Irritable Bowel Syndromenhschoices

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Irritable bowel syndrome - informationprescription

Introduction

Irritable bowel syndrome (IBS) is a common condition of the digestive system. It can cause bouts ofstomach cramps, bloating, diarrhoea and constipation.

The symptoms of IBS usually appear for the first time when a person is between 20 and 30 years of age. They

tend to come and go in bouts, often during times of stress or after eating certain foods.

Symptoms vary between individuals and affect some people more severely than others. However, most peoplehave either diarrhoea, constipation, or bouts of both. You may also have mucus in your stools.

You may find the painful stomach cramps of IBS ease after going to the toilet and opening your bowels.

What causes IBS?

The exact cause of IBS is unknown, but most experts agree it's related to an increased sensitivity of the entire gutwhich can occasionally be linked to a prior food-related illness.

This may be caused by a change in your body's ability to move food through your digestive system, or may be dueto you becoming more sensitive to pain from your gut.

Psychological factors such as stress may also play a part in IBS.

Read more about the causes of IBS.

When to see your GP

Visit your GP if you think you have IBS. They will want to rule out other illnesses, such as an infection, coeliacdisease (a digestive condition where a person has an adverse reaction to gluten) or chronic inflammation of thegut.

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They will ask about your symptoms and whether there is a pattern to them – for example, if they tend to come on

when you are under more stress than usual or after eating certain foods. Your GP may suggest you keep a fooddiary to see whether your diet affects your symptoms.

Further tests will only be needed if you have certain "red flag" symptoms that indicate you may have anotherserious condition. These symptoms include:

unexplained weight loss a swelling or lump in your abdomen or back passage (bottom) anaemia (a lack of red blood cells)

Read more about how IBS is diagnosed.

Treating IBS

There is no cure for IBS, but the symptoms can be managed by making changes to your diet and lifestyle.

Medication is sometimes prescribed for IBS. In many cases, being reassured by your GP can often helpcontrol IBS symptoms.

Although the symptoms of IBS can be troublesome, the condition does not pose a serious threat to yourhealth. For example, it will not increase your chances of developing cancer or other bowel-related conditions.

IBS is unpredictable. You may go for many months without any symptoms and then have a sudden flare-up. It canalso take many months for your symptoms to settle down.

IBS can be painful and debilitating, and can have a negative impact on your quality of life. However, withappropriate treatment you should be able to live a normal, full and active life.

Read more about treating IBS.

Living with IBS

The pain, discomfort and inconvenience of IBS can sometimes affect a person psychologically.

It is estimated that three out of four people with IBS will have at least one bout of depression, and just over half wildevelop generalised anxiety disorder (a condition that can cause overwhelming feelings of anxiety, fear and

dread).



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Speak to your GP if you have feelings of depression or anxiety and they are affecting your daily life.

These types of conditions rarely improve without treatment, and your GP will be able to recommend treatmentssuch as antidepressants or cognitive behavioural therapy (CBT).

Read more about the psychological effects of IBS.

Who is affected by IBS?

IBS is a common digestive condition. It's thought that 10-20% of people experience IBS symptoms at somepoint in their life. IBS affects twice as many women than men.

Read the real-life story of a man who has lived with IBS for more than 20 years to find out how he copes with thecondition.

Symptoms of IBS

The symptoms of IBS are usually worse after eating and tend to come and go in bouts.

Most people have a flare-up of symptoms that lasts two to four days. After this time, the symptoms usually improvebut do not disappear completely.

The most common symptoms of IBS are:

abdominal pain and cramping - often relieved by emptying your bowels a change in your bowel habits - such as diarrhoea, constipation, or sometimes both bloating and swelling of your abdomen excessive wind (flatulence) an urgent need to go to the toilet a feeling that you need to open your bowels even if you have just been to the toilet a feeling you have not fully emptied your bowels passing mucus from your bottom

Due to the embarrassment, pain and discomfort of IBS, many people with the condition also have feelingsof depression and anxiety.



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Bowel symptoms

There are three main patterns of bowel symptoms in IBS. They are:

IBS with diarrhoea - when you have repeated bouts of diarrhoea IBS with constipation - when you have repeated bouts of constipation IBS mixed - when you have repeated bouts of diarrhoea and constipation

These patterns are not set in stone. You can switch from one to another and go for long periods with few or nosymptoms at all.

Find out about the foods and drinks that can trigger the symptoms of IBS.

