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Irritable bowel syndrome (IBS)


Expert reviewer Dr Ian Arnott, Consultant Gastroenterologist
Next review due September 2021

IBS is a common long-term condition that affects your digestive system. It causes pain or discomfort in your tummy and a change in your bowel habits.

About irritable bowel syndrome

About two in 10 people in the UK have IBS and get episodes six times a year or more. How long a flare up lasts varies from person to person and may change from one episode to the next.

You can develop IBS at any age, but you usually have your first symptoms when you’re between 20 and 30. Women are twice as likely as men to report having symptoms of IBS and it’s unusual to get them for the first time after the age of 50.

Symptoms of IBS can be mild or severe enough to affect your work and daily life. Although there’s no cure for IBS, lifestyle changes and other treatments can help. Most people’s symptoms fluctuate over time; some people’s symptoms may improve over time, while others may get worse.

You should speak to your GP about new or different symptoms to check what’s causing them.

Causes of irritable bowel syndrome

It’s still not clear why some people develop IBS and others don’t. But it’s thought that IBS may be caused by 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
  • an imbalance in the bacteria in your intestine

You may also be more likely to develop IBS if you’ve had abdominal or pelvic surgery. Past experience of physical or sexual abuse may also be a risk factor, although it’s not known why.

The brain–gut connection

Studies on IBS have also looked at the part the ‘brain–gut’ connection plays. There’s evidence IBS is caused by mechanisms in both the brain and the bowel. Some specific physical factors, like increased sensitivity to pain in your bowel, are linked to your central nervous system. The microbes in your gut are also part of this brain–gut connection. Psychological and social issues, such as stress and anxiety, contribute to whether you develop IBS symptoms and how long you have them. This is why it’s important to look after how you feel as well as your physical symptoms.

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Symptoms of irritable bowel syndrome

If you have IBS, your symptoms may just be an occasional nuisance. So you may not feel you need to see a doctor about your IBS again once you’ve been diagnosed. But if your symptoms make daily activities difficult, or they don’t feel normal for you, you should speak to your doctor. Outlined below are some of the symptoms of IBS.

  • Pain or discomfort in your tummy (abdomen). You may feel this low down or in the middle of your tummy. The discomfort may vary from a sudden sharp pain to a constant dull ache.
  • Changes in bowel habits, like needing to go more or less often than usual. You could go fewer than three times a week or more than three times a day. Your poo may vary in consistency and appearance, from hard and lumpy to loose and watery. You may alternate between constipation and diarrhoea – IBS may feature one or the other or a mix of both. You may also pass small amounts of mucus. Sometimes you may need to go to the toilet urgently, and at other times you may have problems going and need to strain. After going to the toilet, your bowels may feel like they haven't been completely emptied.
  • Your abdomen may look and feel bloated. This can get worse during the day, and may be eased by breaking wind.

IBS symptoms can come and go – you may not have any symptoms for months and may then have a sudden flare-up. They can be linked to going to the toilet and eating, which may make individual symptoms, like tummy pain, better or worse.

You may find your symptoms get worse:

  • during times of stress and major life events
  • after eating certain foods, for example fatty foods
  • when you’re taking certain antibiotics

IBS can cause other symptoms too. These include:

  • feeling very tired
  • indigestion
  • feeling sick
  • backache and other muscle or joint pains
  • trouble sleeping
  • regular headaches
  • problems with your bladder, such as needing to pass urine more often and urgently, particularly at night
  • painful sex
  • difficulty controlling your bowels, such as leaking faeces when you break wind

These symptoms may be caused by problems other than IBS, such as infections, an over or underactive thyroid, or side-effects of medicines you’re taking. Some can be signs of conditions such as pancreatitis, peptic ulcers, gallstones, diverticular disease or types of cancer. In women they may be linked to premenstrual syndrome (PMS) and endometriosis (which affects your womb). IBS shares some symptoms with inflammatory bowel disease (IBD) – see our FAQs for more details of the differences between them.

