Irritable bowel syndrome (factsheet)

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This factsheet is for people who have irritable bowel syndrome (IBS), or who would like information about it.

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

About irritable bowel syndrome
Symptoms of irritable bowel syndrome
Causes of irritable bowel syndrome
Diagnosis of irritable bowel syndrome
Treatment of irritable bowel syndrome

About irritable bowel syndrome

IBS is one of the most common problems of the digestive system – about 1 in 10 people worldwide have IBS and it's nearly twice as common in women than in men.

IBS can develop at any age, but most people have their first symptoms between the ages of 20 and 35.

Symptoms of irritable bowel syndrome

Most people with IBS find their symptoms an occasional nuisance but don't need to see a doctor. However, for some people, the condition seriously affects their quality of life. If you find it difficult to cope with your symptoms, see a doctor.
Symptoms of IBS include the following.

Pain or discomfort in your abdomen is the most common symptom of IBS and it's often in your lower abdomen on the left-hand side. You may also get stomach cramps. The pain may be mild or severe and may ease if you open your bowels. It can often get worse if you eat. You may feel pain at a particular time of day, often in the evening. Women often find the pain relates to their menstrual cycle.
A change in bowel habit is another common symptom. Your faeces may vary in consistency and may alternate between constipation and diarrhoea. Alternatively, you may just pass small amounts of mucus. At times, you may feel an urgent need to open your bowels or this may feel strained. Afterwards, you may feel that your bowels haven't been completely emptied.
Your abdomen may feel bloated and may look swollen. This is more common in women.

These symptoms may 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 sick
indigestion
a headache
backache
tiredness
problems with your bladder, such as needing to urinate more frequently
problems with your sex life, such as pain during or after having sex, or a lack of interest in sex
anxiety
depression

These symptoms may be caused by problems other than IBS. If you have any of these symptoms, see your doctor for advice.

Causes of irritable bowel syndrome

The exact reasons why you may develop IBS aren't fully understood at present. It may be a combination of:

more frequent or stronger squeezing (contractions) of the muscles in the wall of your bowel – this can happen if the signals that travel from your brain to your gut when food passes through your digestive system are disrupted in some way
increased sensitivity to pain from inside your bowel
inflammation of your bowel, for example an infection such as gastroenteritis
your genetic make-up – you may inherit IBS

You may find that psychological factors, such as stress, may trigger your symptoms. Your symptoms may also get worse after eating certain foods, for example fatty foods.

Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and diclofenac, can also make your symptoms worse.

Diagnosis of irritable bowel syndrome

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

Your doctor will ask you about your pain, when it comes on and what makes it better or worse. He or she will also ask about your bowel movements, such as how often you open your bowels, how easy it is to go, what your faeces look like and if it has blood or mucus in it. There is no single test to confirm IBS therefore your doctor may ask you to have some further tests, such as blood tests, to rule out other conditions.

If you have typical IBS symptoms, it's unlikely you will need further tests. However, your doctor may refer you for further tests if your symptoms may be linked to more serious bowel conditions. These symptoms may include:

weight loss
blood or mucus in your faeces
bowel problems that first develop after age 50
a family history of bowel problems
diarrhoea that lasts longer than six weeks
anaemia

If your doctor thinks that your symptoms may be caused by an infection, you will be asked to give a sample of your faeces – also called a stool sample. This will be sent to a laboratory for testing.

Treatment of irritable bowel syndrome

Although there is no cure for IBS, there are treatments that can help to improve your symptoms. These include making changes to your lifestyle, taking medicines and psychological treatments. With the help of your doctor, you can decide which is best for you.

Self-help

For most people with IBS, making some lifestyle changes is the best way to improve your symptoms.

Diet advice

The following general advice about your diet may help.

Eat regular meals.
Drink enough fluids but try to limit caffeinated drinks, such as tea and coffee, to a maximum of three cups a day and also limit alcoholic and fizzy drinks.
Cut down on foods that are rich in insoluble fibre, such as wholemeal bread, wholegrain rice and cereals that contain bran when your symptoms get worse.
Eat no more than three portions of fruit a day.
Limit processed foods. These may contain 'resistant starch' that is difficult for your body to digest.
If you have diarrhoea, cut out artificial sweeteners such as sorbitol. This is used in some sugar-free sweets, drinks and diet products.
If you feel bloated, try eating oats, which are found in some cereals and porridge, and a tablespoon of linseeds each day.

You may find it helpful to keep a food diary for two to four weeks to see if certain foods cause your symptoms. Always speak to your doctor before changing your diet as advice may differ depending on your symptoms. If certain foods still seem to bring on your symptoms after trying this diet advice, it may help to see a dietitian.

Lifestyle advice

Regular exercise is a good way to help reduce your symptoms. It helps keep your bowel movements regular and reduces stress. The World Health Organization recommends doing 150 minutes (two and a half hours) of moderate exercise over a week. You can do this by carrying out 30 minutes at least five times a week.

If your symptoms are noticeably triggered by stress, try learning stress management or relaxation techniques.

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

Medicines

There are several over-the-counter medicines available from your pharmacist that can relieve some of your symptoms of IBS.