'Red flag' symptoms

Certain symptoms indicate you may have another serious condition and that you need further tests. Thesesymptoms include:

unexplained weight loss a swelling or lump in your abdomen or bottom bleeding from your bottom anaemia (a lack of red blood cells)

Causes of IBS

The exact cause of irritable bowel syndrome (IBS) is unknown, but most experts agree it is related to anincreased sensitivity of the entire gut.

This can be caused by:

a change in your body's ability to move food through your digestive system becoming more sensitive to pain from your gut psychological factors an episode of food poisoning

Digestion process



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Your body usually moves food through your digestive system by squeezing and relaxing the muscles of theintestines in a rhythmic way.

However, in IBS it is thought this process is altered, resulting in food moving through your digestive system eithertoo quickly or too slowly. Either way, there will be discomfort within the abdomen.

If food moves through your digestive system too quickly, you will have diarrhoea because your digestive systemdoes not have enough time to absorb water from the food.

If food moves through your digestive system too slowly, you will have constipation because too much water isabsorbed, making your stools hard and difficult to pass.

It may be that food does not pass through the digestive systems of people with IBS properly because the signalsthat travel back and forth from the brain to the gut, controlling the nerves, are disrupted in some way.

An increase in levels of a chemical called 5-hydroxytryptamine (5-HT), which can occur after eating certainfoods or during times of stress, is also thought to affect the normal functioning of the gut.

Increased sensitivity

Many sensations in the body come from your digestive system. For example, nerves in your digestive systemrelay signals to your brain to let you know if you are hungry or full, or if you need to go to the toilet.

Some experts think that people with IBS may be oversensitive to the digestive nerve signals. This means mildindigestion that is barely noticeable in most people becomes distressing abdominal pain in those with IBS.

Psychological factors

There is a fair amount of evidence to suggest psychological factors play an important role in IBS.

However, this does not mean that IBS is "all in the mind", because symptoms are very real. Intense emotionalstates such as stress and anxiety can trigger chemical changes that interfere with the normal workings of thedigestive system.

This does not just happen in people with IBS. Many people who have never had IBS before can have a suddenchange in bowel habits when faced with a stressful situation, such as an important exam or job interview.

It has also been discovered that many people with IBS have experienced a traumatic event, usually during their



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childhood, such as abuse, neglect, a serious childhood illness or bereavement.

It is possible that these types of difficult experiences in your past may make you more sensitive to stress and thesymptoms of pain and discomfort.

IBS triggers

Certain foods and drinks can trigger the symptoms of IBS. Triggers vary from person to person, but themost common ones include:

alcohol fizzy drinks chocolate

drinks that contain caffeine, such as tea, coffee or cola processed snacks, such as crisps and biscuits fatty food fried food

Keeping a food diary may be a useful way of identifying possible triggers in your diet.

Stress is another common trigger of IBS symptoms. Therefore, finding ways to manage stressful situations is animportant part of treating IBS.

Read more about treating IBS.

Diagnosing IBS

There are no specific tests for IBS, as it does not cause any obvious detectable abnormalities in yourdigestive system.

If you have the symptoms of IBS, your GP will not always need to order blood tests to help diagnose you.

However, in a few cases they may recommend blood tests to rule out other conditions that cause similarsymptoms, such as an infection or coeliac disease (a stomach condition caused by gluten intolerance).

IBS is usually diagnosed by carrying out a physical examination and checking whether your symptoms matchthose typical of the condition.



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Your GP will suspect you have IBS if one of the following criteria applies to you.

you have abdominal pain or bloating that is relieved when you pass a stool you have abdominal pain or bloating associated with episodes of diarrhoea or constipation you are passing stools more frequently than normal

If you have at least two of the following symptoms, a diagnosis of IBS will be confirmed:

a change in how you pass stools, such as needing to strain, feeling a sense of urgency or feeling you havenot emptied your bowels properly

bloating, hardness or tension in your abdomen your symptoms get worse after eating you pass mucus from your back passage

Further tests

Further tests are usually only needed when you have certain "red flag" symptoms that indicate you may haveanother serious condition. These symptoms include:

unexplained weight loss a swelling or lump in your abdomen or back passage bleeding from your back passage anaemia (a lack of red blood cells)

Further testing may also be recommended if you have a family history of bowel cancer or ovarian cancer, or if you

are over 60 years of age and you have had a change in your bowel habits that has lasted for more than six weeks

Tests you may have include:

sigmoidoscopy – where a sigmoidoscope (a thin, flexible tube with a small camera and light at one end) isused to examine your back passage and the lower section of your bowel

colonoscopy – where a device similar to a sigmoidoscope, called a colonoscope, is used to examine youentire bowel

Is IBS harmful?

