Irritable Bowel Syndrome (IBS)

There is still no conclusive evidence on the exact cause for IBS, but certain observations in people suffering from the disease provide clues to factors that might play role in the condition:

• Intestinal muscle contractions. Food is passed through the digestive tract by muscles on the intestinal wall that contract. Contractions that are stronger and last longer than normal move food through the bowel quickly and forcefully, leading to gas, bloating, and diarrhoea. On the other hand, weak contractions move food very slowly through the bowel, leading to constipation.
• Infections. A severe case of diarrhoea and vomiting (gastroenteritis) caused by bacteria or a virus can trigger symptoms of IBS.
• Bacterial overgrowth. Our gut harbours a host of microorganisms called the gut microbiota that play a key role in health. The composition of the gut microbiota depends on a variety of factors including, diet, drugs, and disease. People with IBS may have an increase in the number or change in the type of bacteria in the small intestine leading to symptoms.
• Inflammation in the intestines. Mild inflammation in the intestines appear to be present in some people with IBS. The inflammation is caused by multiple factors and more research is needed to understand its role in causing IBS.
• Sensitive nerves in the intestines. Excessive contraction of the bowel muscles when eating can lead to cramps in the abdomen due to sensitive nerves in the intestines.

Risk factors for IBS

• Being young. People under the age of 50 are more frequently reported to have IBS.
• Having a family history of IBS. Genes and factors in a family’s environment may play a role in IBS.
• Stress. Various stressors and certain mental disorders make people more prone to developing IBS. Stress also contributes towards worsening symptoms.

The symptoms of irritable bowel syndrome (IBS) can vary greatly between affected individuals. Your symptoms can range from mild to disabling, and common ones include:

• Changes to stools and bowel habits. You may experience constipation with small, pellet-like stools that are painful to pass and infrequent. Diarrhoea may also occur where stools are loose and watery, accompanied by an urgency to relieve yourself. The two may alternate in the same patient and sometimes, mucus may be mixed with the stools. You may also feel that your bowel doesn’t empty completely after going to the toilet.
• Excess gas and bloating of the abdomen. People with IBS tend to report feeling very gassy and having trouble with passing gas. This may be due to problems with the nerves and muscles in the intestines. Triggers of excess gas and bloating include consuming gas producing foods, an overgrowth of bad bacteria in the intestines, and certain habits such as chewing gum, eating and drinking too fast, or drinking through a straw.
• Pain or cramps in the abdomen. The pain usually occurs on and off, with the length and severity varying greatly. A common site of the pain is the lower abdomen, particularly on the left side. It can be recognised as a constant dull pain interrupted by short episodes of sharp pain. The pain often improves when stools or gas are passed.

These symptoms are similar to those of colon cancer, and therefore if they appear persistently, please see your doctor for a thorough evaluation.

There are also less common symptoms of IBS such as general tiredness, backache, sweating, nausea, vomiting, and pain when going to the toilet.

To diagnose irritable bowel syndrome (IBS), a complete medical history review and a physical examination will first be done. While there are no specific tests to diagnose IBS, your doctor may suggest some tests or procedures to rule out other conditions.

Medical history review

Your doctor will ask you to describe your symptoms to identify certain patterns that may suggest IBS. Important details about your symptoms include:

• Presence of pain in the abdomen
• Changes in frequency of bowel movements
• Changes in appearance of stools
• Duration of symptoms
• Presence of other symptoms like anaemia, bleeding, and weight loss that are likely to indicate other issues
• Personal and family history of gastrointestinal diseases, information about stressful events experienced, and dietary habits

Physical examination

A physical examination is usually performed to check for:

• Abdominal bloating
• Sounds within the abdomen
• Tenderness or pain in the abdomen

Tests

• Blood test to check for anaemia, infections, and inflammation
• Stool test to check for blood in the stool or other signs of infections or diseases
• Hydrogen breath test to check for bacterial overgrowth in the small intestines or lactose and/or fructose intolerance
• Upper gastrointestinal endoscopy and biopsy to check for coeliac disease
• Colonoscopy to check for colon cancer or inflammatory bowel disease

There is no cure for IBS. Treatment options consist of managing your symptoms and avoiding risk factors that trigger the onset of your symptoms. Your doctor will suggest a treatment plan that works best for you, and it may include a combination of the following:

Lifestyle changes

• Exercising regularly
• Keeping your stress levels in check
• Getting sufficient sleep
• Keeping a symptom diary to help identify trigger factors

Dietary changes

• Following a low FODMAP diet. Certain carbohydrates called FODMAPs should be avoided as they are not absorbed by the small intestine but instead break down and produce gas in the large intestine. Foods to avoid include fructose (such as fruits, honey, high-fructose corn syrup), lactose (dairy products), fructans (wheat, onions, and garlic), galactans (legumes) and polyols (sugar alcohols).
• Avoiding gluten. This is found in wheat, rye, and barley and may also be present in vitamin and nutrient supplements, lip balms, and certain medicines. Avoiding gluten has shown to improve diarrhoea. 
• Increasing fibre intake. Eating foods with more soluble fibre, which is found in certain fruits and vegetables, nuts and seeds, and whole grain products is helpful in relieving IBS symptoms. However, caution is warranted as some patients may experience worsened bloating. Fibre should be gradually increased to help your body get used to it.
• Eating small meals and drinking sufficient water.

Medications and supplements

• Antispasmodic medicines. These relax the muscles in the wall of the large intestine and improve pain. Examples include alverine citrate, mebeverine, hyoscine, and peppermint oil.
• Antibiotics. These help to address the growth of harmful bacteria in the intestines.
• Probiotics. Some probiotics may help ease symptoms in some patients. However, more research is needed on the form, dose, and strains that are effective.

Always consult a doctor before starting on new medications or supplements.

Speak to a gastroenterologist to learn more about IBS and to find the most appropriate treatment for you.

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There are several other conditions which have symptoms that are similar to that of IBS. These conditions include:

• Coeliac disease. A condition caused by an adverse reaction to gluten, which is found in wheat, barley, and rye. Symptoms include diarrhoea, abdominal pain, and bloating.
• Inflammatory bowel disease (IBD). A group of diseases that cause chronic inflammation and irritation in the intestines. Overlapping symptoms include abdominal pain, urgent need to have a bowel movement, loss of appetite, and weight loss. Those with IBD often have bleeding in their intestines and pass bloody stools.
• Colon cancer. A common type of gastrointestinal cancer with symptoms including abdominal pain, change in bowel habits, fatigue, and weight loss.
• Infections of the stomach and intestines by virus, bacteria, and parasites are common conditions affecting adults and children.

People with IBS may also be more prone to having:

• Conditions involving chronic pain, such as fibromyalgia, chronic fatigue syndrome, and chronic pelvic pain
• Digestive diseases like dyspepsia and gastroesophageal reflux disease
• Anxiety and depression