Irritable Bowel Syndrome (IBS) is a condition of the bowel characterised by abnormal bowel habits, indigestion, abdominal pain and loss of appetite. It tends to vary with time, but for many people, the symptoms come and go over a long period.
The term was coined in 1944 by Dr Alvarez because of the belief that IBS was not restricted to the colon, but affected the stomach too. IBS is not a rare condition; approximately 50% of out-patients complaining of digestive issues suffer from it and between 10-25% of people in the general population have it.
IBS can be triggered by a large number of factors such as:
- Infections of the gut
- Certain painkillers (belonging to the “NSAID – non-steroidal anti-inflammatory” class including aspirin and ibuprofen)
- Use of other drugs, such as antibiotics
Less common causes include
- Ovarian surgery (e.g: hysterectomy)
- A course of radiotherapy
There are, however, some individuals who develop IBS with no identifiable cause. As IBS is a complex disorder this is not surprising; there are many individual factors that could trigger the development of the condition and it is likely that both genetics and life-style choices play a role.
Clinicians often use the Rome III criteria to classify diagnose patients with IBS. The requirements for diagnosing IBS in a patient under this system are:
- The patient has suffered from their presenting symptoms for 6 months
- The patient has abdominal pain a minimum of 3 days per month and demonstrates improvement following opening the bowels (defecation)
- The patient experiences one or more of the following:
o An abnormal stool frequency several times per week
o An abnormal stool consistency (either hard or runny)
o Mucous within the stool
IBS cannot be defined if the patient does not present with, or does not regularly suffer from, lower abdominal pain.
Although clinical examination of a person suffering from IBS may be normal, people often feel tender over the left lower quadrant of the abdomen.
Warning Symptoms and Signs
The following symptoms are a warning sign of that there may be something more serious than IBS:
- 10%+ weight-loss that cannot be explained (e.g: by a change in diet)
- Evidence of blood in the stools
- Reduced levels of iron in the blood (anaemia)
- A first degree relative (mother, father, sibling, child) with a known bowel condition such as IBD (inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease). IBD is not the same as IBS.
Doctors often use endoscopy, colonoscopy and blood tests to help reach a diagnosis. Although these procedures may sound unpleasant, they are generally quite mild, and you can go home on the same day as having one of these procedures done. Furthermore, we are always looking for ways to make the diagnosis in the simplest, quickest way possible. The faecal calprotectin test is a very simple, non-invasive test which can help doctors rule IBS in or out and can reduce the need for colonoscopy. We offer this test whenever we think it will be useful.
An effective IBS treatment plan should focus on the symptoms of IBS, preventing any complications associated with IBS (such as side effects from medications) and maximising the quality of life of the sufferer and their family.
A large number of therapies have been proposed for each symptom associated with IBS, and these are discussed in detail by Lacy et. al in the article “The Treatment of Irritable Bowel Syndrome”. It can be read by clicking here.
Although medications can be helpful, they may not always work by themselves. Patients are often encouraged to modify their life-style and eating habits to help alleviate the symptoms they experience. For example, drinking plenty of water and regular exercise are encouraged.
Ultimately though, as with any condition, it is helpful to understand how the treatment works, how long it is likely to take to experience any benefits and understand the potential side effects. Our consultants at the London Gastroenterology centre are experts in the field of IBS and would be happy to explain to you the available treatment options and help you choose the most suitable one.