Irritable Bowel Syndrome: What? Why? How to control symptoms?

Irritable syndrome (IBS) affects 8 in 100 women. Symptoms may be mild in some. In others it may cause a lot of discomfort, interference with daily activities and absence from work with financial consequences.

In most instances, there is no cure as such. However, you can learn to avoid triggers, and manage the symptoms allowing you to stay on top of this condition.

I have suffered from irritable bowel syndrome for years. At times, I feel things are completely under control. At other times, I feel overwhelmed by the symptoms.

At times I think its a type of diet that triggers it, lactose and at times gluten. At other times, I’m not sure. In spite of avoiding all the triggering factors, I still get symptoms.

My daughter has symptoms of IBS, sometimes quite severe. My sons are ok alhamdulillah.

Does IBS run in families?

We will look at the what, why and how to control IBS.

What is Irritable Bowel Syndrome?

The main symptoms of IBS are:

  • Bloating and cramps in the tummy, usually relieved somewhat by a bowel motion.
  • Diarrhoea or constipation, sometimes both.
  • Changes in the appearance and/or frequency of bowel motion.
This should occur at least 1 day a week for 3 months for your doctor to say that you have IBS.

This is the Rome IV criteria for diagnosis of IBS. You can read here if you want to know more about it.

Typically, you will have good and bad days, mostly unpredictable.

You may also experience headaches, tiredness, painful periods, feeling sick and flatulence (gas in the tummy).

In spite of feeling terrible, the good (?) news is that that there is nothing wrong with your bowels generally.

It is not a disease as such. You don’t get more sick as time goes on, as with other illnesses.

It is very bothersome when it happens, but you get nearly complete relief, only to experience it again!

This is something you have to learn to live with, identify and avoid the triggers and try medications if needed that can relieve symptoms.

Do not however self diagnose IBS, in yourself or others.

You should see your GP if you have symptoms. Your GP will do tests to make sure you don’t have any other conditions.

Once you have been told that you have IBS, it is a question of trying different measures and see what works for you.

What other conditions could cause symptoms like IBS?

There are other conditions which may cause symptoms similar to IBS:

Inflammatory Bowel Disease (IBD) – This includes Ulcerative Colitis and Crohn’s Disease, both of which cause inflammation of the gut. In most cases they need treatment and the disease can get worse over time.

Coeliac Disease – This condition affects 1 in 100 people in the UK, maybe more. Many cases are mistaken for IBS.

Your body’s defence mechanism attacks your gut when you eat food with gluten like bread and barley. Generally, if you have a gluten free diet, you have relief from this.

Bile acid diarrhoea – Bile acids are produced by the liver. If they are not absorbed by the blood a large amount of bile acids goes down the gut and you lose salt and water as watery diarrhoea.

This may occur after having your gall bladder removed (cholecystectomy), with Crohn’s disease, diseases affecting the pancreas, and medication like Metformin (used to treat diabetes).

Sometimes there is no cause for bile acid diarrhoea. 1 in 3 IBS sufferers are thought to have bile acid diarrhoea.

Lactose intolerance – People with lactose intolerance develop symptoms like bloating, sickness and diarrhoea when they consume milk and milk products. They don’t produce enough lactase, an enzyme used to break down lactose in milk.

Lactose in the gut is fermented by bacteria in the gut causing symptoms.

If you avoid milk products symptoms improve.

What to expect at your GP appointment

Your GP would make sure you don’t have any of the above conditions before making a diagnosis of IBS.

Your GP would ask you questions about your symptoms.

Symptoms that would prompt your GP to investigate further:

  • Blood in stool
  • Weight loss
  • Diarrhoea at night
  • Family history of gut cancer
  • History of taking antibiotics in the last few days
If you have excessive weight loss in a short period of time, blood in your stool, palpitations or dizziness or a swelling in your tummy, see your doctor straight away. This could be something more serious than IBS.

Your GP would do a stool test to look for infection and blood tests to check for coeliac disease, infection and anaemia.

Your GP would make sure you don’t have any symptoms suggestive of bowel cancer. If need be your doctor would arrange a colonoscopy, a camera test to see the inside lining of the bowel.

Once your GP decides that you have IBS, your GP would give you information about triggers and how to avoid them, and possibly refer you to a dietician. Medications are prescribed if needed for diarrhoea, pain and constipation as the case may be.

Why do you get IBS?

It is thought that there is a disorder of the communication between the the brain and the gut.

The normal distension that occurs in the gut when you eat food is perceived in an exaggerated manner.

You feel pain, cramps and excessive motion of the bowel causing diarrhoea.

It’s not really known what exactly causes IBS. However these factors may play a role:

  • Family history – IBS is seen to run in families, women being affected more than men.
  • Infection – Any infective diarrhoea may precede symptoms of IBS.
  • Gut microbes – Our gut has bacteria which keeps the gut healthy. These bugs may be replaced by other bugs, viruses or fungus, impairing gut health.
  • Stress – If you have experienced early life stress, you are more likely to develop IBS later.
  • Diet – Diet rich in carbohydrates and gluten are thought to trigger IBS in some cases.
Whenever we say that there are so many different causes of any condition, one thing is clear – we really don’t know what causes it!

So treatment, or shall I say control of symptoms, is largely a mixture of dietary restrictions, medications along with advice for destressing. Hypnotherapy, CBT and probiotics are all used, working brilliantly for some and not so much for others.

How to control symptoms of IBS?

1. Diet

Once a diagnosis of IBS has been made, your doctor will advice you regarding diet.

It is thought that certain foods can trigger IBS.

It is useful to keep a diary of what you eat and your symptoms.

If you figure out the trigger, avoid it. Sometimes your doctor will recommend a low FODMAP diet. This diet is low in fruit, vegetables, milk products and wheat. Generally, if you go on any diet it should be in consultation with a dietician.

The downside of a low FODMAP diet is that you may develop:

  • Nutritional deficiencies
  • Eating disorders
  • Altered gut microbes, making the IBS worse.
2. Probiotics

A 2014 compilation of 43 studies found that probiotics were an effective treatment for IBS.

Look out for cultured dairy products and fermented foods like yoghurts, pickles and the like. Make sure bacteria is live. Pasteurization kills the bacteria.

You may want to take probiotic supplements.

3. Exercise

The role of exercise in controlling IBS is not clear. However, exercise helps in improving constipation, which is a symptom of IBS, as shown in a small study

4. Medication

Some medications can be purchased in a pharmacy over-the-counter. Consult a pharmacist if need be.

Buscopan or Peppermint oil for cramps and bloating.

Loperamide for diarrhoea.

Stool softeners for constipation.

5. Low-fat diet

If you have bile acid diarrhoea your doctor will ask you to have a low fat diet and a medicine called a bile acid binder.

These 2 measures are very successful in treating bile acid diarrhoea.

6.Psychological therapies

CBT(Cognitive Behavioural Therapy) is a talking therapy helping the way you think. CBT is founded upon the belief that our thoughts (cognitions), feelings, and behaviours are all related.

Gut- directed hypnotherapy is used to treat IBS. Your clinician will help you achieve concentration and deep relaxation and help control symptoms through guided imagery and progressive muscle relaxation.

 CBT-based interventions and gut-directed hypnotherapy have been shown to be effective.

A 2020 meta analysis (compilation of 41 studies, with 4072 participants) showed that psychological therapies worked in improving symptoms of IBS.

You could ask your doctor to refer you for this therapy.

Difficult to cure, easier to manage

Some people may be symptom free after having IBS for a while.

Most often it waxes and wanes and you learn to live with it.

Education about this condition is important so that you can try different things and see what works for you.

Do share below what works for you.