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Irritable Bowel Syndrome - An Overview of Symptoms, Causes, and Treatment

Updated: Jun 12


Are you struggling with gut symptoms such as bloating, wind, diarrhoea and constipation? If you answered yes, you may be wondering if you have irritable bowel syndrome (IBS).


What is IBS?


IBS is a common functional bowel disorder that affects the digestive system. It is 1.5 times more common in women than men and commonly diagnosed before the age of 50 years. (1).


Common symptoms of IBS include (2):


  • Abdominal pain or cramping: often relieved or partially relieved by having a bowel movement.


  • Changes in bowel habits:

    • Diarrhoea: frequent, loose, or watery stools.

    • Constipation: infrequent, hard, or lumpy stools.

    • Mixed bowel habits: alternating between diarrhea and constipation.

    • Bloating and wind: a feeling of fullness or swelling in the abdomen.

    • Mucus in stool: presence of white mucus in stool.

    • Urgency: a sudden, urgent need to have a bowel movement.

  • Non-gastrointestinal symptoms

    • Fatigue: feeling unusually tired or lacking energy.

    • Difficulty sleeping: poor sleep quality, including trouble falling asleep or staying asleep.

    • Headache: frequent headaches or migraines.

    • Backache: pain in the lower back.

    • Frequent urination: increased need to urinate, often associated with urgency.

  • Psychological symptoms

    • Anxiety: feeling anxious or stressed, which can exacerbate IBS symptoms.

    • Depression: experiencing low mood or depression, common in individuals with chronic IBS.


Conditions with some similar symptoms to IBS (3)


Certain medical conditions, such as coeliac disease, inflammatory bowel disease (IBD) and gastrointestinal infections can mimic IBS symptoms and can also include the following symptoms:

  • Unexplained weight loss.

  • Rectal bleeding.

  • Persistent severe pain not relieved by a bowel movement.

  • Anemia due to low iron levels.


If you experience any of these symptoms, you should seek medical attention as they are not typical of IBS and may indicate a more serious condition.


Endometriosis and PCOS also share some common symptoms with IBS.

The symptoms often experienced in endometriosis and PCOS overlap with those of IBS, making it difficult to distinguish between the conditions, and raising the possibility of misdiagnosis and/or delayed diagnosis.


It is not uncommon for women to have IBS and either endometriosis or PCOS. IBS is more common among women with endometriosis than those without. For example, one study showed that 36% of women with IBS had a concurrent diagnosis of endometriosis (4), while another showed that women with endometriosis were 3.5 times more likely to have been diagnosed with IBS than women without endometriosis (5). PCOS is also associated with an increased risk of IBS (6).


I'll be covering more about the link between these conditions in future blog articles, so I'll keep you posted! In the meantime, if you're having abnormal gastrointestinal symptoms (including changes in bowel habits, abdominal pain, bloating or nausea), you should visit your healthcare professional to determine if you need additional testing and what your treatment options are.


Causes of IBS (3)


The exact cause of IBS is not well understood, but several factors may contribute:


  • Visceral hypersensitivity: there are nerves that line the intestines which are overactive in people with IBS. As a result, normal changes in the gut (such as increases in the amount of gas and water in the gut), can be experienced as painful episodes of bloating and abdominal pain.

  • Altered gastrointestinal motility: abnormalities and changes in the movement of the gut and contents within the gut.

  • Gut-brain interaction: impaired function in how the brain and gut work together.

  • Infections: history of severe infection, such as gastroenteritis.

  • Changes in gut microbiota: imbalance in the bacteria that reside in the gut.

  • Inflammation and altered immune responses: these can affect gut motility, sensitivity, and barrier function causing pain, bloating, and altered bowel habits.

  • Diet and food sensitivities: certain foods and eating habits can trigger IBS symptoms in some people. Common triggers can include foods high in fat, caffeine, alcohol, and artificial sweeteners.

  • Psychosocial factors: stress, anxiety, and depression are often associated with IBS.

  • Genetics: a family history of IBS may increase the likelihood of developing the condition.

  • Hormonal changes: women are more likely to develop IBS, and symptoms often worsen during menstrual periods.


Diagnosis and Types of IBS (3)


There is no specific test for IBS. Diagnosis is typically based on symptoms and ruling out other conditions. IBS should be diagnosed by a doctor who should take a detailed history of symptoms and use the such as the Rome IV criteria.


IBS can be categorised into different types based on the predominant symptoms (3):


  • IBS-C: constipation dominant.

  • IBS-D: diarrhoea dominant.

  • IBS-M: with mixed bowel habits (contsipation & diarrhoea).

  • IBS-U: symptoms that do not fit into the above categories.


