Irritable bowel syndrome

Last published:Nov 30, 2023

If you have irritable bowel syndrome, you may want to talk to your doctor to find out more. Here are some questions that you might want to ask.

• How do you know I have irritable bowel syndrome?

• Could it be a more serious illness?

• Do I need any tests?

• Do you know what's causing it?

• What treatment do I need?

• What should I do if treatment doesn't work?

• What medicines can I take to help with pain, diarrhoea, or constipation? 

• What can I do myself to help control my symptoms?

• Do I need to change my diet?

• Does stress make my irritable bowel syndrome worse?

• Are there any alternative or complementary treatments?

• Will irritable bowel syndrome ever go away?

Last published:Nov 30, 2023

Irritable bowel syndrome (IBS) is a condition that can cause stomach pain, cramps, bloating, constipation, and diarrhoea. It affects about 12 in every 100 adults in the UK.[1]​ Women are more likely than men to get IBS. There is no cure, but lifestyle changes and treatments can help relieve your symptoms.

What is it?

IBS affectsparts of your digestive system.

Doctors aren't sure exactly what happens in your body if you have IBS. But they think the muscles that make up the wall of your bowel don't work as well as they should. Your bowel is the part of your digestive system that turns food your body doesn’t need into solid waste. The muscles in your bowel usually tighten (contract) and relax in a coordinated way to move food along your bowel.

But these contractions might be stronger and last longer than normal if you have IBS, which can cause bloating, cramping, and diarrhoea. Or they might be weaker than normal, meaning that waste stays in your bowel for longer than usual. If this happens, too much water might be absorbed from the waste, leading to constipation.

Doctors also think that IBS could be tied to problems with how the brain communicates with the bowel, with the wrong messages sometimes being sent to the nerves controlling the bowel muscles. Your brain might do this when you are under stress or feeling anxious.

That doesn't mean that IBS is all in your mind - signals from your brain cause real physical changes in your body. But it explains why your mood or emotions can affect your IBS.

We don't know why people get IBS. There is no obvious cause that doctors can test for. And people with IBS don't have any serious structural problems with their bowels. There are probably several different things that act together to cause the condition instead of one specific cause. You also may be more likely to get IBS if someone in your family has it.

What are the symptoms?

IBS affects people in different ways. But everyone with IBS gets pain and discomfort, which often goes away for a while once they have a bowel movement or pass gas. You might also: 

• Have diarrhoea or constipation, or episodes of both

• Feel bloated

• Have slippery, thick fluid in your stools (mucus)

• Feel as if your bowel isn't completely empty after a bowel movement.

The symptoms of IBS might flare up during times of stress and emotional difficulty.

People without IBS get these types of symptoms from time to time. But if you have IBS you get these symptoms much more often than most people.

Sometimes people worry that their IBS might lead to a more serious illness, like cancer. But IBS doesn't damage your bowel or cause more serious problems.

However, the symptoms of IBS can also be a sign of more serious illnesses, so it's important to get them checked out. You should also make sure you see a doctor if you:

• get blood in your stools

• lose weight for no reason, or

• feel tired all the time.

To diagnose IBS, your doctor might recommend having tests to rule out other problems. These might include blood tests, stool tests, x-rays, or a colonoscopy.

During a colonoscopy, a doctor inserts a thin, bendy tube with a small camera on its end into your anus. By moving the tube up into your bowel, the doctor can check for possible problems.

Many people with IBS try to cope with their symptoms themselves. But it can make a big difference if you talk to your doctor. Together you can find ways to improve your symptoms through changes to your diet and lifestyle, and with treatments. To learn more, see our leaflet Irritable bowel syndrome: what treatments work?

What will happen to me?

Your symptoms might improve in time, but IBS doesn't usually go away completely. You might be reassured to know that IBS doesn't damage your bowels or lead to more serious illnesses. How badly it affects you depends largely on whether it stops you doing the things you want to do. 

Learning about your IBS might help you feel more in control and manage your symptoms better. Joining a support group might help. Your doctor might be able to recommend one in your area.

References

Last published:Nov 30, 2023

Irritable bowel syndrome (IBS) is a condition that can cause stomach pain, cramps, bloating, constipation, and diarrhoea. There isn't a cure for IBS, but lifestyle changes and treatments can improve your symptoms.

Talk to your doctor to decide which treatments are right for you. To learn more about IBS and its symptoms, see our leaflet Irritable bowel syndrome: what is it?

Lifestyle and diet

Keeping a symptom diary

Certain things in your life, such as stress and certain foods, might bring on your IBS symptoms. Your doctor might recommend that you keep a symptom diary.

This will allow you to track when you get symptoms, so you can see whether anything seems to trigger them. Once you identify a possible trigger, you can take steps to avoid it.

