Irritable bowel syndrome (IBS)
In irritable bowel syndrome the bowel hurts and works erratically even though there is no inflammation in it, no ulcer and no tumour: the tests find nothing…
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Medicines commonly prescribed for Irritable bowel syndrome (IBS)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CAPSULE, 30 mgActive substance: duloxetineManufacturer: Aurovitas Spain, S.A.U.Prescription requiredDosage form: CAPSULE, 90 mgActive substance: duloxetineManufacturer: Neuraxpharm Spain S.L.Prescription requiredDosage form: CAPSULE, 30 mgActive substance: duloxetineManufacturer: Neuraxpharm Spain S.L.U.Prescription required
In irritable bowel syndrome the bowel hurts and works erratically even though there is no inflammation in it, no ulcer and no tumour: the tests find nothing and the person feels awful. It is not "nerves" and it is not made up — in IBS the sensitivity of the bowel wall and the speed of its contractions are both altered. The condition is very common, usually runs for years in waves and does not shorten life, but it can thoroughly spoil day-to-day living. It can be managed, and that starts with working out what sets your own flare-ups off.
How it shows itself
The leading feature is abdominal pain or cramping tied to the workings of the bowel: it usually builds after eating and eases once you have opened your bowels or passed wind. Alongside it come:
- bloating that grows through the day: the tummy is flat in the morning and clothes feel tight by night;
- diarrhoea — loose stools, often first thing in the morning, with sudden urgency that has people planning their routes around the toilets on the way;
- constipation, with straining, hard stools and the feeling of not having fully emptied;
- wind and mucus in the stool.
Depending on what predominates, IBS is divided into a diarrhoea-predominant, a constipation-predominant and a mixed pattern in which the two alternate. The distinction is not a formality: both the food and the medicines follow from it, and the pattern can change over the years.
IBS rarely stays inside the abdomen. Tiredness and exhaustion are common, as are nausea, low back pain, needing to pass urine often and urgently, discomfort during sex, anxiety and low mood. Symptoms come and go: a few bad weeks are followed by a quiet month, and that variability is what misleads people into hunting for "the guilty food" where there is none.
What stirs up a flare-up
Some flare-ups arrive with no reason at all, but most people gradually assemble their own list:
- fatty, fried and very spicy food, large portions, meals that get skipped;
- caffeine and alcohol, fizzy drinks;
- sorbitol, xylitol and other sweeteners ending in "-ol": sugar-free chewing gum and "sugar-free" products are a cause of diarrhoea and bloating that nobody suspects;
- stress, anxiety, short nights, shift work, long journeys;
- in women, the days before a period and the first days of the cycle.
Tracking this from memory does not work, because the reaction often arrives a day later. A diary is easier: what you ate, what was going on in your life, what your tummy did. Two or three weeks are usually enough for the pattern to show.
Signs that do not belong to IBS
IBS does not explain everything, and there are complaints in the face of which the diagnosis must be questioned. Call an ambulance (in Spain, Italy, Portugal, Poland and Ukraine that is the single European number 112) if there is severe unrelenting abdominal pain with a hard, board-like tummy and a high temperature, heavy bleeding from the back passage, vomiting of blood, or black tarry stools.
See a doctor within days, without waiting for a routine appointment, if there is:
- blood in the stool, or black stools;
- weight loss you were not aiming for;
- pain or diarrhoea that wakes you at night — in IBS the symptoms usually retreat during sleep;
- a temperature;
- a lasting change in your usual bowel habit going on for more than a few weeks, especially if it started in middle or older age;
- signs of anaemia: pallor, breathlessness, marked tiredness;
- a lump you can feel in the abdomen;
- bowel cancer, inflammatory bowel disease or coeliac disease in close relatives;
- in women, constant bloating that never quite goes and persists day after day: that, rather than anything sudden, is how ovarian cancer begins, and it is easily taken for IBS.
Why the bowel becomes oversensitive
There is no single cause; several circumstances coincide.
The gut-brain link. The bowel has its own dense nerve network, constantly trading signals with the brain. In IBS that exchange is tuned differently: ordinary stretching of the bowel by gas is registered as pain. Hence the part played by stress, which does not invent the symptom but amplifies a sensitivity that was already there.
Disturbed motility. The contents move sometimes too fast, so water is not reabsorbed in time, and sometimes too slowly, and then the stool hardens.
A previous infection. In some people IBS starts straight after a bad bout of food poisoning or gastroenteritis. It is one of the most understandable forms, and it more often settles by itself within a year or two.
Gut flora and fermentation. Some carbohydrates are poorly absorbed in the small bowel, reach the large bowel and are fermented there by bacteria, producing gas. In someone with ordinary sensitivity that passes unnoticed; in IBS it causes pain and a bursting feeling.
