Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is a common, long-term condition of the digestive system. Symptoms can include stomach cramps, bloating, diarrhoea and/or constipation.

IBS is thought to affect up to one in five people at some point in their life, and it usually first develops when a person is between 20 and 30 years of age. Around twice as many women are affected as men.

The condition is often lifelong, although the symptoms may change over several years.

IBS does not pose a serious threat to your physical health and doesn't increase your chances of developing cancer or other bowel-related conditions.

IBS symptoms

The symptoms of IBS vary between individuals and affect some people more severely than others. Symptoms can become worse, often during times of stress or after eating certain foods.

You may find some of the symptoms of IBS ease after going to the toilet and moving your bowels.

Read more about the symptoms of IBS

When to see your GP

Visit your GP if you have IBS symptoms. Your GP will carry out some blood tests to rule out other conditions.

Read more about diagnosing IBS

What causes IBS?

The exact cause of IBS is unknown. Many causes have been suggested but none have been proven to directly lead to IBS.

The symptoms of IBS are very similar to many other conditions. Before making any dietary changes, ensure that your GP or gastroenterologist has ruled out Inflammatory Bowel Disease (IBD), coeliac disease or other bowel conditions.

How is IBS treated?

There is no cure for IBS, but the symptoms can often be managed by making changes to your diet and lifestyle.

For example, it may help to:

• follow a healthy, balanced diet
• stay hydrated
• exercise regularly
• manage your stress levels

Medication is sometimes prescribed for people with IBS to treat the individual symptoms they experience.

Read more about treating IBS

Living with IBS

IBS is unpredictable. You may go for many months without any symptoms, then have a sudden flare-up.

The condition can also be painful and debilitating, which can have a negative impact on your quality of life and emotional state. Living with IBS may lead to feelings of depression and anxiety.

Read more about living with IBS

IBS is a life long condition and symptoms often vary.

In some people, the symptoms seem to be triggered by something they have had to eat or drink.

Main symptoms

The most common symptoms of IBS are:

• abdominal (stomach) pain and cramping, which may be relieved by moving your bowels
• a change in your bowel habits – such as diarrhoea, constipation or sometimes both
• bloating and swelling of your stomach
• excessive wind (flatulence)
• occasionally experiencing an urgent need to move your bowels

Additional problems

In addition to the main symptoms, people with IBS can experience other problems. These can include:

• a lack of energy (lethargy)
• feeling sick
• backache

The symptoms of IBS can also have a significant impact on a person's day-to-day life and can have a deep psychological impact. As a result, many people with the condition have feelings of depression and anxiety.

When to see your GP

You should see your GP if:

• you think you have IBS symptoms, so they can try to identify the cause - they can often do this by asking about your symptoms, although further tests are occasionally needed to rule out other conditions
• you're feeling anxious or depressed - these problems rarely improve without treatment and could make your IBS symptoms worse

You should see your GP immediately if you have other symptoms, including:

• unexplained weight loss
• a swelling or lump in your stomach or back passage
• bleeding from your back passage
• signs of anaemia
• bladder problems - such as needing to wake up to urinate at night, experiencing an urgent need to urinate and difficulty fully emptying the bladder
• pain during sex (dyspareunia)
• incontinence

These can sometimes be a sign of a potentially more serious condition.

Read more about diagnosing IBS

There are no specific tests for IBS. It does not cause any obvious detectable abnormalities in your digestive system.

In most cases, a diagnosis will be based on whether you have typical symptoms of IBS.

Your GP will consider assessing you for IBS if you have had any of the following symptoms for at least 6 months:

• abdominal (stomach) pain or discomfort
• bloating
• a change in bowel habit – such as passing stools more often, diarrhoea and/or constipation

A diagnosis of IBS will then be considered if you have stomach pain or discomfort that is either relieved by pooing, or is associated with a need to poo frequently or a change in the consistency of your poo.

This should be accompanied by at least two of the following four symptoms:

• a change in how you poo – such as needing to strain, feeling a sense of urgency or feeling you have not emptied your bowels properly
• bloating, hardness or tension in your stomach
• your symptoms get worse after eating
• passing mucus from your back passage

Ruling out other conditions

Many cases of IBS can be diagnosed based on your symptoms alone. Sometimes further tests may be needed to check for other possible causes.

Your GP will arrange blood tests to rule out other conditions that cause similar symptoms. These include infections or coeliac disease (a digestive condition where a person has an adverse reaction to gluten).

A sample of your stools will also often be tested for the presence of a substance called calprotectin. This substance is produced by the gut when it's inflamed. Its presence in your stools could mean your symptoms are being caused by inflammatory bowel disease (IBD).

