What you need to know about irritable bowel syndrome

Irritable bowel syndrome (IBS) is a very common chronic illness that affects the large intestine. It is a functional disorder, meaning there is a problem with the functionality but no abnormality in the structure.

So, in IBS the function of the gut is upset, but all parts of the gut look normal. It commonly presents with cramping, abdominal pain, bloating, gas, diarrhoea and constipation. It does not cause changes in bowel tissue or increase risk of colorectal cancer.

Only a small number of people with IBS have severe symptoms. Many people can control these by managing diet, lifestyle and stress. Others will need medication and/or counselling.

Signs and symptoms

The signs and symptoms of irritable bowel syndrome can vary widely and are non-specific. Among the most common are:

• Abdominal pain or cramping. This often eases when you pass stool (faeces) or wind.
• A bloated feeling.
• Flatulence (gas).
• Diarrhoea or constipation.
• Mucus in the stool.

For most people, IBS is a chronic condition, although there will likely be times when the symptoms are worse and times when they improve or even disappear. It is important to see a doctor if you have any of the symptoms persistently because it may indicate a more serious condition, like colon cancer.

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Some red flags that suggest a need for additional tests include:

• Condition starts after age 50.
• Weight loss.
• Rectal bleeding.
• Fever.
• Nausea or recurrent vomiting.
• Abdominal pain, especially if it’s not completely relieved by a bowel movement, or occurs at night.
• Diarrhoea that is persistent or awakens you from sleep.
• Anaemia related to low iron.

Causes

It is not known exactly what causes irritable bowel syndrome, but a variety of factors play a role. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm to move food from your stomach through your intestinal tract to your rectum.

The cause of IBS may have something to do with overactivity of parts of the intestines. Pain and other symptoms may develop if the contractions become abnormal or overactive.

If you have IBS, the contractions may be stronger and last longer than normal, causing gas, bloating and diarrhoea. Or the opposite may occur, with weak intestinal contractions slowing food passage and leading to hard, dry stools.

Abnormalities in your gastrointestinal nervous system also may play a role, causing you to experience greater than normal discomfort when your abdomen stretches from gas or stool.

Poorly coordinated signals between the brain and the intestines can make your body overreact to the changes that normally occur in the digestive process. This overreaction can cause pain, diarrhoea or constipation.

Picture: iStock

Common triggers include

• Food. A wide range of foods has been implicated: chocolate, spices, fats, fruits, beans, cabbage, cauliflower, broccoli, milk, carbonated beverages and alcohol to name a few.

• Stress. Most people with IBS find symptoms are worse or more frequent when stressed. But stress doesn’t cause IBS.

• Hormones. Many women findthe symptoms are worse during menstruation, so hormonal changes are thought to play a role.

• Other illnesses. Sometimes an acute episode of gastroenteritis or too many bacteria in the intestines (bacterial overgrowth), can trigger IBS.

Risk factors

You are more likely to have IBS if you:

• Are young. IBS tends to occur in people under age 45.

• Are female. About twice as many women as men have it.

• Have a family history of IBS. This may be related to genes, environmental factors or both.

• Have a mental health problem. Anxiety, depression, a personality disorder and a history of childhood sexual abuse are risk factors.

Picture: iStock

Treatment

Treatment focuses on the relief of symptoms as the cause is largely unknown. In most cases, you can successfully control mild symptoms of irritable bowel syndrome by managing stress and changing diet and lifestyle.

Lifestyle changes that may assist include: eliminating high-gas foods and gluten, a low carbohydrate diet, eating at regular times, taking care with dairy products and exercising regularly.

Medications to use if lifestyle changes don’t work include fibre supplements, anti-diarrhoeal medications, anticholinergic and antispasmodic medications, antidepressants and antibiotics.

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