Of all the illnesses that affect the gut, the Irritable Bowel Syndrome (IBS) is one of the most common. It is a major source of mental and physical ill health that affects over 12 million (approximately 15%) people in the UK and costs the tax payer at least 200 million pounds per annum. It can occur at all ages but is slightly more prevalent in women. The symptoms are a combination of abdominal discomfort, either pain or bloating, plus a disturbance in defaecation, which may be either diarrhoea or constipation or a mixed pattern. Specific symptoms such as frustrated defaecation (wanting to go without being able to), pain relieved by passing a motion, and the passage of mucus are common.
People with IBS also experience backache, fatigue, indigestion, anxiety, depression, bladder frequency, breathlessness, headache and many ‘unexplained symptoms’ Thus it is not surprising that there are overlaps between IBS and chronic fatigue syndrome, fibromyalgia, functional dyspepsia and migraine.
The bowel symptoms of IBS are really those of irritation and found in other diseases that affect the bowel. So it is important that the doctor rules out the commoner bowel diseases like Coeliac Disease, Crohn’s Disease and Colitis and is mindful of the possibility of bowel cancer, though all of these are much less common than IBS. Red flag symptoms such as weight loss and the passage of blood may signal the possibility of more life threatening conditions, which can be screened out by specific blood and stool tests.
Although there is no single agreed cause for IBS, it may be instigated by an attack of gastroenteritis, a course of antibiotics or a particularly traumatic experience or unsettling change in a person’s life. Many patients with IBS show a mild inflammation and their bowel is sensitive to anything that stimulates or irritates it; in practice food and mood.
Among the foods that can upset the sensitive gut are fatty foods (e.g. meat, sauces and cream), coffee, hot spices, insoluble fibre such as wheat bran and a range of poorly absorbed sugars, known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) found in many fruits, onions, beans and lentils, sprouts and cauliflower, wheat and in some people, milk. But since emotional upset can also enhance the sensitivity of the gut, IBS symptoms and sensitivity to foods may fluctuate according to ‘what is happening’ in a person’s life.
There is no specific cure for IBS. The symptoms of IBS are so diverse and so much influenced by a person’s diet, life style and life experience, that management is often an individual combination of stress and life style management, dietary restriction, medications and therapies. This is often best carried out as a collaboration between an informed patient and a health care professional, who understands the nature of IBS.
So treatment of IBS is probably best carried out as a form of guided self management. If people can understand how their life situation, diet and life style can trigger their IBS, then they can be supported to make the necessary adjustments to calm their symptoms. Adopting a more balanced life style with time for contemplation, exercise and creativity, can help to create an attitude of mindfulness, essentially a state of confident self awareness and control, that can calm the brain centres that regulate gut reactions. Knowing which foods they can eat, what medications can help to suppress their symptoms and achieving a trusting relationship with their health care professionals confer that sense of well being and confidence that can restore bowel health.
Charities can play an essential role in this model of self care. The IBS Network is the UK’s national charity for IBS. Its on-line IBS Self Care Plan (www.theibsnetwork.org/the-self-care-plan) is an information resource on every aspect of IBS and is free to everybody. Membership of The IBS Network costs just £24 per year (£2 per month) and includes professional one to one support via e-mail, an telephone helpline operated by IBS Nurses, a quarterly magazine and monthly newsletter, access to self-help groups and can’t-wait cards.
It’s not just IBS! The IBS Network is currently running a national campaign to promote greater awareness of IBS and the impact it has on people’s lives, improvement of quality of care by health care professionals, an infrastructure to support self-care and the reduction of the social stigma of IBS
People with IBS deserve better. So please support The IBS Network. Sign our petition, become a member, join our campaign to help people with IBS better.
Dr Nick Read,
Chair and Medical Adviser
The IBS Network
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Next review: 1 July 2020