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Irritable bowel syndrome (IBS) is a chronic (long-term) disorder that affects the digestive system. It causes abdominal pain, diarrhoea and constipation.
There are different types of IBS, depending on your main symptom. It's known by a variety of other names, including spastic colon, spastic colitis, mucous colitis, nervous diarrhoea, nervous colon and nervous or functional bowel. However, some of these names misrepresent the condition. Colitis, for example, is an inflammation of the colon and this symptom isn't found in people with IBS.
The symptoms of IBS can fluctuate. There may be times when your symptoms are particularly troublesome and times when you experience no symptoms at all.
Although IBS poses no serious threat to health, it can have an adverse effect on a person's quality of life. The exact causes of IBS are unknown.
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The most common symptoms of irritable bowel syndrome (IBS) are:
- abdominal pain and cramping which is often relieved by emptying your bowel,
- a change in your bowel habits, such as diarrhoea, constipation or, sometimes both,
- bloating and swelling of your abdomen,
- excessive wind,
- experiencing an urgent need to go to the toilet, which can result in incontinence if a toilet is not nearby,
- a feeling that you have not fully emptied your bowel, and
- the passing of mucus from your rectum (back passage).
The symptoms of IBS are usually worse after eating. Most people will experience a 'flare-up' of symptoms, lasting between 2-4 days, after which the symptoms improve, or disappear altogether.
For reasons that are not completely understood, IBS can also cause symptoms in other parts of your body, as well as in your bowel. These symptoms include:
- lower back pain,
- muscle and joint pain,
- constant tiredness,
- nausea,
- headache,
- burping,
- bad breath, and
- a frequent and urgent need to urinate.
Due to the pain, discomfort and embarrassment that are sometimes associated with IBS, some people also experience feelings of anxiety and depression.
The exact cause of irritable bowel syndrome (IBS) is unknown. However, most experts believe that it may be caused by a number of interrelated factors. Possible factors include:
- an abnormality with how the muscles move food through the digestive tract
- having digestive organs that are particularly sensitive to pain,
- a malfunctioning immune system,
- a problem with how the central nervous system controls the digestive system,
- an unusual response to infection, and
- environmental, dietary, and genetic factors that are as yet unknown.
Psychological factors in IBS
There is a great deal of evidence that psychological factors play an important role in IBS. This is not to suggest that IBS is 'all in the mind' because the symptoms people experience are very real.
Changes in emotional states, such as stress, or depression, often cause a flare-up of symptoms. IBS is also more common in people who have experienced a previous traumatic experience.
How you think and feel can have an important effect on your body. When you are feeling stressed, or depressed, your body undergoes chemical changes and it is possible that these changes can affect how your digestive system works, making the symptoms of IBS worse.
This is why psychological treatments, such as relaxation therapy, are often effective in helping to control the symptoms of IBS.
- an abnormality with how the muscles move food through the digestive tract
- having digestive organs that are particularly sensitive to pain,
- a malfunctioning immune system,
- a problem with how the central nervous system controls the digestive system,
- an unusual response to infection, and
- environmental, dietary, and genetic factors that are as yet unknown.
Psychological factors in IBS
There is a great deal of evidence that psychological factors play an important role in IBS. This is not to suggest that IBS is 'all in the mind' because the symptoms people experience are very real.
Changes in emotional states, such as stress, or depression, often cause a flare-up of symptoms. IBS is also more common in people who have experienced a previous traumatic experience.
How you think and feel can have an important effect on your body. When you are feeling stressed, or depressed, your body undergoes chemical changes and it is possible that these changes can affect how your digestive system works, making the symptoms of IBS worse.
This is why psychological treatments, such as relaxation therapy, are often effective in helping to control the symptoms of IBS.
If you have the symptoms of irritable bowel syndrome (IBS), your GP will usually recommend that you undergo a blood test in order that other conditions that cause similar symptoms, such as infection, or Coeliac disease (a stomach condition caused by gluten intolerance) can be ruled out.
GPs can usually confidently diagnose IBS by asking you about your symptoms.
Your GP will ask you whether you have had any of the following symptoms that have lasted for at least six months:
- changes in your bowel habits, such as constipation, or diarrhoea,
- pain and discomfort in your abdomen, and
- a bloated feeling.
