Irritable Bowel Syndrome: Information Booklet for Patients & Caregivers

What is Irritable Bowel Syndrome and who gets it?

Imtable Bowel Syndrome (IBS) is a common functional disorder of the gut. (The gut includes the bowels) A functional disorder is one where there is a problem with the function of a part of the body, but were there is no abnormality in the structure. So, in IBS, the function of the gut is upset, but all parts of the gut look normal, even when looked at under a microscope.

IBS causes abdominal pain and other symptoms (listed below). Up to 1 in 5 people in the UK develop IBS at some stage in their life. IBS can affect anyone at any age, but it commonly first develops in young adults and teenagers. Women are affected more often than men.

What are the symptoms of Irritable Bowel Syndrome?

  • Pain and discomfort may occur in different parts of the abdomen. Pain usually ‘comes and goes. The length of each bout of pain can vary greatly. The pain often eases when you pass stools (motions or feces) or wind. Many people with IBS describe the pain as a ‘spasm’ or ‘colic’. The severity of the pain can vary from mild to severe, both from person to person, and from time to time in the same person.
  • Bloating and swelling of your abdomen may develop from time to time. You may pass more wind than usual
  • Stools (sometimes called motions or feces)
    • Some people have bouts of diarrhea, and some have bouts of constipation.
    • Some people have bouts of diarrhea that alternate with bouts of constipation.
    • Sometimes the stools become small and pellet like. Sometimes the stools become watery or ribbony.
    • At times, mucus may be mixed with the stools. Occasionally, you may pass mucus alone when you go to the toilet.
    • Many people have a feeling of not fully emptying their rectum after going to the toilet.
    • Some people have urgency, which means you have to get to the toilet quickly. A morning rush’ is common That is, you feel an urgent need to go to the toilet several times shortly after getting up This is often during and after breakfast.
  • Other symptoms sometimes occur and include nausea (feeling sick). headache, belching, poor appetite, tiredness, backache, muscle pains, feeling quickly fuir after eating, heartburn, and bladder symptoms (an associated irritable bladder’).

Some people have occasional mild symptoms Others have unpleasant symptoms for long periods. Many people fall somewhere in between, with flare-ups of symptoms from time to time. Some doctors group people with IBS into one of three categories:

  • Those with abdominal pain or discomfort, and the other symptoms are mainly bloating and constipation.
  • Those with abdominal pain or discomfort, and the other symptoms are mainly urgency to get to the toilet and diarrhea.
  • Those who alternate between constipation and diarrhea.

However, in practice, many people will not fall neatly into any one category, and considerable over-lap occurs

Note: passing blood is not a symptom of IBS. You should tell a doctor if you pass blood

Do I need any tests?

There is no test that confirms the diagnosis of IBS. A doctor will diagnose IBS from the typical symptoms. However, some tests are done in some cases to rule out other conditions such as ulcers, colitis, gut infections, etc. For example, tests may be done if symptoms are not typical, or if you develop symptoms of IBS in later life (over the age of about 45) when other conditions need to be ruled out.

What causes Irritable Bowel Syndrome?

The cause is not clear. It may have something to do with over-activity of parts of the gut. The gut is a long muscular tube that goes from the mouth to the anus. The small and large bowel (also called the small and large intestine) are parts of the gut inside the abdomen. Food is passed along by regular contractions (squeezes) of the muscles in the wall of the gut Pain and other symptoms may develop if the contractions become abnormal or overactive. The area of over-activity in the gut may determine whether constipation or diarrhea develops. The cause of over-activity in parts of the gut is not clear. One or more of the following may play a part:

Over-activity of the nerves or muscles of the gut. It is not known why this may occur. It may have something to do with over-activity of messages sent from the brain to the gut. Stress or emotional upset may play a role. About half of people with IBS can relate the start of symptoms to a stressful event in their life. Symptoms tend to become worse during times of stress or anxiety.

Intolerance to certain foods may play a part in some cases. However, this is thought to be only in a small number of cases.

Infection and bacteria in the gut. IBS is not caused by an ongoing gut infection However, in about 1 in 6 cases, the onset of symptoms seems to follow a bout of gastroententis (a gut infection which can cause diarrhea and vomiting). So, perhaps a virus or other germ may sensitize or trigger the gut in some way to cause persisting symptoms of IBS Also, in some cases, symptoms get worse after taking a course of antibiotics Antibiotics kill certain harmless bacteria in the gut which changes the balance of bacteria types in the gut.

What are the treatments for Irritable Bowel Syndrome?

Many people are reassured that their condition is IBS, and not something more serious such as colitis. Simply understanding about IBS may help you to be less anxious about the condition, which may ease the severity of symptoms Symptoms often settle for long periods without any treatment in some cases, symptoms are mild and do not require treatment. If symptoms are more troublesome or frequent one or more of the following may help

Foods, drinks and lifestyle

Some people with IBS find that one or more foods can trigger symptoms, or make symptoms worse (food intolerance or sensitivity) Food intolerance is more common in people with 185 who have diarrhea as a main symptom. If you are not sure if a food is causing symptoms, it may be worth trying a bland diet if symptoms are difficult to control. For example, one meat, one fruit, and one vegetable. (ideally, this is best done under the supervision of a dietician.) Then, add in different foods gradually to your diet to see if any cause the symptoms. It may be possible to identify one or more foods that cause symptoms. This can be a tedious process, and often no problem food is found. However, some people say that they can control their symptoms by identifying one or more foods that cause symptoms, and then not eating them.

