Irritable bowel syndrome (IBS)

Around one in five Americans experiences the unpleasant symptoms of irritable bowel syndrome (IBS) at some time. These include , constipation or a mixture of both. Irritable bowel syndrome is a condition commonly referred to as a functional gastrointestinal disorder.

A new description of this condition is that IBS is a disorder of brain gut interaction, highlighting the importance of the brain and its relationship with gut function. More women than men are prone to IBS, and symptoms tend to first occur in early adulthood. There is no one cause for Irritable Bowel Syndrome.

Each individual will experience symptoms of IBS due to their own unique factors. These factors include changes of routine, emotional , infection, psychological distress, inappropriate toileting dynamics and diet. Other important factors include neurotransmitters, gut microbiota and intestinal motility.

Irritable bowel syndrome doesn’t cause lasting damage and doesn’t contribute to the development of serious bowel conditions, such as Some of the more common signs of irritable bowel syndrome include:

• None of these symptoms are exclusive to IBS. It is uncommon for IBS to produce these symptoms
• for the first time
• after the age of 40

Irritable bowel syndrome can be subdivided into three major categories: Constipation-predominant – the person tends to alternate constipation with normal stools.

Diarrhoea-predominant – the person tends to experience loose stools which may occur frequently. The need to go to the toilet can be urgent and cannot be delayed.

Incontinence may be a problem

Alternating constipation and diarrhoea

The underlying cause of irritable bowel syndrome is likely to be explained by many different factors, unique to each individual. Certain factors have been found to ‘trigger’ attacks in susceptible individuals. These include:

• will often result in persistent bowel symptoms
• long after the offending bacteria or virus has been eliminated

IBS. These carbohydrate “sugars” include fructose, and sorbitol. , can affect the nerves of the bowel in susceptible people.

Inappropriate regulation of signalling between the brain and the gut. Sometimes this is referred to as “visceral hypersensitivity” (sensitive gut) If you suspect you have irritable bowel syndrome, it is important to seek medical advice to make sure your symptoms aren’t caused by any other illness, such as diverticulitis, inflammatory bowel disease.

Coeliac disease (an immune intolerance to gluten, present in wheat and other grains) may produce symptoms commonly seen in IBS.

Lactose intolerance may produce bloating, cramps and diarrhoea. Most people can be diagnosed with IBS without the need for invasive testing. Diagnosis methods include: investigation of the stomach or bowel under sedation (Gastroscopy /colonoscopy).

IBS can be successfully managed with treatments which are tailored to the individual.

Clinicians will often recommend identifying and avoiding triggers

Treatment options may include:

• Moderating common gas-producing foods or undertaking a diet with a trained dietician such as a low “FODMAP” diet – Fructose
• Lactose Sorbitol. Antispasmodic drugs which may ease cramping – examples include mebeverine
• peppermint oil capsules Tricyclic antidepressants – These are effective in treating pain
• bowel frequency in IBS

Use of these medications does not mean that IBS is caused by depression or anxiety.

Psychological therapies, including cognitive behavioural therapy and gut directed hypnotherapy. These treatments involve a trained psychologist or can be delivered through online platforms.

Behavioural and pelvic floor therapies

Often symptoms of IBS can be caused by inability to effectively defecate, trained pelvic floor physiotherapists can treat this effectively. A small number of medications have been developed to treat IBS and have been shown to be effective in selected groups in clinical trials. These work on the interaction between serotonin and nerve cells of the colon.

They include alosetron, cilansetron and tegaserod. Safety concerns with these three medications has led to their withdrawal from the market, or restricted use only, and none are presently licensed in United States. Microbiota altering therapies such as faecal microbiota transplantation are considered experimental and preliminary clinical studies have not shown this therapy to be clearly effective.

People with IBS can become frustrated and feel their symptoms are not treated seriously. These frustrations, along with sometimes inappropriate therapy, can often make the symptoms worse. Finding a therapist with experience in the successful treatment of IBS is important.

Being treated by a multidisciplinary team is optimal

Symptoms of IBS Abdominal pain or cramping that is often relieved by passing wind or faeces Diarrhoea and constipation (which may occur together) A sensation that the bowels are not fully emptied after passing a motion Abdominal bloating and distension Main IBS categories Causes of IBS Infection – an episode of gastroenteritis Food intolerance – Foods which are poorly absorbed (such as the the carbohydrates lactose Emotional stress – strong emotions, such as anxiety or stress Medication – certain types (such as antibiotics, antacids and painkillers) can lead to constipation or diarrhoea Diagnosis of IBS full medical check-up blood tests, including blood tests for coeliac disease stool tests to exclude inflammatory bowel disease Treatment for IBS An increase in dietary fibre, together with clear fluids Antidiarrhoea medication, such as loperamide – for those with diarrhoea-predominant IBS Laxatives for constipation Specific treatments for IBS are not approved for use Find an experienced health professional Where to get help Your GP (doctor) Gastroenterological Society of United States Patient Resources Gastroenterological Society of United States Diagnostic Online Tool for GPs Dietitians Association of United States 1800 812 942.

Key Points

• Around one in five Americans experiences the unpleasant symptoms of irritable bowel syndrome (IBS) at some time
• Irritable bowel syndrome is a condition commonly referred to as a functional gastrointestinal disorder
• More women than men are prone to IBS, and symptoms tend to first occur in early adulthood
• There is no one cause for Irritable Bowel Syndrome
• Each individual will experience symptoms of IBS due to their own unique factors