Your GP will be looking for some specific symptoms that are needed for a positive diagnosis of IBS. These are either:
- abdominal pain, or discomfort, that goes away after you empty your bowel, or
- abdominal pain, or discomfort, with a change in your bowel habits - for example, you may go to toilet more often than you did before, or you may produce stools that look different from usual.
For IBS to be diagnosed, you will also need to have at least two of the following symptoms:
- a change in how you pass stools, such as needing to strain, feeling a sense of urgency, or feeling that you have not emptied your bowels properly,
- bloating, hardness or tension in your abdomen,
- symptoms that are worse after eating, or
- the passing of mucus from your rectum (back passage).
When further tests are required
Further testing is usually only required when you have specific symptoms, or signs, that suggest that you may have a more serious condition than IBS. These symptoms include:
- unexplained weight loss,
- abdominal and rectal mass (localised swelling in the abdomen and/or rectum),
- bleeding from your rectum (back passage), and
- anaemia (a condition that occurs when there is a reduced number of red blood cells, or haemoglobin concentration in the blood).
Further testing may also be recommended if you have a family history of bowel, or ovarian, cancer, or if you are over 60 years of age and you have experienced a change in your bowel habits that has lasted more than six weeks.
GPs can usually confidently diagnose IBS by asking you about your symptoms.
Your GP will ask you whether you have had any of the following symptoms that have lasted for at least six months:
- changes in your bowel habits, such as constipation, or diarrhoea,
- pain and discomfort in your abdomen, and
- a bloated feeling.
Your GP will be looking for some specific symptoms that are needed for a positive diagnosis of IBS. These are either:
- abdominal pain, or discomfort, that goes away after you empty your bowel, or
- abdominal pain, or discomfort, with a change in your bowel habits - for example, you may go to toilet more often than you did before, or you may produce stools that look different from usual.
For IBS to be diagnosed, you will also need to have at least two of the following symptoms:
- a change in how you pass stools, such as needing to strain, feeling a sense of urgency, or feeling that you have not emptied your bowels properly,
- bloating, hardness or tension in your abdomen,
- symptoms that are worse after eating, or
- the passing of mucus from your rectum (back passage).
When further tests are required
Further testing is usually only required when you have specific symptoms, or signs, that suggest that you may have a more serious condition than IBS. These symptoms include:
- unexplained weight loss,
- abdominal and rectal mass (localised swelling in the abdomen and/or rectum),
- bleeding from your rectum (back passage), and
- anaemia (a condition that occurs when there is a reduced number of red blood cells, or haemoglobin concentration in the blood).
Further testing may also be recommended if you have a family history of bowel, or ovarian, cancer, or if you are over 60 years of age and you have experienced a change in your bowel habits that has lasted more than six weeks.
Access to toilet facilities
Finding access to toilets can be an important issue if you are experiencing symptoms of sudden and urgent diarrhoea. In the most severe cases of irritable bowel syndrome (IBS), some people are afraid to visit public places in case they experience an episode of incontinence.
There are a number of steps that you can take to help you deal with the problem. For example, the IBS charity, 'The Gut Trust' operates a 'Can't Wait' card scheme. This is a small card, confirming that you have a medical condition which indicates that you may require immediate access to toilet facilities. Should you need to, you can use the card to gain access to the toilet facilities of businesses, supermarkets, or other organisations.
Another alternative is to join the National Key Scheme. The National Key Scheme (NKS) offers independent access to people with certain health conditions, such as IBS, to around 7,000 locked public toilets around the country.
Psychological impact
As IBS is not a life-threatening condition, it is sometimes trivialised it as being nothing more that a form of indigestion. However, the pain, discomfort, and inconvenience caused by IBS can have a profound psychological affect on the individual.
It is estimated that the majority of people with moderate to severe IBS will experience feelings of depression and anxiety at some point in their life.
If you find that you have been feeling particularly down over the past month, and you no longer take pleasure in the things that you used to enjoy, you may be depressed. You should see your GP for advice and treatment.
Cognitive behavioural therapy (CBT) may also help you cope better with your condition and any feelings of depression and anxiety that you have.
You may also want to consider joining an IBS support group because talking to people who share your condition can reduce feelings of loneliness, isolation, and stress. Your GP may be able to provide details of support groups in your local area.