The symptoms of IBS can be uncomfortable and sometimes very painful.



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However, there is no evidence to suggest that IBS will get worse or turn into bowel cancer or other gut-related

conditions.

Treating IBS

The symptoms of irritable bowel syndrome (IBS) can often be reduced by changing your diet andlifestyle, and understanding the nature of the condition.

In some cases, medication or psychological treatments may also be helpful.

IBS-friendly diet

Changing your diet will play an important part in controlling your symptoms of IBS. However, there is no "one sizefits all" diet for people with IBS. The diet that will work best for you will depend on your symptoms and how youreact to different foods.

It may be helpful to keep a food diary and record whether certain foods make your symptoms better or worse. Youcan then avoid foods that trigger your symptoms. But it is important to remember these foods do not need to beavoided for life.

Fibre

People with IBS are often advised to modify the amount of fibre in their diet. There are two main types of fibre:

soluble fibre – which the body can digest insoluble fibre – which the body cannot digest

Foods that contain soluble fibre include:

oats barley rye

fruit, such as bananas and apples root vegetables, such as carrots and potatoes golden linseeds

Foods that contain insoluble fibre include:



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wholegrain bread bran cereals nuts and seeds (except golden linseeds)

If you have IBS with diarrhoea, you may find it helps to cut down on the insoluble fibre you eat. It may also help toavoid the skin, pith and pips from fruit and vegetables.

If you have IBS with constipation, increasing the amount of soluble fibre in your diet and the amount of water youdrink can help.

Your GP will be able to advise you what your recommended fibre intake should be.

The National Institute for Health and Clinical Excellence (NICE) provides more detailed advice about IBS and diet(PDF, 39kb).

Eating tips

Your IBS symptoms may improve by following the advice below:

have regular meals and take your time when eating avoid missing meals or leaving long gaps between eating drink at least eight cups of fluid a day, particularly water and other non-caffeinated drinks such as herbal tea restrict your tea and coffee intake to a maximum of three cups a day

lower the amount of alcohol and fizzy drinks you drink reduce your intake of resistant starch, starch that resists digestion in the small intestine and reaches the

large intestine intact – it is often found in processed or re-cooked foods limit fresh fruit to three portions a day – a suitable portion would be half a grapefruit or an apple if you have diarrhoea, avoid sorbitol, an artificial sweetener found in sugar-free sweets, including chewing

gum and drinks, and in some diabetic and slimming products if you have wind and bloating, consider stopping all cereals for six weeks or increasing your intake of

linseeds (up to one tablespoon a day)

Avoid exclusion diets (where you do not eat a certain food groups, such as dairy products or red meat) unless youare being supervised by a professional dietitian.

Exercise



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Most people find exercise helps relieve the symptoms of IBS. Your GP will be able to advise you about the type of

exercise that is suitable for you.

Aim to do a minimum of 30 minutes vigorous exercise a day, at least three times a week. The exercise should bestrenuous enough to increase your heart and breathing rates. Brisk walking and walking uphill are both examplesof vigorous exercise.

Read more about the benefits of exercise and the different types of fitness activities you can try.

Probiotics

Probiotics are dietary supplements that product manufacturers claim can help improve digestive health. Theycontain so-called "friendly bacteria" that supposedly destroy "bad bacteria", helping to keep your gut anddigestive system healthy.

Some people find taking probiotics regularly helps relieve the symptoms of IBS. However, there is no scientificevidence to prove that probiotics work and have beneficial health effects.

If you decide to try probiotics, make sure you follow the manufacturer's instructions and recommendationsregarding dosage.

Reducing stress

Reducing the amount of stress in your life may help lower the frequency and severity of your IBS symptoms. Someways to help relieve stress include:

relaxation techniques, such as meditation or breathing exercises physical activities, such as yoga, pilates or tai chi (where deep breathing and relaxation is combined with

slow and gentle movements) regular exercise, such as walking, running or swimming

If you are particularly stressed, you may benefit from a talking therapy, such as stress counselling or cognitivebehavioural therapy (CBT).

Read more about how to manage stress.

Medication



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A number of different medications are used to help treat IBS, including:

antispasmodic medicines – which help reduce abdominal pain and cramping laxatives – used to treat the symptoms of constipation antimotility medicines – used to treat the symptoms of diarrhoea antidepressants – originally designed to treat depression, but can also help reduce abdominal pain and

cramping

These medications are discussed in more detail below.

