Irritable Bowel Syndrome

What is it?
Irritable Bowel Syndrome (IBS) is a mix of abdominal symptoms for which there is no obvious cause. It is estimated that as many as one in five people suffer from it at some time in their lives, and it is the most common reason for consulting a gastroenterologist. Although unpleasant, IBS is not a life-threatening condition and doesn’t result in cancer or serious intestinal disease.

What are the causes?
We don’t know exactly what causes IBS, but around 50% of sufferers can date the start of their symptoms to a major life event such as bereavement, job change or house move. A smaller percentage can date it to a bout of gastroenteritis but in many people there is no identifiable trigger. Causes which may play a part in aggravation the problem are; food intolerances, infection or bacteria in the gut and use of antibiotics. Symptoms can occur at any age but is most common in teenagers and young adults and affects twice as many women as men.

What are the signs and symptoms?
The four most common symptoms are constipation, abdominal pain, bloating and diarrhoea. Other symptoms can include, excessive flatulence, gurgling noises from the stomach, rectal pain, headaches, and backache.
Because it can mimic many other intestinal disorders, you should consult your doctor if you have:

• difficulty swallowing when food gets stuck
• indigestion-type pain that wakes you up at night
•  unexplained weight loss
• bleeding from the back passage
• chronic, painless diarrhoea

Symptoms can ‘wax and wane’ and you could have long periods with no symptoms.

How is it diagnosed?
There is no single test to diagnose IBS, so it is usually made on the presence of a set of typical symptoms, especially in younger people. Sometimes tests will be undertaken to eliminate other conditions, including blood tests to rule out anaemia, other causes of inflammation and celiac disease. It is a good idea to keep a diary of your symptoms to discuss with your doctor.
Depending on the doctor’s assessment you may also need more investigations including:

• Endoscopy, examination of the oesophagus, stomach or large intestine with an endoscope.
•  Ultrasound

How is it treated?
There is no single treatment to deal with all symptoms of IBS but medicines can be used to treat specific symptoms. These include:

• antispasmodics to relieve stomach cramps
• bulk laxatives, such as Fybogel and Regulan, to relieve constipation. More powerful types, known as stimulant laxatives such as Senokot and Dulco-lax,  are not usually recommended as they can cause stomach cramps
• charcoal tablets and anti-foaming agents to disperse trapped gas. These include Wind-eze and Rennie deflatine
• anti-diarrhoeals such as Imodium
• tricyclic antidepressants are sometimes prescribed for symptoms not adequately responding to other treatment

Symptoms can be improved by:

• physical activity and exercise can improve digestion and reduce stress
• heat treatment with hot packs or hot-water bottles to relieve stomach pains
• reducing stress by using relaxation techniques

Is there anything I can do to prevent it?
As the causes of IBS are unknown it’s not possible to say how to avoid it but the best way to try to prevent it is to maintain a healthy digestive system. Current national guidelines about IBS include the following points about diet which may help to minimise symptoms:

• Have regular meals and take time to eat at a leisurely pace.
•  Avoid missing meals or leaving long gaps between eating.
• Drink at least eight cups of fluid per day, especially water or other non-caffeinated drinks such as herbal teas.
• Restrict tea and coffee to three cups per day (as caffeine may be a factor in some people).
• Restrict the amount of fizzy drinks to a minimum.
• Don't drink too much alcohol.
• Consider limiting intake of high-fibre food (though an increase may help in some cases).
• Limit fresh fruit to three portions (of 80 g each) per day.
• If you have diarrhoea, avoid sorbitol, an artificial sweetener found in sugar-free sweets (including chewing gum) and drinks, and in some diabetic and slimming products.
•  If you have a lot of wind and bloating consider decreasing intake of oats (for example, oat-based breakfast cereal or porridge) and linseeds (up to one tablespoon per day). You can buy linseeds from healthfood shops.