Investigating 'red flags'

Further tests will be needed when you have certain "red flag" symptoms that indicate you may have a potentially more serious condition. These symptoms include:

• unexplained weight loss
• a swelling or lump in your stomach or back passage
• bleeding from your back passage
• anaemia 

Further testing may also be recommended if you:

• have a family history of bowel cancer or ovarian cancer
• are over 50 years of age and have had a change in your bowel habits that has lasted for more than six weeks

In these cases, your doctor may recommend having a colonoscopy to check for abnormalities in your gut. This is where your rectum and large bowel (colon) are examined using an endoscope, which is inserted into your back passage (rectum).

The symptoms of irritable bowel syndrome (IBS) can often be managed by changing your diet and lifestyle, and understanding the nature of the condition.

In some cases, medication or psychological treatments may also be helpful.

Adjusting your diet

The first step in trying to reduce your symptoms of IBS is to follow a healthy, balanced diet. Aim to:

• eat regular meals including breakfast, lunch and an evening meal (if required, small snacks can be included)
• avoid missing meals or eating late at night
• take time over your meals, making time to sit down and chew your food well

Use the Eatwell Guide to help you include foods from each food group in your daily routine.

Fluid

Having enough fluid is important for overall health. It may also ease your symptoms, especially constipation. This is also particularly important when increasing the fibre in your diet or to replace fluids lost when experiencing diarrhoea.

Try to have at least 8 cups or glasses (1.5-2 litres) of fluid per day (you may need more if you have diarrhoea or are increasing your fibre intake). Good choices include water, sugar free drinks and drinks with no caffeine. Aim to reduce fizzy drinks or those that are high in caffeine.

Caffeine

Caffeine is most commonly found in tea, coffee, energy drinks and cola. UK guidelines state that adults should have no more than 400mg of caffeine per day and no more than 200mg per day during pregnancy. If you think caffeine may affect your symptoms, try to reduce it further or eliminate it completely.

The following tables describe the typical caffeine content in common drinks. Check product labels for accurate amounts for specific brands and varieties.

Tips to reduce your caffeine intake include:

• Reduce your intake of tea and coffee and aim to switch to decaffeinated or naturally caffeine-free varieties such as herbal teas.
• Limit cola and iron brew. Decaffeinated varieties are available, but limiting fizzy drinks generally is best.
• Energy drinks such as Red Bull, Monster and Rock Star are very high in caffeine and should be avoided.

Alcohol

Alcohol can make IBS symptoms worse. Aim to follow recommendations for safe alcohol intake and drink no more than 14 units per week.

If you do drink 14 units, spread this out over three or more days and have regular alcohol-free days.

Read more about alcohol guidelines.

Fatty foods

High fat foods should be limited as part of a healthy diet. They have also been shown to aggravate some IBS symptoms, especially diarrhoea. These foods include:

• fried foods
• fast food
• pastries
• crisps
• cakes

To improve health and potential IBS symptoms only include these foods in small amounts and infrequently. Many reduced or low-fat varieties are available for a healthier alternative.

Sweeteners

A sweetener called sorbitol can cause diarrhoea. This is found in some sugar-free sweets, chewing gum and mints. It can also be found in ‘diabetic’ and slimming products. Check the labels and limit these products.

Processed foods

Processed or reheated foods contain resistant starch, which can be difficult for your body to digest. Processed foods include:

• ready meals
• potato and pasta salads
• oven chips
• part-baked breads

These starches can aggravate wind, bloating and diarrhoea symptoms. To limit these, make your own meals using fresh foods wherever possible.

Fibre

People with IBS are often advised to modify the amount of fibre in their diet.  Foods that contain fibre include:

• vegetables
• fruit
• pulses
• wholemeal bread

Your GP may be able to advise on what your recommended fibre intake should be.

Low FODMAP diet

If you experience persistent or frequent bloating, a special diet called the low FODMAP diet can be effective.

A low FODMAP diet should only be followed if:

• you've followed the advice above and not had symptom relief
• you've seen your GP and had other issues ruled out
• you've been referred by your GP and have the support of a trained Specialist Dietitian

A low FODMAP diet isn't suitable for everyone and must only be used following a dietetic consultation.

The low FODMAP diet is a short term intervention following a process of not eating then gradually re-introducing foods to your diet to find out which foods affect your IBS symptoms. 

Probiotics

Probiotics are dietary supplements that product manufacturers claim can help improve digestive health. They contain so-called "friendly bacteria" that can supposedly restore the natural balance of your gut bacteria when it has been disrupted.

Some people find taking probiotics regularly helps to relieve the symptoms of IBS. However, there is little evidence to support this. It's unclear exactly how much of a benefit probiotics offer and which types are most effective.