Antispasmodic medicines

Antispasmodic medicines work by helping relax the muscles in your digestive system. Examples of

antispasmodic medicines include mebeverine and therapeutic peppermint oil.

Side effects associated with antispasmodic medicines are rare. However, people taking peppermint oil may haveoccasional heartburn and irritation on the skin around their anus (bottom).

Antispasmodic medicines are not recommended for pregnant women.

Laxatives

Bulk-forming laxatives are usually recommended for people with IBS-related constipation. They make your stoolsdenser and softer, which means they are easier to pass.

It is important you drink plenty of fluids while using a bulk-forming laxative. This will help prevent the laxative fromcausing an obstruction in your digestive system.

Start on a low dose and then, if necessary, increase it every few days until one or two soft stools are producedevery one or two days. Do not take a bulk-forming laxative just before you go to bed.

Side effects associated with taking laxatives can include bloating and wind. However, if you increase your dosegradually, you should have few, if any, side effects.

Antimotility medicines

The antimotility medicine loperamide is usually recommended for IBS-related diarrhoea.



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citalopram fluoxetine paroxetine

Common side effects of SSRIs include blurred vision, diarrhoea or constipation and dizziness.

Read more about selective serotonin reuptake inhibitors (SSRIs).

Psychological treatments

If your IBS symptoms are still causing problems after 12 months of treatment, your GP may refer you for a type oftherapy known as a psychological intervention.

There are several different types of psychological therapy. They all work by teaching you techniques to help youcontrol your condition better. The availability of psychological interventions on the NHS may vary from region toregion.

Hypnotherapy

Hypnotherapy has been shown to help some people with IBS reduce their symptoms of pain and discomfort.

Hypnosis is used to change your unconscious mind's attitude towards your symptoms.

You can have hypnotherapy as an outpatient in some NHS hospital pain clinics, or you can learn self-hypnosistechniques to do at home.

Psychodynamic interpersonal therapy (PIT)

Psychodynamic interpersonal therapy (PIT) is a type of talking treatment that has had some success in helpingpeople with IBS.

It is a form of psychotherapy based on the principle that your unconscious thoughts, beliefs and attitudes caninfluence how you think, act and feel.

Your therapist will help you to explore how your past might have unconsciously affected you. They will also help youto confront unhelpful beliefs, attitudes and behaviours in order to try to change them.

Cognitive behavioural therapy (CBT)



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Cognitive behavioural therapy (CBT) is another type of talking treatment that can help with IBS.

CBT is based on the principle that the way you feel depends partly on the way you think.

Studies have shown that if you train yourself to react differently to IBS by using relaxation techniques and stayingpositive, you should see a decrease in your pain levels.

CBT may also help you to cope better with stress, anxiety and depression.

Complementary therapies

Some people claim therapies such as acupuncture and reflexology can help people with IBS. However, there is nomedical evidence to suggest they are effective and they are not recommended.

Self-help advice for IBS

eat regular meals don't skip meals or eat late at night don't eat too quickly - take your time sit down to eat and chew your food well take regular exercise make time to relax and relieve stress

Access to public toilets

Being able to easily access public toilets is important if you have sudden, urgent bouts of diarrhoea. Twoschemes that can help are:

the IBS Network, which provides members with a Can't Wait Card to help them gain immediate access totoilet facilities in offices, stores and other UK businesses

the National Key Scheme (NKS) by Disability Rights UK, which provides access to the 9,000 lockeddisabled toilets around the country

Complications of IBS

As irritable bowel syndrome (IBS) is not life-threatening, people who do not understand the condition



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are sometimes quick to trivialise it.

However, the symptoms of IBS often have a significant impact on a person's day-to-day life. The pain, discomfortand inconvenience of IBS is very real and can have a deep psychological effect.

For example, it is estimated that three out of four people with IBS will have at least one episode of depression,and just over half will develop generalised anxiety disorder (GAD). This is a long-term condition that can causefeelings of unease, worry or fear.

You should visit your GP if you are feeling anxious or depressed. These conditions rarely improve withouttreatment and they could make your IBS symptoms worse.

Your GP will be able to recommend an effective treatment programme for you, such asantidepressants or cognitive behavioural therapy (CBT), or a combination of the two.

IBS is a 'syndrome'

It's important to understand that IBS doesn't progress to a more sinister condition. It's classified as asyndrome because it consists of many different symptoms.

If you have IBS, you won't usually need to have any investigations and complications can arise if invasiveinvestigations are carried out unnecessarily. Speak to your GP for further information.

