Irritable Bowel Syndrome (IBS)

What is IBS?
Irritable bowel syndrome (IBS) is a collection of gut symptoms that occurs in the absence of any other pathological cause. It is a common condition affecting up to 20% of the population and usually first affects peoples in their 20’s. It can often cause distressing symptoms and have a significant impact on quality of life.
We are not sure of what causes IBS but in some patients it seems to be triggered after an episode of gastroenteritis.

Do I have IBS?
IBS symptoms include the following:
Bloating
Abdominal pain
Diarrhoea
Constipation
Urgency to open bowels
Feeling of incomplete bowel emptying

The symptoms need to be present for at least 6 months in order to positively diagnose IBS. Stress and anxiety can trigger the symptoms or make them worse. Typically, the bloating and abdominal pain is worse after eating and better after opening the bowels. The bowel habits may be altered in different ways, some patients have diarrhoea, others constipation and some with a mixed / alternating pattern.

Other Causes
Seeing a doctor is important if you feel you may have IBS – the symptoms are non-specific and other conditions can cause similar symptoms.
It is important for a clinician to take a thorough history and examination to rule out inflammatory bowel disease (ulcerative colitis and Crohn’s) and coeliac disease. Other less frequently encountered conditions also need to be excluded depending on risk factors, age and symptoms. For instance, bowel cancer may present with a change in bowel habit and ovarian cancer can present with symptoms of bloating.
Blood tests are usually recommended as a first line investigation, but other tests may be required such as stool tests, abdominal / pelvis ultrasound and colonoscopy.
It is only if these tests come back as negative that a diagnosis of IBS can be made.

Red flags
If you have any of the following symptoms it is worth seeing a doctor as soon as possible to rule out any other causes. Sometimes these symptoms can be associated with potentially sinister conditions:
Blood in the stools
Weight loss
New onset symptoms after the age of 40

What Treatment is available?

It is important to tackle IBS symptoms with a holistic approach. We know that stress is linked closely with IBS symptoms so this is an important area to focus on. Exercise and relaxation practices such as yoga and meditation can be hugely beneficial. There is also some evidence that acupuncture can help. In some cases, psychological therapies like CBT (cognitive behavioural therapy) and hypnotherapy have been shown to be effective.
Diet is an important aspect of IBS management. Ensuring you eat meals at approximately the same time each day and at regular intervals can help with symptoms. Also maintaining good hydration throughout the day and cutting down on tea, coffee and alcohol can help.
Specific dietary changes can also result in improved symptoms – this includes changing the type of fibre that you consume and low FODMAP diets – see article “5 dietary changes for IBS patients” for more information.
There are different types of medication that can help:
For abdominal pain and bloating – antispasmodic medications that relax the bowel (such as hyoscine and mebeverine) can be helpful. Also peppermint oil capsules can significantly reduce bloating.
In patients with diarrhoea predominant symptoms the use of loperamide can settle loose stools. Bulk-forming laxatives can be used in constipation predominant IBS.
Second line treatments include the use of antidepressant medications (both tricyclic antidepressants and selective serotonin reuptake inhibitors) – they are used in lower starting doses than those used for depression. These medications require monitoring and follow up and can often result in a significant reduction in symptoms.

For more information or a comprehensive consultation and a bespoke management plan please contact us at the GP Clinic London.