What is IBS?

Author: Dr Ana Wilson, Consultant Gastroenterologist at St Mark's Hospital

Date: Mar 2017

What exactly is IBS?
Irritable bowel syndrome (IBS) is a common, long-term condition of the digestive system which can cause bouts of stomach cramps, bloating, diarrhoea and constipation. Abdominal pain and discomfort is often recurrent and the symptoms can vary between individuals, affecting some people more severely than others.

What causes IBS? Is it genetically linked?
We don’t know for certain what causes IBS, however it is thought to be interplay between hypersensitive gut and psychological, social and environmental influences. Some studies have suggested that patients with IBS have a low level of inflammation and altered gut motility. There is evidence that relatives of patients with IBS are more likely to develop IBS. Similarly, there is a higher concordance rate amongst monozygotic twins (i.e. exactly the same DNA) than dizygotic twins (only half DNA shared) suggesting that there may be genetic contribution, but the exact genes have not been identified.

Who gets IBS (what age do symptoms manifest)?
Anyone can get IBS but its prevalence decreases with age. Usually symptoms manifest in young adults in their twenties or thirties. It is worth noting also that women are 1.5-2 times more likely to get IBS than men.

What are the symptoms? / are these symptoms often confused as something else?
The symptoms commonly associated with IBS include abdominal pain, discomfort, diarrhoea, constipation and bloating. The symptoms tend to come and go in periods lasting a few days to a few months at a time, often increasing during times of stress or after eating certain foods. When considering your symptoms and whether these might be a sign of IBS, it is important to exclude other illnesses, for example coeliac disease, inflammatory bowel disease, ovarian problems, and thyroid abnormalities, amongst others.

How do I know if I have IBS or a sensitive stomach?
Truthfully, it is very difficult to tell. Usually patients who have a ‘sensitive stomach’ (subjective not medical) would have had it all their lives. It is all about perception.

How can we spot if we have IBS - are there any defining features?
The defining features / symptoms of IBS include abdominal pain, discomfort, diarrhoea, constipation and bloating. If you notice a new onset of symptoms, it is important to see a GP to exclude anything else. He/she will refer you to a specialist (gastroenterologist) if needed.

Is it true the Pill can trigger IBS?
There is evidence that symptoms of IBS can vary with menstrual cycle, as female hormones tend to affect gut motility and ‘sensitivity’. One large study (939,281 women) looked at oral contraceptives and IBS and subsequently found a positive association between drospirenone (Yasmin) and IBS, but no relation between other oral contraceptives and incidence of IBS.

What about FODMAP foods – how are these linked to IBS?
There is evidence that low FODMAP diet improves symptoms of IBS, but this should be guided by a dietician.

How can we control IBS?
Controlling IBS depends purely on the symptoms. Stress relief and diet are the cornerstones of management. For bloating and pain, diet and anti-spasmodics are key and if symptoms are particularly bad, then a low dose of drugs such as amitryptiline and nortryptiline can be taken. For constipation, again the combination of diet, stress relief and biofeedback is key, and for diarrhoea as above plus loperamide (Immodium). Probiotics have been shown to be of benefit, particularly Lactobacillus and Bifidobacterium infantis 35624.

What are your top tips for dealing with IBS?
Where possible it is important to practice a healthy lifestyle, with healthy diet and regular meals, and avoiding excess of alcohol, processed food and caffeine. It is also a good idea to quit smoking and make sure you enjoy gentle exercise and relaxation/meditation (yoga etc). Talk to your GP if you are worried and you may well be referred to a specialist for specialist help.

Article reproduced with permission from St Marks Hospital Foundation / pha media - 2016

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Next review: 7 March 2021