Inheritance and life background. IBS is commoner in those who have it in the family, commoner in women, and commoner in people who have been through hard events, prolonged stress or abuse.
How the diagnosis is reached
There is no test for IBS. The diagnosis rests on the pattern of complaints: recurrent abdominal pain linked to opening the bowels or to a change in how often or how formed the stools are, going on for months. It is a diagnosis in its own right, not a label for "we found nothing".
The tests serve a different purpose — ruling out conditions that look similar. They usually include:
- a full blood count and inflammatory markers;
- a blood test for coeliac disease, whose symptoms are almost indistinguishable from IBS and which turns up in an appreciable share of people who carried an IBS label for years;
- faecal calprotectin, a protein that rises when there is inflammation in the bowel and helps separate IBS from ulcerative colitis and Crohn's disease without going straight to a colonoscopy;
- stool tests for infections and parasites if the diarrhoea began after a trip abroad or a bout of food poisoning;
- where relevant, a thyroid check, a test for lactose intolerance and, in women, a gynaecological examination.
Colonoscopy is not for everyone: it is arranged when there are warning signs from the list above, when symptoms begin in middle age, and when close relatives have bowel disease. If there are no warning signs and the blood tests are quiet, repeating investigations every six months achieves nothing except feeding the fear.
Food: what helps and what gets in the way
There is no universal IBS diet, and that is the first thing to accept. The starting point is not bans but routine: eat regularly, do not skip meals or overload late in the evening, do not rush your food, drink enough water.
After that you adjust to your own pattern:
- With diarrhoea, cut back insoluble fibre — bran, wholemeal bread, fruit and vegetable skins, nuts and seeds — drop the sweeteners ending in "-ol", and keep the fluids up while the stools are frequent and loose.
- With constipation, the opposite: add soluble fibre — oats, psyllium, linseed, carrot, potato, pulses in modest amounts — and build it up gradually, or the bloating will get worse. Wheat bran in IBS harms more often than it helps.
- With bloating, oats and linseed help, as do smaller more frequent meals and cutting back on the big gas producers: cabbage of every kind, onion, pulses, freshly baked bread.
The diet low in fermentable carbohydrates, known as the low FODMAP diet, deserves a mention of its own. It genuinely helps a lot of people, but it is not a list of foods banned for life. It is a three-step procedure: strict restriction for a few weeks, then reintroducing foods one at a time to find out which ones really affect you, and finally a settled way of eating built on what you found. It should be done with a dietitian. Home-made, open-ended versions of it impoverish the diet, damage the gut flora and narrow life down to a dozen permitted foods while explaining nothing in the end.
Medicines and other help
IBS medicines relieve a particular symptom rather than curing the condition, so they are chosen to fit your pattern and taken in courses or as needed. None of them should be self-prescribed for years on end.
- Antispasmodics, for pain and cramping, usually before meals or during a flare-up.
- Peppermint oil in capsules that dissolve in the bowel — a remedy with a demonstrated effect on pain and bloating. It can make heartburn worse.
- Antidiarrhoeal medicines in the diarrhoea pattern; they are best taken in advance, before leaving the house or setting off on a journey, rather than once an episode has started.
- Laxatives: for constipation the bulking and osmotic ones are preferred. Lactulose is usually avoided in IBS because it adds to wind and bloating. Stimulant laxatives are not suitable for continuous use.
- Probiotics are worth trying as a single preparation for about a month. If nothing has improved in that time, cycling through brands leads nowhere.
- Low-dose antidepressants are prescribed not for low mood but as painkillers: they reduce the sensitivity of the bowel wall. It is worth knowing this in advance, so that such a prescription does not read as a hint that the pain is imaginary.
Beyond medicines, what works well is anything acting on the gut-brain link: regular physical activity, relaxation techniques and, in stubborn cases, psychological therapy and gut-directed hypnotherapy. This is not "treating the nerves"; it is a way of breaking the circle in which pain feeds anxiety and anxiety feeds pain.
Online consultation
An online appointment suits IBS well, because here the conversation matters more than the examination. The doctor will go through the character of the pain and of your bowel habit, identify which pattern you have, rule out the conditions that disguise themselves as IBS, and tell you which tests are worth doing and which you would be doing for nothing. They will check the warning signs separately, since their presence changes the whole plan. With the diagnosis already made, the appointment is a good place to look at your food diary, put together a plan for flare-up days, discuss a restriction diet and how not to stay on it for life, and decide what to do when the usual measures have stopped working. With warning signs, blood in the stool for the first time or severe pain, an online appointment is not the right route — a hands-on examination is needed.
This material is for information only and does not replace medical advice.
Consult with a doctor about Irritable bowel syndrome (IBS)
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Online doctors for Irritable bowel syndrome (IBS)
Discuss your symptoms and possible next steps for Irritable bowel syndrome (IBS) with a doctor online.