'I've found the wheat-free ranges at the supermarket very helpful'

After having IBS for more than 20 years, Ansar Ahmed Ullah is learning to live with the condition.

"I think my IBS came from too many curries!" says Ansar Ahmed Ullah. He first came to London in the early1980s. Living in shared accommodation, he relied on spicy takeaways for his main meal in the evening. "We'dalso go to the community centre at lunchtime, where they served curry and rice," he remembers.

In the mid-1980s, Ansar started to suffer from frequent constipation, bloating, occasional diarrhoea and stomachpain. On one occasion, the pain was so bad that he was rushed to hospital. "I was there for a week," heremembers. "The doctors gave me all kinds of tests. They thought I might have a stomach ulcer, but they didn't findanything."

Eventually, Ansar spoke to his GP, who diagnosed IBS. He was prescribed painkillers and a muscle relaxant drug

to ease his constipation. Unfortunately, neither drug was effective. Ansar decided to try to treat himself.



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He joined the IBS Network to learn about his condition. He had several food allergy tests and discovered that hewas sensitive to wheat, spicy food and dairy products.

"Luckily, I'm still able to eat chicken and fish," he says. "Avoiding dairy and wheat is very difficult. I love milk in mytea. I've never been able to stand the taste of soya, and I love bread and biscuits. I've found the wheat-free rangesat the supermarkets very helpful, though."

Ansar says he's tried every IBS remedy on the market. "I've more or less resigned myself to the fact that I'm notgoing to be cured of IBS," he says. "But it can be very difficult.

"The mornings are the worst. When I was employed, I was constantly late because I had to spend so long in thetoilet with constipation. There's not a lot of awareness of IBS, particularly among young people, so it's hard forpeople to understand what you're going through."

Ansar says IBS also affects his relationship with his partner. "She does sometimes get annoyed when she needsto go somewhere in a hurry and I'm still in the toilet. It's also very awkward when you're out and about and you needto use a loo suddenly or for a long period of time. The IBS is in the back of my mind all the time. I have to considerit when I go anywhere or do anything."

However, Ansar tries not to let his IBS get him down. "I do my best to stick to my wheat-free diet and I make sure Ieat plenty of fruit. I've found that really helps the constipation. I'm also planning to take more exercise. I already goto Pilates classes and I've got a bike, which I should really use more! I think I'm learning to live with my IBS."

'A non-dairy diet seems to help'

Geoff Lyon, 57, has had severe IBS since early childhood. He tells us his story.

"It all started when I was about eight years old. I was getting a lot of unexplained diarrhoea and feeling sick. Icouldn't go anywhere without wanting to go to the toilet. My parents didn't understand what was wrong with me.

"As I grew up, it didn't get any better. I was still suffering diarrhoea and nausea, as well as constipation,headaches and feeling tired all the time. Sometimes it would wake me up at night and I'd sit for a couple of hourson the toilet sweating, with a severe cramping pain in my gut. I wouldn't be able to go, then suddenly I'd have agush of diarrhoea. I would be exhausted the next day.

"It wasn't until 1980, when I was 29, that I was referred to hospital to have a barium enema (when the colon is filled

with a liquid that shows up on X-ray) and a blood test. They couldn't find anything seriously wrong and eventually



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diagnosed irritable bowel syndrome (IBS). I was relieved to finally have a diagnosis.

"I was given an antispasmodic drug to take two to three times a day, which slows the contractions in your gut. Inow control my IBS with codeine phosphate, an antidiarrhoeal drug.

"Not only has the treatment helped, but also cutting dairy products from my diet. About nine years ago my doctorsuggested I try a non-dairy diet. It seems to help. I've always loved milk and cream, so it was difficult switchingfrom them to soya products, but it's worth it. One Christmas I gave in and had some cream trifle. Within half anhour I was on the toilet, which proves it isn't good for me.

"At the moment I still get attacks quite frequently, but they're not as bad and I'm more in control of them. I knowwhen I'm going to have an attack, as I become really lethargic and my stomach distends the night before, like I'msix months pregnant.

"I've noticed that if I'm stressed, my IBS kicks in a couple of days later, so I try to relax and remove any stress frommy life.

"I run a self-help group for the IBS Network, which I'd recommend joining. You get lots of factsheets and a 'Can'tWait Card' that you can show to hotels or shops if you desperately need to use their toilet facilities."

Additional information

Useful organisations

The Gut Trust

Unit 5, 53 Mowbray Street, Sheffield, S3 8ENTel : 0114 272 32 53

http://www.theguttrust.org/



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