If you have, or are concerned about any of these symptoms, contact your GP. You should particularly see your doctor if you’ve got IBS symptoms – especially tummy pain and weight loss – for the first time when you’re over 50. You should also discuss any new symptoms or changes with your doctor too.

Diagnosis of irritable bowel syndrome

Your GP will ask about your symptoms and may examine you. They’ll also ask about your medical history.

Your GP will ask you about your pain; when you notice it, and what makes it better or worse. They’ll 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 stool looks like.

For help checking your poo see our infographic below.

Checking your poo infographic


The doctor will also ask about your own and your family’s medical history. They may talk to you about your eating habits to identify food and drinks that may be linked to your symptoms.

The doctor will talk to you about how your symptoms affect your home and work life. It’s important to discuss any worries you have with your GP. IBS is often linked to feelings of anxiety or depression, so talking about how you feel is important. The doctor may ask about any recent stress, for example, or past physical or sexual abuse, as this may be linked to your IBS.

Your GP may examine you to rule out other possible causes. This may involve looking at, feeling and listening to your tummy, and examining your bottom (rectum). The doctor may want to check if you’ve lost weight.

Diagnosis is generally based on having typical IBS symptoms for at least six months. But although IBS can’t be confirmed with a test, your GP may recommend some to rule out other conditions. These could be tests on your blood and stool samples; for example, to check if you’ve got IBD rather than IBS. Other tests might include an ultrasound, X-ray, computer tomography (CT) scan, sigmoidoscopy or colonoscopy.

You’ll need to have further tests if you have other symptoms such as:

  • unexplained weight loss
  • blood or mucus in your stool
  • bowel problems that first developed after you turned 50
  • diarrhoea that lasts for longer than six weeks
  • anaemia
  • fever

You may also be advised to have further tests if you have a family history of bowel or ovarian cancer. Your doctor may be particularly concerned if you have symptoms at night.

Symptom diary for irritable bowel syndrome

If you have, or think you might have, IBS, keeping track of certain things can help you and your doctor understand what’s happening.

There are online and app-based food diaries available, or you might like to use our downloadable food diary below. If so, you should use this diary for two to four weeks and then share your completed diary with your doctor. Together, you can find out what’s going on and decide a treatment plan that’s right for you.

Click on the icon below to download the diary (PDF, 1MB).

IBS diary image

How to help yourself

There’s no cure for IBS, but changes to your diet and lifestyle may help to improve your symptoms.

Diet advice

You may find some of the following dietary measures help. What works for you may depend on your main symptoms, particularly whether you mostly get constipation or diarrhoea.

  • Eat regular meals and give yourself plenty of time to eat them. Avoid missing meals or leaving long gaps between eating.
  • Make sure you drink at least eight cups of fluid every day, especially water and drinks that don’t contain caffeine, like herbal teas. Try to drink no more than three cups of caffeinated drinks, such as tea and coffee, each day. Don’t drink too much alcohol or fizzy drinks.
  • It may help to either increase the amount of fibre you eat, or reduce it, especially high-fibre foods like brown rice or wholemeal bread. If your doctor suggests eating more fibre, try to eat soluble rather than insoluble fibres (like bran). Soluble fibres include things like oats, nuts and seeds, or fruits like bananas. Be sure to monitor how any change to the type and amount of fibre you eat affects your symptoms. You can start to build up a picture of what works and doesn’t work for you. Your doctor will be able to make suggestions too.
  • Try to limit the amount of processed foods you eat. These may contain 'resistant starch' that’s 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, chewing gum and drinks.
  • 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 yogurts and food supplements. It’s thought that certain probiotics can help to ease IBS symptoms, but more research is needed to make sure they definitely do. If you decide to try probiotic supplements, stick to one brand and take them at the recommended dose for at least four weeks. See our FAQs for more information on probiotics and IBS. There’s no evidence prebiotics can help IBS.
  • Reducing the amount of certain sugars in your diet may help your symptoms, especially bloating and tummy pain. These are found in FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) foods, which are hard to digest. They include onions, wheat, beans, lentils, milk, mushrooms, honey and apples. You should get advice from a dietitian before starting a low-FODMAP diet.

