IBS Triggers & Treatments to Ease Your Symptoms

Irritable bowel syndrome (IBS) is a chronic condition that affects the digestive system. It causes abdominal discomfort or pain along with bloating or changes to the bowel habit. In IBS, opening the bowels typically relieves abdominal pain.

Certain symptoms like bloating, trapped wind and abdominal cramps can prove embarrassing, particularly if you have diarrhoea or need to rush to the loo several times a day. Many suffer in silence, reluctant to go to their doctor or pharmacist to discuss such personal issues.

There is no specific test to confirm IBS. Doctors make a firm diagnosis with defined criteria of symptoms, persisting for at least 6 months, and in the absence of other digestive conditions that could account for symptoms.

IBS is a common condition that isn’t life-threatening and that doesn’t put you at higher risk of serious conditions like bowel cancer. But it’s a long-term condition that can be debilitating and cause a significant impact on work, study, enjoyable social activities and daily tasks. It can take its toll on your mood and quality of life. Symptoms may be continuous or intermittent, and this chronic waxing-and-waning picture can last for years.

It’s very common, with 1 to 2 people in every 10 suffering in the UK, and that’s likely to be an underestimate, as many don’t seek medical help. Symptoms usually start when people are in their 20s and 30s and it’s more often found in women.

Everyone with IBS has a different experience, so symptoms and their solutions need to be tailored to you. But most people follow the same pattern each time it flares up, so it’s best to think about which symptom predominates your experience. As a rough guide, bowel habit will be altered more than a quarter of the time to meet the criteria for diagnosis.

Diarrhoea-predominant IBS

Some experience loose or runny stool, an increased frequency and an urgency to go. Occasionally leakage may be a problem. There’s a typical “morning rush” sensation, where people have an urge to pass stool several times, once they’ve woken or around breakfast time. They may feel like the bowels aren’t completely emptied.

Abdominal pain-predominant IBS

People often experience stomach cramps and constant or gnawing pain, and they often say this improves after a bowel movement.

Bloating and gas

Many complain of lots of gas in the tummy, causing bloating and flatulence, and typically this is relieved after they've opened their bowels. It’s more common in women, and some experience a tummy that feels hard, tense or distended.

Constipation-predominant IBS

Some experience difficulty passing hard stool or open their bowels much less frequently. Some feel like they haven’t completely emptied the bowels.

Mixed stool pattern IBS

It’s not common, but some find they switch between diarrhoea and constipation, which makes treatment a bit more tricky.

Other symptoms

Nausea, reflux symptoms and feeling full early in a meal all fit with the syndrome. Eating may worsen symptoms, and some pass mucus, a clear or white gel-like substance, with a bowel motion.

Non-gastric symptoms include headaches, backache, fatigue and lack of energy, urinary symptoms and pain having sex (dyspareunia).

When should I see my doctor?

IBS can mimic other conditions, so we need to make sure you have no red flags that alert us as doctors that something more serious could be causing your symptoms. Red flags include:

• unexplained weight loss
• bleeding from the back passage
• a change in bowel habit (looser or more frequent stools) over the age of 60, for more than 6 weeks
• persistent or frequent bloating in females, especially if aged over 50
• an abdominal or rectal mass
• a family history of bowel cancer, ovarian cancer, coeliac disease or inflammatory bowel disease like ulcerative colitis or Crohn’s disease

If you have any red flag symptoms, book an urgent appointment with your doctor. If they think that cancer is a possibility – notably bowel or ovarian cancer – they will refer you urgently to a specialist team for investigations like blood tests, a colonoscopy (a small camera tube passed via your back passage) or a scan.

IBS used to be considered a diagnosis of exclusion – doctors could diagnose it if tests for other gut conditions were negative – but this is now considered outdated and your doctor will ask in detail about symptoms and duration, and diagnose if these fit the criteria. So if your bowel symptoms have persisted for several months, and diet and lifestyle changes have not resolved them, do book an appointment with your doctor.

They will ask about your symptoms, what you’ve tried so far, and your family history. They will examine your abdomen and they may suggest an examination of the back passage. They may order blood tests, stool tests and possibly a colonoscopy, to rule out other causes of your symptoms.

If history, examination or tests show abnormalities that point to gut conditions like Crohn’s disease, ulcerative colitis or coeliac disease, they will likely refer you to the gastrointestinal team for specialist input.

If your doctor determines that IBS is the most likely diagnosis, they may prescribe relevant medications according to your symptoms, and they may refer you to a dietician for specialist diet.

IBS can present with a range of symptoms, so treatments are tailored to provide relief for specific symptoms, and a multi-faceted approach is sometimes needed to deal with multiple causes for the same symptoms.

