Irritable Bowel Syndrome (IBS) Q&A
Three leading IBS specialists answer common questions on IBS covering signs and symptoms, reaching diagnosis, and effective treatments
The Consultants
- Dr Ayesha Akbar is a consultant gastroenterologist at The Clementine Churchill Hospital
- Dr John W O'Donohue is a consultant gastroenterologist at The Blackheath Hospital
- Dr Richard Paul Sarsam is a consultant gastroenterologist at The Princess Margaret Hospital
What is IBS (irritable bowel syndrome)?
Dr Ayesha Akbar: Irritable bowel syndrome, also known as IBS, is a common long-term disorder of the digestive system characterized by multiple symptoms. Symptoms often fluctuate and include diarrhoea, constipation, bloating and abdominal pain. IBS is very common, and affects twice as many women as men. Up to 1 in 5 people may suffer from IBS at some point.
Dr John W O'Donohue: Irritable bowel syndrome describes a variety of symptoms related to the gut, usually longstanding. It can range from mild with only occasional symptoms, to severe, daily symptoms.
Dr Richard Paul Sarsam: IBS is a common bowel disorder characterised by a disturbance of bowel function to constipation alternating with loose bowel movements, incomplete sense of evacuation, abdominal pain and abdominal bloating. The symptoms vary from mild causing little discomfort to more severe interfering with the daily activity of the individual affected. The symptoms may be severe for a period of time then settle in a few weeks or months with no specific treatment.
Food intolerances are now thought by some to cause the majority of symptoms in IBS. Other causes may sometimes need to be ruled out before a diagnosis is made.
What are the causes of IBS?
Dr Ayesha Akbar: Although the exact cause is unknown, studies suggest IBS is likely to be caused by multiple factors. Most individuals have 'visceral hypersensitivity' where the gut is more sensitive to stimulants. Research suggests there may be 'peripheral factors', i.e. changes at the levels of the gut and chemical, pain and nerve receptors; and also 'central factors' relating to the brain and central nervous system. It is highly likely that a combination of these two is involved, and the so-called 'brain-gut axis' is affected. There are more nerve fibres that go to the bowels than any other part of the body, so it is understandable that what affects the brain/mind can have a powerful impact on the gut.
Sometimes individuals develop gastroenteritis and as a result the visceral hypersensitivity state is triggered due to the inflammation, and a post-infectious irritable bowel syndrome occurs. Studies suggest this may occur in 5-32% of people following a bout of gastroenteritis, and often improves with time.
Dr John W O'Donohue: Food intolerance are now thought by some to cause the majority of symptoms in IBS. Other causes may sometimes need to be ruled out before a diagnosis is made.
Dr Richard Paul Sarsam: No one really knows the cause of IBS. There are many theories but no convincing scientific explanation. Although stress and diet are often implicated this is very simplistic and there are many other unidentified factors contributing to the development of IBS.
What are the symptoms of IBS?
Dr Ayesha Akbar: There are three cardinal symptoms of IBS from a practical viewpoint, which are:
- Abdominal pain
- Bloating
- Change in bowel habit (constipation, diarrhea or a mixture)
Dr John W O'Donohue: IBS may have any combination of abdominal pain, cramps, bloating, constipation or diarrhoea - sometimes nearly all at the same time or at different times. IBS symptoms in men and women tend to be the same.
Dr Richard Paul Sarsam: The typical symptoms are central and left sided lower abdominal pain which improves following a bowel movement, abdominal bloating which fluctuates during the day and is not typically present when the individual first wakes up in the morning and a varied bowel habit between constipation with rabbit pellet stools and loose bowel movements. The following are not symptoms of IBS; abdominal pain in the middle of the night, rectal bleeding and weight loss.
Anyone can be affected by IBS though the disorder is typically seen in young adults between the ages of 16-30.
Who is affected by IBS?
Dr Ayesha Akbar: Anyone can be affected by IBS, and many of us experience these symptoms at some point in our lives, with literature suggesting 1 in 5 people are affected at some point, often at times of stress. However, the condition is twice as common in females. IBS is also more common in individuals who suffer from fibromyalgia, depression and migraines.
Dr John W O'Donohue: Nearly one in four people will have IBS. Usually, it starts in the 20s. Slightly more women than men are affected, but IBS in men is very common too.
Dr Richard Paul Sarsam: Anyone can be affected by IBS though the disorder is typically seen in young adults between the ages of 16-30. In some cases, IBS develops after a gastro-intestinal infection also known as post infective IBS. Patients with anxiety and depression are more likely to have IBS than those without these disorders.
How is IBS diagnosed?
Dr Ayesha Akbar: IBS is traditionally a diagnosis by exclusion. It is important to take a full history and ensure that there are no alarm symptoms such as weight loss, rectal bleeding, or loss of appetite. Examination should be normal, and bloods including a haemoglobin, CRP, coeliac serology and Ca-125 in women should be normal. A negative faecal calprotectin test is also reassuring. Beware of a short history, or symptoms in men.
Dr John W O'Donohue: It's diagnosed by the symptoms. There is no test that positively diagnoses IBS. Often other conditions may mimic it, and tests may need to be done to rule these out.
Dr Richard Paul Sarsam: IBS is diagnosed by the combination of symptoms described above. Blood tests such as coeliac screening (gluten allergy) and CRP (to look for inflammation) are often carried out at the GP surgery to help rule out other conditions.
A pelvic ultrasound scan is usually done in females when bloating is the main symptom to rule out an ovarian problem.
A colonoscopy or sigmoidoscopy (a slim flexible tube with a mini camera inserted through the anus under sedation) is performed in some cases such as those with new onset bowel symptoms over the age of 45, for those with diarrhoea as the main symptom or those with a family history of colon cancer at a young age.
We aim to control symptoms as there is no cure.
How can IBS be treated?
Dr Ayesha Akbar: We aim to control symptoms as there is no cure. Some things that can help are:
- Anti-spasmodic medication is prescribed for bloating
- Consider a FODMAP diet via a dietician
- Probiotics
- Anti diarrhoeal agents or laxatives depending on symptoms
- Low dose anti-depressants
- Psychological support
- Linaclotide (for constipation predominant IBS not responding to laxatives/antispasmodics)
Dr John W O'Donohue: Food intolerances can be the root cause. We offer tests for some of these.
Dr Richard Paul Sarsam: There is no curative therapy for IBS. Dietary elimination with or without the help of a dietician can help some individuals such as elimination of brown fibre and dairy products. Gut hypnosis is helpful in severe cases by relaxing the bowel. Drugs to reduce bowel sensitivity such as amitriptyline can help those with pain as the main symptoms. New drugs such as Linaclotide and lubiprostone are now approved for those with severe constipation and bloating.
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How do I book an appointment?
If you're concerned about symptoms you're experiencing or require further information on this subject, talk to a GP or see an expert consultant at your local Circle Hospital.