Common triggers

Nine out of 10 people with IBS say certain foods trigger their symptoms. You may find it helpful to record what you eat in our symptoms diary above, particularly if you’re prone to diarrhoea. Common ‘trigger’ foods include dairy products, citrus fruits, caffeine, chocolate, alcohol, tomatoes and eggs. There’s no definite evidence, but for some people a gluten-free diet may help.

Speak to your GP before making major changes to your diet, especially if you’re pregnant or have another medical condition. They can refer you to a dietitian for specialist advice.

Lifestyle advice

Your doctor may discuss how much physical activity you do, and ways you could do more. Regular exercise may help to reduce your symptoms. Aim to do at least 30 minutes of moderate exercise a day, on at least five days each week.

Your GP may also advise you on losing weight if you’re overweight or obese.

It’s important to make time for leisure activities and to relax, especially if your symptoms seem to be triggered by stress.

You may find it helpful to talk to other people who are in a similar situation to you. There are charities that help support people with IBS and some may organise or suggest self-help groups that you may find useful.

If these self-help measures don't work, see your GP for advice. They can help you identify anything that may be making your IBS worse, and suggest other treatments. They may also want to refer you to a gastroenterologist (a doctor who specialises in identifying and treating conditions that affect the digestive system) to confirm your IBS diagnosis.

Treatment options for irritable bowel syndrome

As well as diet and lifestyle changes, you may also wish to try medicines and talking therapies. The treatments you’re offered will depend on your particular symptoms and what’s causing them. Your GP will help you decide which treatments are best for you.

Medicines

If your symptoms don’t improve with diet and lifestyle changes, you may wish to try medicines. Several over-the-counter medicines may relieve some of your IBS symptoms, particularly constipation and diarrhoea. Speak to your pharmacist about what is available.

Your GP may also try you on different medicines to see what works best for you. You may need to take a combination of these to control your symptoms.

Medicines for constipation

Laxatives such as ispaghula can help if you have constipation. These are known as bulk-forming laxatives. Bowel-stimulating laxatives (such as senna) may also help, but should only be used for a short while. Speak to your GP if you find you’re using laxatives regularly but are still constipated.

Another type of medicine used to treat IBS with constipation is linaclotide. And if these medicines fail to work, your doctor may prescribe a medicine called prucalopride.

Medicines for diarrhoea

If you have diarrhoea, antidiarrhoea medicines, such as loperamide, may help. But don’t take them for more than five days in a row without your doctor’s advice.

Medicines for tummy pain and wind

If you have pain, paracetamol can help reduce this.

Antispasmodic medicines, such as mebeverine hydrochloride, hyoscine butylbromide and peppermint oil capsules, may help your abdominal pain and wind. Again, speak to your GP if you find you need to use these regularly.

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. Your doctor will want to monitor you regularly.

There’s no evidence to suggest that alternative treatments like acupuncture, reflexology, or taking aloe vera or charcoal can help IBS symptoms, but some people may find these helpful.

Talking therapies

Anxiety and depression are often linked to IBS, and psychological factors can contribute to how severe symptoms are. If your symptoms don't improve with medicines, your GP may recommend psychological treatments.

Talking treatments, such as cognitive behavioural therapy (CBT), hypnotherapy or psychotherapy, may help to relieve your IBS symptoms. But research is still ongoing, and there’s not enough evidence of the benefits of mindfulness.

If you would like to try a talking therapy, your GP may be able to suggest a suitable therapist. You can also look for a therapist yourself. If you do this, make sure you check they’re fully qualified and registered with a relevant professional organisation.

Frequently asked questions

  • You may develop IBS after a bout of food poisoning (gastroenteritis). Three in 10 people get IBS symptoms after severe gastroenteritis.