The foods that are most commonly reported to cause IBS symptoms are wheat (in bread and cereals), rye, barley, dairy products, coffee (and other caffeine-rich drinks such as tea and cola), and onions.

Some people report an improvement in symptoms when they cut down from drinking a lot of alcohol or stop smoking if they smoke. Regular exercise may also help to ease symptoms Stress and other emotional factors may trigger symptoms in some people.

It may help to keep a food and lifestyle diary for 2-4 weeks to monitor symptoms and activilles, Note everything that you eat and drink, times that you were stressed, and when you took any formal exercise. This may identify triggers such as a food, alcohol, or emotional stresses, and may show if exercise helps to ease or prevent symptoms.

Treating constipation

Constipation is sometimes a main symptom of 1BS if so, it often helps to eat foods with plenty of fiber, and to drink plenty (two liters of fluids per day or more to keep the stools moist) Fiber (roughage) is the part of the food which is not absorbed into the body it remains in your gut, and is a main part of the stools You can eat plenty of fiber by eating plenty of fruit, vegetables cereals fruit juice, wholemeal bread, etc.

If increasing Tiber and fulds does not ease constipation then bulk-forming taxatives (sometimes called fiber supplements) can help These increase the bulk of your faeces and are not mediones’ as such Unprocessed bran is the cheapest. You can sprinkle bran on breakfast cereals, or mix it with fruit juices, stews, soups, yoghurts, crumbles, scones, etc. Alternatives are Ispaghula husk methylcellulose and Sterculia You can buy these from pharmacies and health food shops or get them on prescnption. Their full effect may take some days to develop.

A role of caution fiber and buik-forming taxatives partly work by absorbing water (a bit like blotting paper) The combination of plenty of fiber or bulk forming laxatives and fluid produces sof bulky stosis which should be easy to pass out when you go to the toliet When you eat a high fiber diet or take bulk forming laxatives you should drink plenty A least two lers per day (8-10 cups) The feces may become dry and difficult to pass out if you do not have enough to drink Very rarely, lots of fiber or bulk-forming laxatives and not enough fluid causes an obstruction in the gut.

Note: fiber or bulk-forming laxatives do not usually help with other symptoms of 185 such as pain or bloating. Also, in some people with IBS, especially those with diarrhea, extra fiber or bulk-forming taxatives makes symptoms worse (particularly bloating). So, it may not be such a good idea to increase fiber or take bulk-forming taxatives if you are not constipated.

Sometimes other types of laxatives are advised for short periods if the measures above are not enough to ease a troublesome bout of constipation.

Treating diarrhea

An anti-diarrhea medicine may be useful if diarrhea is a main symptom. Loperamide is the most commonly used anti-diarrhea medicine for 1BS You can buy this at pharmacies. You can also get it on prescription which may be more cost effective if you need to take it regularly.

The dose of Loperamide needed to control diarrhea varies considerably. Many people use Loperamide ‘as required’ but some take it regularly. Many people learn to take a dose of Loperamide in advance when they feel diarrhea is likely to be a problem. For example, before going out to places where they know it may be difficult to find a toilet.

Antispasmodic medicines

These are medicines that relax the muscles in the wall of the gut. Your doctor may advise one if you have spasm-type pains. There are several types of antispasmodics and they work in sightly different ways Therefore, if one does not work well, it is worth trying a different one. If one is found to help, then you can take it as required when pain symptoms flare-up. Many people take an antispasmodic medicine for a week or so at a ume to control pain when bouts of pain flare-up. Some people take a dose before meals if pains tend to develop after eating. Note: pains may ease with medication but may not go away completely.

Antidepressant medicines

An antidepressant medicine in the Tricyclic group is sometimes used to treat IBS In particular, it tends to work best if pain and diarrhea are the main symptoms (Tricyclic antidepressants have other actions separate to their action on depression. They are ined in a variety of painful conditions, including IBS) Unlike antispasmodics, you need to take an antidepressant regularly rather than as required. Therefore, an antidepressant is usually only advised if you have persistent symptoms, or frequent bad flare-ups that have not been helped by other treatments.

Psychological treatments (talking treatments)

Situations such as family problems work stress, exams, recurring thoughts of previous abuse etc, may trigger symptoms of IBS in some people People with anxious personalities may find symptoms difficult to control. The relationship between the mind brain, nervous impulses, and over-activity of internal organs such as the gut is complex. Some people have found such things as relaxation techniques, stress counseling, cognitive behavior therapy, psychotherapy, hypnotherapy, and similar therapies useful in controlling symptoms of IBS.

Psychological treatments are generally mainly considered in people with moderate to severe IBS, when other treatments have failed, or when it seems that stress or psychological factors are contributing to causing symptoms However, some of these treatments may not be available on the NHS in your area, or there may be long waiting fists

What is the outlook (prognosis)?

In most people with IBS, the condition tends to persist long-term. However, the severity of symptoms tends to wax and wane’ and you may have long spells without any symptoms, or with only mild symptoms. Treatment can often help to ease symptoms when they flare-up. In a minority of cases, symptoms clear for good at some stage.

IBS does not shorten your expected life span; it does not lead to cancer of the bowel. and does not cause blockages of the gut or other serious conditions.