Irritable bowel syndrome (IBS) is a disorder rather than a disease. In other words, if you were to take all the intestines out and look at them under the microscope they would appear entirely normal, so it is not a disease. It is how the bowel functions that is the problem and in particular how it moves.
Many of the symptoms of IBS are because the bowel is either overacting or underacting and therefore symptoms develop because it is not moving as the bowel should do.
The main and most severe symptom is bloating. Other symptoms include abdominal cramps and a change in bowel habit, either an alternating bowel habit between constipation and frequent stools, or just constipation alone.
Diarrhoea-predominant IBS does happen but it is less common.
The symptoms tend to vary between individuals and some are more severely affected than others. The symptoms tend to also come and go in periods lasting a few days to a few months at a time, often during times of stress or after eating certain foods.
There is no agreed medical opinion on the underpinning cause of IBS. However, whilst stress and anxiety may not directly cause IBS, they are widely considered exacerbating factors, and that if the stress can be reduced this may help to relieve the symptoms of IBS.
Symptoms can also develop from certain foods. Evidence suggests that symptoms can get worse when consuming milk-based products. Common things like oranges and onions are often not well-tolerated by people that have IBS. There is also popularity for gluten-free products or wheat-reduced diets as a way to relieve IBS symptoms, but the effects of these diets on IBS are inconclusive.
The demographic has changed as previously it was predominantly women who at least went to the GP with IBS symptoms, whereas now it is more equal in terms of gender. There has also been a noticeable rise in the level of stress and anxiety experienced by younger generations, and this has seen IBS becoming more frequently reported among teenagers and those in their 20s. But there has been a rise in anxiety and stress generally in recent years, and IBS can be experienced by almost anyone. In particular, there has been a rise in the cases of IBS amongst men.
There is not one main treatment for IBS. If this was straightforward and easy then everybody would be given the same type of medication, but this is not currently the case. Very simple things like peppermint oil or anti-spasmodic drugs can relieve symptoms.
It is important to rule out celiac disease, which can mimic IBS, by monitoring the diet closely, and making sure that the patient does not have inflammatory bowel disease, particularly Crohn's, that can also display symptoms similar to IBS.
The treatment really will be to analyse the patient’s stress levels. The patient should look at whether or not their symptoms are worse during the week or when they go home in the evening to their partner or family, to identify what may be triggering it and then addressing that. There are other things like the FODMAP diet, which is for anyone with bowel problems, but it can be very difficult to strictly abide by this diet.
There are all sorts of different treatments, diets, and therapies that can be tried by an individual person which would require talking to a GP and other healthcare professionals.
IBS, although it is not a disease, is a very life-interrupting condition. A patient is never going to come to any serious harm from IBS in that it will never turn into another condition, but it does interfere with people's lives, particularly the bloating, which can be quite disabling because it alters how the person appears and feels. If they can manage to treat it this will help the patient feel more comfortable and able to carry on with their day-to-day lives.
In terms of conventional treatment, there are few side effects that need to be considered. As the condition is not a disease, it does not require any strong medication or treatment that could potentially come with any significant side effects.
However, some of the diets that are recommended, apart from the FODMAP diet which is usually supervised by a dietitian, may be nutritionally unsound as they do not include a correct balance of nutrients.
Dietary advice has changed over the years, often because a new study proves a previous theory wrong, and so it is important for patients to approach diets through trial and error as our reaction to certain foods can vary between individuals.
The treatment is usually administered by either a health professional or by the patient simply educating themselves. A patient may also consult a dietitian or see a hypnotherapist, the latter of which has been shown to be quite useful for IBS. It is not a condition that a specialist gastroenterologist is usually required in order to supervise the treatment, but rather will point people in the right direction.
It is a condition that mainly requires self-management, partly because the medical therapies have not proven to be the most effective. Taking as much rest and relaxation as possible, using therapies like mindfulness, seeing a psychologist, undergoing CBT for certain stress-related disorders, receiving acupuncture, and looking at their diet, are just some of the highly effective measures that the patient can do to try and help their condition.
This depends on the individual. If there is any diarrhoea, and other causes have been excluded, then a lactose-free diet is always worth a try. There are plenty of alternatives to milk, like lactose-free milk or soya milk. However, people can develop illusions about diets or ungrounded dietary advice can sometimes be issued to patients.
For example, previously people were encouraged to go on a diet that was high in bran and that's now been shown not to be helpful for IBS. Recently, the FODMAP diet has been tried in some patients but it can be a very difficult diet to follow and unless the patient has got severe symptoms, most people will struggle to continue adhering to the diet.
The advice given to most IBS patients is that they monitor which foods they eat that may trigger the IBS and try cutting such foods out of their diet.
Stress tends to increase the levels of adrenaline and research has shown there is a direct link between the brain and the gut. If a person is stressed or anxious, they tend to get a lot of tension in their neck and shoulders, which is an external symptom that can actually be felt and seen. The same thing happens in the gut.
The gut will tend to go into spasm and experience muscular hyperactivity when a person is stressed. It is in that way the tension that we recognise in our shoulders and necks also happens in the gut.