Antidiarrhoea medicines, such as loperamide, may help. However, only take them as and when you need them and not on a regular basis.
Laxatives, such as ispaghula husk, can help if you have constipation. These are bulk-forming laxatives. Stronger laxatives called bowel-stimulating laxatives, such as senna, may also help. However, if you find you need to take them quite often it's important to speak to your doctor.
Antispasmodic medicines, such as mebeverine hydrochloride, alverine citrate and peppermint oil capsules, may help with stomach cramps and wind. Again speak to your doctor if you find you need to use these often.
Probiotics contain helpful bacteria and yeasts and are contained in some yoghurts. There is some evidence that certain strains can be helpful for IBS symptoms, but this isn't conclusive.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol (acetaminophen). Don't take ibuprofen or aspirin (acetylsalicylic acid) as they may make your symptoms worse.

Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Your doctor may prescribe you medicines for IBS. These include prescription-only versions of the medicines mentioned above. Your doctor may also prescribe you a low-dose antidepressant as this can reduce the pain of IBS, even if you're not depressed.

Talking therapies

Your doctor may consider referring you for psychological treatment.

Talking treatments, such as cognitive behavioural therapy (CBT), hypnotherapy or psychotherapy can help relieve the symptoms of IBS. These are often useful for people who have personal difficulties to deal with. Your doctor can refer you to a suitable therapist.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

What are probiotics and how can they help with symptoms of irritable bowel syndrome?
I've heard that a bout of food poisoning can cause irritable bowel syndrome. Is this true?
Are there any complementary medicines I can try to help with my irritable bowel syndrome symptoms?
My son has irritable bowel syndrome and it interferes with his school life. What can I do to help him?

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

Answer

Probiotics are a food supplement. They contain live bacteria and yeasts that can be helpful in restoring the balance of bacteria in your gut. Some people with irritable bowel syndrome (IBS) find them helpful in controlling their symptoms.

Explanation

Probiotics are food supplements containing live bacteria and yeasts that help restore the balance of bacteria in your gut. Bacteria are often thought of as harmful and causing ill-health, but there are many good bacteria that live in and on your body that help keep you healthy. This is especially so in your gut. Good bacteria in your gastrointestinal tract may prevent harmful organisms from growing in your bowel or entering your body through your intestine. Some people think that taking probiotics helps to keep the levels of bacteria in your gut even, keeping it working efficiently.

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. Probiotics can also be bought as yogurts or drinks (eg Danone, Activa or Actimel).

Research into the effectiveness of probiotics in treating IBS has produced conflicting results. Some studies have found that they do help relieve symptoms of IBS, whereas others have found that they don't. It's recommended that people with IBS take probiotics for a trial period of four weeks to see how they find them. If they have made no difference to your symptoms after this time, either stop taking them or try a different brand.

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

Further information

The British Dietetic Association
www.bda.uk.com

Sources

Irritable bowel syndrome. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 19 August 2009
Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care. National Institute for Health and Clinical Excellence (NICE), 2008. www.nice.org.uk
Probiotics. The British Dietetic Association, 2007. www.bda.uk.com

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

Answer

Yes, after a bout of food poisoning (gastroenteritis) there is a risk of developing irritable bowel syndrome (IBS), particularly when it is caused by certain bacteria.

Explanation

Gastroenteritis is an inflammation of your stomach and intestines caused by an infection. In the UK, about one in five people are affected by 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 dairy, eggs and poultry
campylobacter, often from dairy, meats and poultry
bacillus, from reheated rice
vibrio, often from seafood
Escherichia coli (E. coli), often from minced beef

Approximately one in 14 people who have had bacterial gastroenteritis will go on to develop symptoms of IBS. You are at particular risk if you are female or if you had diarrhoea for a long period of time during your bout of gastroenteritis.

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

Further information

Food Standards Agency
www.eatwell.gov.uk

Sources

Gastroenteritis. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 24 August 2009
American Journal of Gastroenterology 2003; 98 (9):1970–75
Gastroenteritis and irritable bowel syndrome. GP Notebook. www.gpnotebook.co.uk, accessed 24 August 2009
Neal KR, Hebden J, Spiller R. Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome: postal survey of patients. BMJ 1997; 314: 779.

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

Answer

Complementary medicines aren’t recommended to treat symptoms of irritable bowel syndrome (IBS).

Explanation

Some research has suggested that using relaxation techniques, biofeedback and herbal medicine may be helpful in controlling symptoms. The evidence is limited and more research is needed to be certain of their effectiveness, although the same could be said of many approaches to the treatment of IBS.

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

Sources

Irritable bowel syndrome. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 24 August 2009
Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care. National Institute for Health and Clinical Excellence (NICE), 2008. www.nice.org.uk

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

Answer

Children with irritable bowel syndrome (IBS) do sometimes find that their symptoms can interfere with school. However, by keeping your child's teachers informed about his or her condition and how it affects them, you may be able to keep this disruption to a minimum.

Explanation

Having a child with IBS can be difficult, especially if his or her symptoms are bad enough to interfere with schooling. However, there are things you can do as a parent to make things easier for your child.

It's important to let your child's school know about his or her condition, and to make sure this information filters down to the teachers. This will make it easier for your child to leave classes in a hurry if he or she needs to do so without drawing unnecessary attention. Also, it helps if the school nurse is aware of the situation so your child can get medicines (if needed) without having to explain every time and feel embarrassed.

Some children may need to take time off school if their symptoms are particularly bad. If this happens, it's useful to set up a system whereby your child can receive school work on a regular basis to do at home. This will stop him or her falling behind, making returning to the classroom easier.

It's also important to ensure that during your child's time away from school, he or she maintains contact with friends. This will help to keep some normality in your child’s life and may help take his or her mind off the symptoms.

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

Further information

The Gut Trust
0872 300 4537
www.theguttrust.org

Sources

Coping at school. The Gut Trust. www.theguttrust.org, accessed 24 August 2009