Irritable bowel syndrome (IBS) is a long-term condition that causes recurring pain or discomfort in the abdomen (tummy) and altered bowel habits. It can develop at any age, but most people have their first symptoms between the ages of 15 and 40. Women are more likely than men to get IBS and to have more severe symptoms. About one in seven Australians have symptoms of IBS.
IBS is what’s known as a functional disorder. This means that although there’s a change in how your gut functions, no corresponding change in structure can be seen if it’s examined, via biopsies and X-rays for example. It’s one of the most common problems of the digestive system, typically causing pain in the abdomen, bloating, constipation or diarrhoea.
Most people with IBS find their symptoms an occasional nuisance but don't feel the 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, visit your GP for more advice.
People with IBS often continue to get symptoms from time to time, and these symptoms include:
The most common symptom of IBS is pain or discomfort in the abdomen, such as stomach cramps. The pain ranges from mild to severe, and may be made better by opening the bowels or passing wind. It is often made worse by eating.
Pain may occur at a particular time of day, often in the evening. Women often find the ups and downs of pain seem to parallel and may be related to their menstrual cycle.
Your faeces may vary in consistency from hard and pellet-like to loose and watery. Alternatively, you may just pass small amounts of mucus. Your bowel movements may alternate between constipation and diarrhoea. 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.
Often, one IBS symptom will recur more often than the others – either pain, constipation or chronic diarrhoea.
Other symptoms that are sometimes present in IBS include:
It’s important to note that these symptoms are not specific to IBS. They may be caused by problems other than IBS, including coeliac disease which is a sensitivity to gluten (a protein found in wheat and other cereals) that can damage the lining of the intestine. If you have these symptoms, it is very important not to self-diagnose and to see your GP instead, who will investigate for the presence of coeliac disease or other conditions.
For more information about coeliac disease and a gluten-free diet, click here.
The exact cause of IBS is unknown. It's likely a combination of:
Symptoms can be triggered by stress, whether it’s from work anxieties, exams, relationship difficulties, or life events such as divorce or bereavement. They may get worse after eating specific foods and drinks, such as tea, coffee and fatty foods, for example. Antibiotics and non-steroidal anti-inflammatory medicines, such as ibuprofen and diclofenac, can also make symptoms worse.
It’s important not to self-diagnose IBS because a number of conditions, such as coeliac disease, Crohn’s disease, ulcerative colitis and endometriosis, have similar symptoms. So to exclude other possible diagnoses, see your GP.
Your GP will ask about your symptoms and examine you and may also ask about your medical history. You’ll also be asked about your pain, when it comes on and what makes it better or worse. They may also ask about your bowel movements, for example, how often you open your bowels, how easy this is and what your faeces look like. You may also be asked to have some blood tests.
If you have typical IBS symptoms and are under 50, you may not need further tests. However, your GP might refer you for further tests if your symptoms can be linked to other bowel conditions. These symptoms include:
Your GP may refer you for a sigmoidoscopy or a colonoscopy. This involves using an endoscope, a flexible, tube-like instrument, to look inside your bowel. A specialist doctor may take a biopsy (a small piece of tissue) from your bowel lining for examination in a laboratory. This test helps to rule out more serious conditions.
If your GP thinks your IBS may be caused by an infection, you’ll be asked to give a sample of faeces. This will be sent to a laboratory for tests. You may also need an X-ray of your abdomen. This is called a barium enema and in this test, a liquid containing a small amount of barium, a type of metal, is passed through a tube into your rectum where it enters the large intestine. The barium allows inflamed or ulcerated areas of the colon to show up clearly on X-ray images.
Although there is no simple cure for IBS, there are treatments that can help reduce the symptoms. These include changes to your lifestyle, medicines and psychological treatments. With the help of your GP, you can decide which is most suited to you.
Because IBS is a syndrome and not a disease, it cannot be cured. But once you know your own personal triggers – whether it be foods, components in foods or stress – there are things you can do to take control and ease your symptoms.
Diet advice
For most people with IBS, a healthy lifestyle is the best way to improve symptoms. The following general advice about diet may help.
New advances in IBS treatment – the low FODMAP diet
Researchers from Melbourne’s Monash University have found that eating a diet that is low in certain carbohydrates (sugars) helped to alleviate symptoms in 75 percent of the IBS patients they treated. These carbohydrates are called FODMAP for short - an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. Essentially, these are molecules in foods that are not well digested and absorbed by some people with IBS symptoms. A low FODMAP diet is increasingly being advised by dietitians in the treatment of IBS but it must be done under the care and guidance of an Accredited Practising Dietitian.
Other lifestyle advice
Regular exercise is a good way to help reduce your symptoms by helping to keep your bowel movements regular and reduce stress.
If your symptoms are noticeably triggered by stress, try stress management or relaxation techniques. Keeping a diary to compare your symptoms with life events may also be helpful. If you recognise that certain events trigger your symptoms, it may be easier to deal with the problem that is causing the symptoms. If these self-help treatments don't work, see your GP for advice. They can help you identify factors that may be making your IBS worse, and suggest other treatments.
There are several non-prescription medicines available from your pharmacist that can relieve some of the symptoms of IBS, including:
Always read the accompanying consumer medicines information leaflet and if you have any questions, ask your pharmacist for advice.
Your GP may prescribe medicines for IBS. These include prescription-only versions of the medicines mentioned above. Sometimes low-dose antidepressants may be prescribed to help reduce the pain of IBS, even if you're not depressed.
If your symptoms don't improve after a year of treatment, your GP may consider psychological therapies. Talking treatments such as cognitive behavioural therapy, hypnotherapy or psychotherapy can help relieve the symptoms. These may be most useful for people who have personal difficulties to deal with. Your GP may refer you to a suitable therapist.
Dietitians Association of Australia
www.daa.asn.au
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Last published: 30 July 2011
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