    Gastroenteritis is caused by an infection that leads to diarrhoea and vomiting, which usually clears up on its own after a short while. In the UK, about two in 10 people get gastroenteritis each year. Learn more about gastroenteritis.

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

    An infographic from Bupa UK on how to wash your hands properly

  • Many people with IBS can trace their first symptoms back to childhood, although they may not have seen their doctor about it then. Young children may not be able to accurately describe their symptoms, making it harder to diagnose. But according to studies in Asia and the US, as many as two in 10 children and adolescents may have IBS. Tummy pain linked IBS is a leading cause of school absences.

    Children experience similar IBS symptoms to adults. Bloating is less common, but three in 10 children with IBS have symptoms of nausea, vomiting and indigestion. These can be triggered by problems at school and with eating, including overeating.

    Most children have only mild symptoms. But a minority have more severe symptoms that can affect their normal daily activities and school attendance and performance.

    Your child’s doctor may suggest changes to their diet and lifestyle. This could include increased fibre. The recommended daily fibre intake for children is 15g for two-to-five-year olds, 20g at ages five to 11, and 25g for adolescents. There’s no evidence low-FODMAP diets work for children.

    Osmotic laxatives and stool softeners can help if your child’s main symptom is constipation, as these are generally safe for regular use. Antidiarrheal medicines can ease diarrhoea and you should make sure your child gets enough replacement fluids. The doctor may also suggest counselling and hypnotherapy, and referral to a paediatric gastroenterologist. This is a children’s doctor who specialises in diagnosing and treating conditions that affect the digestive system.

  • Probiotics contain live bacteria and yeasts that may help to keep you healthy.

    You can buy probiotics as food supplements (capsules or tablets) from your pharmacist, supermarkets or health food shops. You can also buy probiotics as yogurts or drinks.

    Because there are so many different types, it’s not fully known whether probiotics actually work. Some people with irritable bowel syndrome (IBS) find probiotics help relieve gas, bloating and pain. They’re unlikely to help diarrhoea but could generally regulate your bowel habits.

    If you choose to take probiotics for IBS, take them for four weeks at the recommended dose to see if they help your symptoms. Always read any patient information that comes with them. For most people, probiotics aren’t thought to be harmful or have serious side-effects.

  • IBS and inflammatory bowel disease are two different conditions, but they can cause some similar symptoms.

    Inflammatory bowel disease describes conditions that cause inflammation in your bowel. It usually refers to Crohn’s disease and ulcerative colitis.

    Crohn's disease can affect any part of your digestive system from your mouth, down through your stomach and bowel to your anus. It can cause mouth ulcers, an urgent need to open your bowels, tummy pain and diarrhoea (which may be bloody).

    In ulcerative colitis, the lining of your large bowel and back passage (rectum) becomes inflamed and develops ulcers. The main symptoms are bloody diarrhoea, an urgent need to go to the toilet and open your bowels and pain in your tummy.

    If you have IBS, you don’t have any inflammation in your bowel.

    Since IBS and inflammatory bowel disease can cause similar symptoms, it can be difficult to know which condition you have. But if you have inflammatory bowel disease, you may also have other symptoms, particularly:

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

    Depending on whether you have Crohn’s disease or ulcerative colitis, other symptoms can include tiredness, sore eyes, mouth ulcers and arthritis.

    See your GP if you have any of these symptoms. If your GP thinks you may have inflammatory bowel disease or something else wrong with your bowel, you’ll need to have some tests. Tests on a stool sample from your first bowel movement of the day can help differentiate between IBS and inflammatory bowel disease. This is known as faecal calprotectin. It’s important to have a correct diagnosis so you can be offered the right treatment.


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  • Reviewed by Laura Blanks, Specialist Health Editor, September 2018
    Expert reviewer Dr Ian Arnott, Consultant Gastroenterologist
    Next review due September 2021



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