics or IBS, talk to your GP.

    What is the difference between irritable bowel syndrome and inflammatory bowel disease?

    Answer

    IBS is a different condition to inflammatory bowel disease but some of the symptoms are similar.

    Explanation

    Inflammatory bowel disease is a term for conditions that cause inflammation in the bowel. It most often refers to Crohn’s disease and ulcerative colitis.

    Crohn's disease is inflammation of your digestive pathway. It can affect any part of your digestive system, from your mouth down through your stomach and bowel to your anus.

    In ulcerative colitis, the lining of your large bowel and back passage (rectum) becomes inflamed and develops ulcers. This means that your large bowel can't absorb as much water as usual and it leads to diarrhoea.

    Symptoms of IBS include:

    • pain or discomfort in your abdomen (tummy)
    • constipation
    • diarrhoea
    • passing mucus
    • a bloated abdomen

    If you have inflammatory bowel disease, you may also have diarrhoea and a painful abdomen, so sometimes it’s confusing to know which condition you have. However, if you have inflammatory bowel disease you will also have other symptoms, including:

    • weight loss
    • a fever
    • bleeding from your rectum (back passage)

    See your GP if you have any of these symptoms. It’s important to get the correct diagnosis to ensure you can be offered the appropriate treatment.

  • Resources Resources

    Further information

    Sources

    • Irritable bowel syndrome in adults. Diagnosis and management of irritable bowel syndrome in primary care. National Institute for Health and Care Excellence (NICE), 2008. www.nice.org.uk
    • Simon C, Everitt H, van Dorp H. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press; 2010:426−7
    • Irritable bowel syndrome. The British Society of Gastroenterology. www.bsg.org.uk, accessed 29 January 2014
    • Irritable bowel syndrome. Medscape. www.emedicine.medscape.com, accessed 15 January 2014
    • Irritable bowel syndrome. NICE Clinical Knowledge Summaries. cks.nice.org.uk, revised February 2013
    • Irritable bowel syndrome. BMJ Best Practice. www.bestpractice.bmj.com, accessed 24 February 2014
    • Irritable bowel syndrome. Map of Medicine. www.mapofmedicine.com, published 24 September 2013
    • Halmos EP, Power VA, Shepherd SJ et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014; 146(1):67-75.e5. doi:10.1053/j.gastro.2013.09.046
    • UK evidence-based practice guidelines for the dietetic management of irritable bowel syndrome (IBS) in adults. McKenzie Y AA, Anderson W et al, 2010. www.bda.uk.com
    • Start Active, Stay Active. A report on physical activity for health from the four home countries’ Chief Medical Officers. Department of Health, 2011.www.gov.uk
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 24 January 2014
    • Tang QL, Lin GY, Zhang MQ. Cognitive-behavioral therapy for the management of irritable bowel syndrome. World J Gastroenterol 2013; 19(46):8605−10. doi:10.3748/wjg.v19.i46.8605
    • Ford AC, Talley NJ, Schoenfeld PS et al. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut 2009; 58(3):367−8. doi:10.1136/gut.2008.163162
    • Dai C, Zheng CQ, Jiang M et al. Probiotics and irritable bowel syndrome. World J Gastroenterol 2013; 19(36):5973−80. doi:10.3748/wjg.v19.i36.5973
    • Oral probiotics: an introduction. National Center for Complementary and Alternative Medicine (NCCAM). www.nccam.nih.gov, published January 2007
    • Probiotics for antibiotic-associated diarrhoea, clostridium difficile infection and irritable bowel syndrome: a review of clinical evidence and safety. Canadian Agency for Drugs and Technologies in Health. 17 January 2013. www.cadth.ca
    • Hoveyda N, Heneghan C, Mahtani KR et al. A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome. BMC Gastroenterology 2009; 9(15):1−11. doi:10.1186/1471-230X-9-15
    • Gastroenteritis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, revised September 2009
    • Zijdenbos IL, de Wit NJ, van der Heijden GJ et al. Psychological treatments for the management of irritable bowel syndrome. Cochrane Database of Systematic Reviews 2009, Issue 1. doi:10.1002/14651858.CD006442.pub2
    • Liu JP, Yang M, Liu Y et al. Herbal medicines for treatment of irritable bowel syndrome (Review). Cochrane Database of Systematic Reviews 2006, Issue 1. doi:10.1002/14651858.CD004116.pub2
    • Ulcerative colitis. Crohns and Colitis UK. www.crohnsandcolitis.org.uk, published 2011
    • Crohn's disease. Management in adults, children and young people. National Institute for Health and Care Excellence (NICE), 2012. www.nice.org.uk
    • Irritable bowel syndrome: a global perspective. World Gastroenterology Organisation, 2009. www.worldgastroenterology.org
    • Pediatric irritable bowel syndrome treatment and management. Medscape. www.emedicine.medscape.com, published October 2012
    • Personal communication, Mr Stephen Pollard, Consultant General Surgeon, Spire Leeds Hospital, 7 March 2014
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