This month I wanted to talk about irritable bowel syndrome. Okay, I know it's not glamorous, but it's an issue that I see a lot of women deal with. The problem is that the underlying cause of IBS is unknown, which makes it a tricky one to diagnose and to treat. There is also a lot of confusion surrounding the topic, so I wanted to break everything down for you, from the symptoms and diagnosis to how you can alleviate IBS through medication and diet. Keep scrolling for everything you need to know about irritable bowel syndrome.
Irritable bowel syndrome is a common disorder affecting the bowel and digestive tract. It has a variety of symptoms, including abdominal pain, bloating and bouts of alternating diarrhoea and constipation. The symptoms tend to come and go with or without a particular trigger.
It is a very common disorder, affecting 10–20% of the population, more commonly with women, and the underlying cause is unknown. However, the symptoms do seem to involve abnormal smooth-muscle activity within the bowel wall that leads to bowel spasms, pain and bloating.
Evidence also shows that the symptoms of IBS are associated with increased levels of anxiety, which has a direct effect on gut activity.
IBS is known as a “functional” disorder of the bowel. This means there is a problem with the function of the bowel, but there is no underlying structural abnormality of the bowel. So even when the symptoms of IBS are present, the cells in the bowel itself look exactly the same as those of a healthy bowel with no symptoms.
The symptoms can vary from person to person in terms of severity and frequency.
According to National Institute of Clinical Excellence, the symptoms that must be present to make the diagnosis of IBS include:
At least a six-month history of:
- Abdominal pain
- Change in bowel habit
Associated symptoms include:
- Abdominal pain relieved by bowel opening
- Symptoms triggered by eating
- Bladder symptoms
IBS is a clinical diagnosis; this means it is based on the presence of symptoms rather than a specific test, as there is no single test prove or disprove it.
If you have symptoms of abdominal pain, bloating and changing bowel habit between constipation and diarrhoea, you should visit you doctor for an assessment.
Typically your doctor will arrange some blood tests, including:
- Full blood count,
- Liver function test
- U and E (kidney function test)
- Inflammatory markers
If symptoms such as weight loss and diarrhoea are more prominent, other tests such as a coeliac screen and faecal calprotectin could be added, to test for coeliac disease and inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis.
If any of the following red-flag symptoms are present, your doctor will refer you urgently for further investigations including:
- Weight loss
- Blood in the stool
- Rectal bleeding
In the past, IBS was referred to as a diagnosis of exclusion. However, medical evidence now shows that exhaustive tests are not needed to reach this diagnosis.
The diagnosis of IBS can be made by your GP based on the clinical symptoms and the results of the blood tests above. Unless the red flag symptoms are present, referral to a specialist is not needed for the diagnosis or management of IBS. Ultrasound scans, colonoscopy and stool tests are not needed to diagnose IBS.
Unfortunately, there is no cure for IBS, but the symptoms can be effectively managed with a combination of medication, diet and lifestyle adaptations.
General dietary advice includes:
- Eat regularly. Avoid large gaps in between meals.
- Try to eat little and often, rather than large heavy meals.
- Drink plenty of fluids, at least two litres of water per day.
- Avoid excess caffeine; aim for 1–2 cups of tea/coffee per day.
- Avoid fizzy drinks.
- Adjust your fibre intake according to your symptoms; if you have diarrhoea, reduce the intake and if you have constipation increase it. It can be quite tricky to get the balance right. Consider limiting high-fibre foods, such as bran, processed foods and fruit.
FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. Foods high in FODMAPs, such as peaches, apples and cherries are thought to be linked to increasing the symptoms of IBS. Whereas foods low in FODMAPs are thought to help reduce the symptoms of IBS.
Your GP can direct you to information sources regarding FODMAP diets. It basically involves eliminating high FODMAP foods and adopting a low-FODMAP diet. The process also helps you to understand which food groups trigger your symptoms more than others and then help you build your meals and recipe ideas around this.
Want to try a low-FODMAP diet? Check out The Complete Low FODMAP Diet (£12).
Antispasmodic medications, such as Buscopan IBS Relief (£4), can be effective in reducing bowel spasms that can lead to many of the symptoms of IBS.
Peppermint oil has been shown to be equally effective as antispasmodics in reducing the symptoms of bowel symptoms, with very few reported side effects.
The use of laxatives to relieve constipation and loperamide to reduce diarrhoea can also be prescribed to reduce these symptoms in the short term.
A holistic approach to managing IBS is the best way to deal with symptoms in the long run. A key part of this is addressing underlying issues especially those related to mood and anxiety levels.
Simple steps including relaxation techniques, exercise and mindfulness to help the symptoms.
Your GP can also advise you regarding medications and refer you for counselling or cognitive behavioural therapy to help you manage the symptoms of anxiety long-term.
IBS is a functional disorder of the gut characterised by intermittent symptoms of abdominal pain, bloating and alternating diarrhoea and constipation.
The diagnosis is based on the presence of these symptoms, and the absence of more serious red flag symptoms.
There is no cure, but the symptoms can be effectively managed with diet, medications, lifestyle adaptations and addressing underlying emotional stressors, which can also have a large impact on the symptoms.
Next up! Dr. Jane Leonard talks about PCOS.