Diarrhoea in IBS is believed to be related to disrupted nerve connections between the gut and the brain, causing uncoordinated bowel contractions. When these contractions speed up, they cause diarrhoea, and when they slow down, you get constipation. This may be one reason why stress plays a significant role in diarrhoea-predominant IBS.

Some treatments aim to slow down overactive contractions in the bowel. Anti-diarrhoeal agents such as Imodium (contains loperamide 2mg) work to reduce gastric motility and reduce the frequency of passing motions.

Other agents may also be useful to bind and thicken up the consistency of stool to make them less watery, such as products containing kaolin mixture or bismuth subsalicylate, like Pepto-Bismol.

Diarrhoea reduces the absorption of electrolytes and minerals, and this can cause fluid loss leading to dehydration, both of which can be countered using a hydration electrolyte salt drink mixture such as O.R.S or Dioralyte.

Abdominal cramps can be very painful for IBS sufferers, and they often get diarrhoea alongside an urgency to open the bowels. There are anti-spasmodic medicines such as those containing alverine or mebeverine, such as Colofac IBS.

Peppermint oil is a traditional remedy for relaxing the smooth muscle in the bowel and the cramping it can cause, and is available as capsules.

Bloating, trapped wind and flatulence: Peppermint oil’s ability to relax smooth muscle can also help to reduce trapped wind. Other products such as Wind-Eze (contains simeticone) can help to relieve flatulence (excess gas), trapped wind and bloating.

Constipation: There’s a choice of laxatives available and these work in different ways. The most suitable laxatives are osmotic laxatives or stools softeners. Osmotic laxatives such as Lactulose solution, or macrogol-based sachets like Movicol, work by drawing more water into the large bowel, thereby making stools softer, more hydrated and easier to pass. They get to work within 12 to 48 hours.

Stool softeners like Dulco-Ease (contains docusate sodium) work by making stools more permeable to water and fats by affecting the surface tension of any hard dry stools, making them softer and easier to pass. They have a mild stimulant activity, too, working on the nerves in the colon and rectum to contract, thereby helping to move stools out of the large bowel.

Widely used for other causes but less helpful for IBS are stimulant laxatives like Senokot (contains senna) or Dulcolax (containing bisacodyl). These work by stimulating movement of the stool down the intestines, by speeding up a process called peristalsis. Buy this action can cause abdominal cramps, which many with IBS find intolerable.

A laxative that adds bulk to stool can be helpful for both constipation or diarrhoea, as stool is harder to pass when it gets hard and compacted. Those containing a soluble fibre are a good place to start, like psyllium husk or isphagula husk, found in Fybogel sachets.

Finally, if constipation has been persistent for a few days, a rectal product may help like glycerol or glycerin suppositories, or an enema.

Dietary supplements can help to support a good bacterial balance in the gut. Prebiotics and probiotics may improve some IBS symptoms, although possibility not bloating. Supplements containing lactase enzymes, like Lactaid or Milkaid, also help to improve digestion, and they may reduce bloating. Products containing organic mineral polymethylsiloxane polyhydrate (PMSPH), such as Enterosgel, can help bind toxins and allergens in the gut, and help eliminate them from the body, reducing symptoms of constipation, diarrhoea, cramping or bloating.

The cause of IBS is still largely unknown and it’s likely to be multiple factors at play. Research suggests that something disrupts the normal functioning of the bowel, and it becomes over-sensitive to very mild stimulation, causing a variety of reactions.

Food intolerance best describes the sensitivity of many IBS sufferers to certain foods, resulting in abdominal spasms and a gassy gut. This is different to a food allergy, which is not thought to be a factor in IBS. Your gut may not be upset by all of these foods, but The IBS Network, a national UK charity, lists common culprits as:

• wheat
• milk, butter and cream
• fruits like plums, apricots, peaches, mangos, apples and pears
• onions, leeks and garlic
• beetroot
• brassicae like cauliflower, cabbage and sprouts
• pulses like peas, beans and lentils
• coffee
• chocolate
• hot spices like chilli
• red meat
• fatty ready meals and sauces
• fried food

For women IBS is twice as common, and it’s more common in child-bearing age than the post-menopausal phase of life. Many report symptoms are worse around menstruation.

Anxiety and depression are more common in those with IBS, and in turn, the chronic and disabling symptoms and social isolation of IBS seem to push people into anxiety and depression.

Stress plays a significant factor in IBS, and many regard their gut as the barometer of their emotional well-being. If people haven’t been taking time to relax and recuperate, eat and sleep well, IBS can flare up. It also comes at times of deadlines, pressure or conflict, in both the home or workplace.

Post-bacterial gastroenteritis kicks off IBS symptoms in up to 1 in 3 people. However, bacterial gut infections are much less common than viruses in causing gastroenteritis or food poisoning.