What Is Irritable Bowel Syndrome (IBS)?
Irritable bowel syndrome (IBS) is the most common primary care hindgut condition. It can cause instances of stomach cramps, bloating, diarrhoea and/or constipation.
IBS varies in symptoms from person to person and can come and go in periods of just a few days to a few months. Often issues such as suffering from stress and eating particular types of foods can trigger symptoms.
Classical symptoms are of cramping abdominal pain, abdominal bloating, alteration in bowel habit, either diarrhoea or severe constipation, mucus discharge, complete evacuation of faeces and gastroesophageal reflux disease (GORD). The persistence of these symptoms, or the passage of blood through the rectum, should initiate a referral to your GP. IBS is assumed to be associated with abhorrent signals between the brain and the gut. It can also be triggered by a severe infective episode of gastroenteritis, or it can even be stress related.
Symptoms of IBS may ease after defecation. When experiencing IBS there may be periods of abnormal stool frequency (more than three times a day or less than twice per week). The form may change from lumpy/hard to loose/watery or patients may notice a change in passage i.e. strain, urgency, tenesmus. There may be passage of mucous per rectum.
The well established Rome criteria based on clinical symptoms can help to diagnose IBS.
What Actually Happens?
This is a common problem which affects a large number of the adult population. Classic symptoms include: abdominal pain, abdominal bloating and an alteration in bowel habit, either diarrhoea or constipation. There are three main sub-types: constipation predominant IBS, diarrhoea predominant IBS, or mixed IBS. Management of the condition includes lifestyle and dietary modifications. Faecal calprotectin testing has some use in excluding inflammatory bowel disease. Colonoscopy is indicated in the presence of rectal bleeding or a persistent alteration in bowel habit.
A low Fermentable Oligo-Di-Monosaccharides and Polyols (FODMAPs) diet has been found to be useful in the management of a diarrhoea predominant IBS (in conjunction with constipating agents) and in patients with significant bloating. Probiotics which alter the intestinal flora have also been found to be useful in patients with bloating. Patients with a constipation predominant IBS benefit from laxatives and may obtain relief from trans anal (colonic) irrigation. The management of refractory IBS involves cognitive behavioural therapy and other relaxation and bowel retraining techniques. Once a diagnosis has been established, avoiding catalysts and acknowledging how to live with it, are all important in the overall management of IBS.
Managing The Condition
Investigation after concise history taking and examination can often be managed on an outpatient basis, following basic blood tests (thyroid function test, coeliac screen) and stool tests. In the presence of persisting symptoms such as constant diarrhoea or rectal bleeding, colonoscopy may be required, especially when over the age of 35, to exclude an alternative causes for the symptoms. Management often involves certain dietary modifications, for example, the low FODMAPS diet has gained increasing acceptance recently for improving symptom control. Refractory IBS can often be managed with good symptomatic outcomes through avoidance of precipitating factors, various relaxation techniques and bowel retraining techniques.
What Tests May Be Carried Out To Diagnose IBS
- Routine biochemistry, Full Blood Count, ESR, CRP, TFT’s. Tissue transglutaminase (including immunoglobulins) if diarrhoea is a prominent symptom.
- Consider stool culture if infection is suspected.
- Faecal Elastase 1 for pancreatic disease.
- Colonic imaging. Colonoscopy is the gold standard for colonic imaging – it is diagnostic (direct visualisation and biopsies of the large bowel and terminal ileum) and well as well as therapeutic (principally polyp removal).
- CT pneumocolon is an alternative promising investigation that is less invasive. However, it is purely diagnostic and does not allow the taking of mucosal biopsies/removal of polyps.
To ask a question about a IBS (irritable bowel syndrome) or to book an appointment, contact our specialist team available Monday – Friday 8am – 6pm and on Saturday from 9am – 1pm.
Our gastrointestinal specialists team have a dedicated and caring approach and will seek to find you the earliest appointment possible with the correct specialist for your needs. If you are self-paying you don’t need a referral from your GP. You can simply refer yourself and book an appointment. If you have medical insurance (e.g. Bupa, Axa PPP, Aviva), you will need to contact your insurer for authorisation for any treatment and, in most cases, you will require a referral letter from your GP. If you do not have a GP, then we have an in-house private GP practice that you can use.Alternatively we can suggest the most appropriate course of action for you to take, given your location and individual circumstance.