If you want to try a probiotic product, you should take it for at least four weeks to see if your symptoms improve. You should follow the manufacturer's recommendations regarding dosage.

Medication

A number of different medications can be used to help treat IBS, including:

• antispasmodics – which help reduce abdominal (stomach) pain and cramping
• laxatives – which can help relieve constipation
• antimotility medicines – which can help relieve diarrhoea
• low-dose antidepressants – which were originally designed to treat depression, but can also help reduce stomach pain and cramping independent of any antidepressant effect

All medication should be taken following the packet or a doctor's advice.

Psychological treatments

If your IBS symptoms are still causing problems after 12 months of treatment, your GP may refer you for a type of therapy known as a psychological intervention.

There are several different types of psychological therapy. They all involve teaching you techniques to help you control your condition better. There is good evidence to suggest they may help some people with IBS.

Psychological treatments that may be offered to people with IBS include:

• psychotherapy – a type of therapy that involves talking to a trained therapist to help you to look deeper into your problems and worries
• cognitive behavioural therapy (CBT) – a type of psychotherapy that involves examining how beliefs and thoughts are linked to behaviour and feelings, and teaches ways to alter your behaviour and way of thinking to help you cope with your situation
• hypnotherapy – where hypnosis is used to change your unconscious mind's attitude towards your symptoms

The availability of psychological interventions on the NHS may vary from region to region.

Reducing stress

Reducing your stress levels may also reduce the frequency and severity of your IBS symptoms. Some ways to help relieve stress include:

• relaxation techniques – such as meditation or breathing exercises
• physical activities – such as yoga, pilates or tai chi
• regular exercise – such as walking, running or swimming

If you are particularly stressed, you may benefit from a talking therapy, such as stress counselling or cognitive behavioural therapy (CBT).

Living with IBS can be challenging but with the right support and information, it's completely manageable.

Making small changes to your daily diet, routine and mindset will have a big impact on managing your condition.

IBS and your mental health

You may experience feelings of depression and anxiety due to IBS flare ups and complications.

Speak to your GP if you have feelings of depression or anxiety that are affecting your daily life. These problems rarely improve without treatment and your GP can recommend treatments such as antidepressants or cognitive behavioural therapy (CBT), which can help you cope with IBS, as well as directly treating the condition.

With appropriate medical and psychological treatment, you should be able to live a normal, full and active life with IBS.

Easing bloating and cramping

Living with IBS means that you will often experience bloating or cramps after eating. There are some things you can do which will ease any bloating or cramping you may have. These include:

• eating small but regular meals
• eating oats regularly
• avoiding foods that are hard to digest such as cauliflower and Brussels sprouts
• exercising regularly

Exercise

Many people find that exercise helps to relieve the symptoms of IBS. Your GP can advise you on the type of exercise that is suitable for you.

Aim to do a minimum of 150 minutes of moderate-intensity aerobic activity, such as cycling or fast walking, every week.

The exercise should be strenuous enough to increase your heart and breathing rates.

Read more about physical activity guidelines for adults.

Travelling with IBS

Travelling with IBS may take a bit of extra planning but it's still very possible.

If you're travelling a long distance by car, you could:

• be aware of possible rest stops on your journey where you could use the toilet (there are apps available for this)
• bring your own food
• drink plenty of water and stay hydrated

If you're travelling by aeroplane you could:

• book an aisle seat to allow easy access to the toilet
• avoid eating aeroplane meals that could trigger IBS symptoms
• drink plenty of water and stay hydrated
• carry diarrhoea/constipation tablets in your hand luggage
• ensure the medication your require for your trip is packed, and any liquid medication is kept in your suitcase

IBS and relationships

Having a chronic illness such as IBS can put a strain on any relationship. Your partner may feel worried or anxious when you're in pain. It's important to talk about your worries together.

In a new relationship, it could be better to tell your new partner about your IBS sooner rather than later. It's better to be up front about the issues you may have so that they can understand what you're going through.

Being open about how you feel and what your family and friends can do to help may put them at ease. But do not feel shy about telling them that you need some time to yourself, if that is what you want.

Support groups

There is a large community of people with IBS and charities such as The IBS Network who exist to help give you the information and support needed to understand IBS.

Joining your local IBS support group is a good way to meet people who really understand what you are going through. They can help give you advice on how to live well with IBS and support you whilst you're adapting to your new lifestyle.

To find your nearest IBS support group, visit The IBS Network. If there isn't a support group available near you, you can speak to other people with IBS on their forum or speak to someone on their helpline (0114 272 3253) which is open Monday-Friday, 9.00am-4.30pm.