Managing stress

Many people get flare-ups of IBS symptoms when they are feeling stressed. So taking steps to manage stress is often one of the first treatments doctors recommend. Things you might try include:

• deep breathing exercises

• meditation

• yoga

• relaxation classes, and

• taking regular exercise.

Talking to a counsellor or joining an IBS support group might also help. Your doctor can help you explore your options. 

Changing your diet

Sometimes people with IBS have difficulty digesting certain foods, which can make their symptoms worse. These foods can include:

• dairy products

• foods that contain a type of sugar called fructose, and

• coffee and other drinks that contain caffeine.

You might need to cut these out of your diet completely if you notice they are causing your IBS to flare-up.

With the help of a symptoms diary you might be able to identify foods that make your IBS worse. But it's a good idea to check with a doctor or a dietitian before you make any changes to your diet. Avoiding certain foods can make your life difficult, and it's easy to miss out on important nutrients.

Some people find that their IBS improves when they cut out a type of carbohydrate that is difficult for the body to absorb. These carbohydrates are called FODMAPs. You can ask your doctor or dietitian for details on a low-FODMAP diet, or look online.

If constipation is one of your IBS symptoms, you might benefit from eating more fibre (specifically soluble fibre, which breaks down in water). Fibre is a bulky substance that your body can't digest. The extra bulk helps make your stools large and soft, and helps your bowels work properly. Good sources of soluble fibre in foods include:

• Barley

• Oat Bran

• Beans, and

• Specific fruits and vegetables (e.g., apples, strawberries, pears, carrots, peas, and avocados).

You can also get fibre supplements from pharmacies or health food shops. Some examples are ispaghula husk and methylcellulose. Make sure you drink plenty of water if you're taking fibre supplements. Fibre sometimes gives people wind or makes them feel bloated.

Probiotic supplements can hep improve IBS in some people. You can buy these as yoghurts or capsules that contain 'friendly bacteria'.

The idea is that these add to the helpful bacteria that live in your bowels and aid in digestion. Research suggests that probiotics with a specific type of bacteria, called Bifidobacterium infantis, might be particularly helpful in IBS.

Exercise

Exercise can be helpful for some people with IBS, especially for constipation. But there’s less evidence that it can help with stomach pain.

Medicines

If lifestyle and diet changes don't do enough to improve your symptoms, medicines can also help. These include:

• anti-spasmodic medicines, which help to control the muscles around your bowel

• medicines for diarrhoea

• medicines for constipation, and

• antidepressants.

Your medicines might change depending on what symptoms you are having (for example, constipation or diarrhoea).

Anti-spasmodic medicines

Anti-spasmodics can help with IBS, especially if your main symptom is pain or bloating. These medicines work by relaxing the wall of your bowel.

People often take anti-spasmodics for a week or so at a time when their IBS gets bad. It's better to take these medicines when your symptoms flare up, rather than to take them every day. Anti-spasmodics can sometimes cause side effects, such as nausea, dry eyes, dry mouth, and dizziness.

Peppermint oil works in the same way as anti-spasmodics. It might help reduce pain and bloating. You can buy peppermint oil as drops or tablets from a pharmacy. Peppermint oil sometimes causes heartburn as a side effect.

Medicines for diarrhoea

Doctors often recommend a medicine called loperamide to treat bouts of diarrhoea in IBS. You can buy it yourself from a pharmacy. Some people get mild side effects from loperamide. These include dizziness, constipation, and nausea.

If loperamide doesn't work for you, there are other options. Talk to your doctor about what might be best for you.

Medicines for constipation

If one of your main symptoms is constipation, you might first want to try eating more fibre or taking fibre supplements. If these don't help, you could also try a laxative to help you go to the toilet.

If you aren't able to take laxatives, or if over-the-counter laxatives don't help enough, your doctor might recommend treatments available only on prescription. 

Antidepressants

Some antidepressants seem to help with IBS. Your doctor might suggest an antidepressant if other treatments haven't helped and you still have pain.

You need to take an antidepressant every day for it to work. You probably won't feel the benefits for at least 2 or 3 weeks. 

Antidepressants can cause side effects, including nausea, weight gain, fatigue, and a dry mouth. However, doctors often prescribe antidepressants at a lower dose for IBS than for depression. So there might be less chance of side effects.

Other treatments

Some research shows that hypnotherapy might help people with IBS to relax and cope with their symptoms. If you have this treatment, a therapist will help you focus on your symptoms and what you can do about them while you're in a relaxed state.

Cognitive behaviour therapy is a talking treatment (a psychotherapy). It aims to change the way you think about your illness and give you more control over it. Studies have suggested that it might help people get fewer symptoms of IBS.

If most of your IBS symptoms are related to pain, you could also be referred to a pain specialist or clinic by your doctor.