Treatment


The treatment of IBS is often guided by the type of IBS which has been diagnosed (as listed above). However, symptoms can be managed with making changes to your diet, modifying your lifestyle and being aware of medications which can help.


Dietary Changes:


  • Find your balance: follow a balanced diet, have regular meals, and take time to eat.


  • Limit caffeine and alcohol: restrict tea and coffee to 3 cups per day, and reduce your intake of fizzy drinks and alcohol (7).


  • Stay hydrated: keeping hydrated helps your digestion run smoothly and can alleviate symptoms, especially if constipation is an issue.

  • Fibre focus: You may need to adjust the type and quantity of fibre in your diet, depending on your symptoms. For example, if you experience diarrhoea, try reducing the amount of high fibre foods. On the other hand, if you're constipated, you will need to focus on gradually increasing your intake of high fibre foods, such as wholegrains, oats, vegetables, fruit, and linseeds.


  • The Low FODMAP diet (8): some types of carbohydrates, which are poorly absorbed in the small intestine, can contribute to IBS-type symptoms. These carbohydrates are called FODMAPs, which are Fermentable, Oligo-saccharides, Di-saccharides, Mono-saccharides And Polyols. A low FODMAP diet can be used to reduce symptoms of IBS and it involves eliminating certain carbohydrates for several weeks. If you have been diagnosed with IBS it’s important to work with a FODMAP trained dietitian so that you can get the right support and guidance to make the most appropriate changes for you.


  • Probiotics: these are strains of healthy bacteria that can help balance out “good” and “bad” bacteria in the gut and could help minimise IBS symptoms. There are many food items containing probiotics, such as fermented foods, yoghurts and drinks, as well as a variety of probiotic supplements. Look for the words lactobacillus and bifidobacteria on food labels.


  • Track your symptoms: a food and symptom diary is a useful tool to identify any trigger foods which might be making your IBS symptoms worse.


Lifestyle Adjustments:


  • Try to be active every day: whether it’s a brisk walk, yoga (8), or dancing around your living room, find an activity you enjoy.


  • Stress less: stress can be a big IBS trigger. Techniques like mindfulness, meditation, and even simple deep-breathing exercises can be effective in managing symptoms.


Medications (3):


Sometimes, dietary and lifestyle changes aren’t enough, and that’s okay. There are several medications that can help manage IBS symptoms:


  • Antispasmodics: medications like hyoscine (Buscopan) can help reduce abdominal cramps.


  • Laxatives and antidiarrheals: depending on whether you’re dealing with constipation or diarrhoea, options like polyethylene glycol (for constipation) or loperamide (Imodium for diarrhoea) can be very effective.


Next Steps:


Living with IBS can be challenging, but with the right approach, you can manage your symptoms and improve your quality of life. Remember, it’s all about finding what works best for you. By working closely with your healthcare professional and a registered dietitian you can develop a management plan that works for you, take control of your digestive health, and reduce the impact of IBS on your daily life.


If you’re looking for some personalised support, you can book your free 20-minute Discovery Call here, or you can also email me: laura@nurture-for-life.com


References


  1. Hungin, A.P., et al., The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Aliment Pharmacol Ther, 2003. 17(5): p. 643-50.

  2. Boeckxstaens, G.E., et al., Phenotyping of subjects for large scale studies on patients with IBS. Neurogastroenterol Motil, 2016. 28(8): p. 1134-47.

  3. Lacy, B.E., et al., Bowel Disorders. Gastroenterology. 150(6): p. 1393-1407.e5.

  4. Moore, J.S., et al., Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. Aust N Z J Obstet Gynaecol, 2017. 57(2): p. 201-205.

  5. Seaman, H.E., et al., Endometriosis and its coexistence with irritable bowel syndrome and pelvic inflammatory disease: findings from a national case-control study--Part 2. BJOG, 2008. 115(11): p. 1392-6.

  6. Mather, R., et al., Polycystic ovary syndrome is associated with an increased prevalence of irritable bowel syndrome. Digestive Diseases and Sciences. 2010. Apr;55(4):1085-9.

  7. NICE (2017) Irritable bowel syndrome in adults: diagnosis and management. Clinical guideline [CG61]. Available at: https://www.nice.org.uk/guidance/conditions-and-diseases/digestive-tract-conditions/irritable-bowel-syndrome (Accessed 27 May 2024).

  8. Tuck, C.J., et al., Fermentable oligosaccharides, disaccharides, monosaccharides and polyols: role in irritable bowel syndrome. Expert Rev Gastroenterol Hepatol, 2014. 8(7): p. 819-34. 22.

  9. Schumann, D., et al., Randomised clinical trial: yoga vs a low-FODMAP diet in patients with irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 2018 Jan;47(2):203-211.




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