IBS uncovered

Between six and 10 million people in the UK have irritable bowel syndrome (IBS) but the condition is still misunderstood. Professor Peter Whorwell reveals the facts you didn’t know, and looks at the latest thinking on causes and treatments

Some people may only suffer occasional bloating and abdominal pain, but for others IBS can be much more extreme. Some women report the pain being as bad, or even worse, than labour pain. Constipation can leave people unable to pass stools properly for as long as a week, while those with diarrhoea-type symptoms can find their lives become disrupted by the urgency with which they need to go to the toilet. Some even experience incontinence.
For many, the bloating is the most debilitating symptom because it feels so uncomfortable. Around 50 per cent of patients experience a sensation of bloating, but their abdomen doesn’t actually distend. The other 50 per cent of people with IBS do find their girth increases – in some cases, by up to six inches in one day. Some even buy clothes in two sizes, one for ‘good’ days, and another for ‘bad’ days. If you have IBS, you may be struggling with some or all of these symptoms. It can be upsetting and tiring, affecting your whole life. Here are nine of the latest facts and advice to help you manage your condition:

1 There are lots of symptoms
Although the telltale signs of IBS are abdominal pain, bloating, constipation and/or diarrhoea, there are many other common, yet little-known, symptoms. It was once thought IBS only affected the colon, but we now know it can affect the whole length of the gut, meaning a whole range of potential symptoms.
Feeling tired all the time is common, while some patients have irritable bladder problems, including discomfort and the need to urinate more frequently. IBS can also cause back pain, but few GPs would recognise this as a symptom of the condition – in fact, a recent US study suggested it isn’t unusual for people to have unnecessary back surgery when in fact the problem is IBS. It’s also possible for IBS to cause gynaecological symptoms such as pain during or after intercourse. One study found 50 per cent of women seeking help for pain during intercourse had the syndrome. Similarly, about half of patients seeing a urologist for loin pain have IBS.

2 There isn’t just one cause
We still don’t know exactly what causes IBS, and there are probably a number of factors at play. It was once considered to be a motility problem, to do with the muscles in the bowel going into spasm. While this may be true to some degree, what’s probably more pertinent is that in people with IBS, the gut lining is oversensitive, so when there are spasms they may feel them more. It could also be that the brain’s processing of pain is abnormal. There’s some suggestion IBS may be due to inflammation, as research has shown that 20 per cent of cases follow an infection with campylobacter (a bacteria that causes food poisoning) or similar, and some of these patients have been found to have low-grade inflammation in the gut. The belief is that some of these cases could be treated with an antibiotic – but this is controversial as an antibiotic could disrupt gut flora, which may make matters worse.
Between 30 and 40 per cent of people with IBS have an affected family member, but it isn’t clear why – it may be partly due to learned behaviour; for example, a child seeing her mother clutching her stomach or talking about symptoms.

3 Your period affects IBS
You may have noticed that your symptoms are worse during your period. Many more women than men experience IBS, and that’s because hormonal changes can be linked to the condition. There’s also a theory that hormones called prostaglandins released from the uterus during menstruation can aggravate symptoms – and for some women, the Pill can stop IBS. However, as with everything else about the condition, it’s very individual, and some women actually find their symptoms clear up during their period.

4 Ease back on high-fibre foods
Many people who have digestive problems increase the amount of fibre they eat, including lots of brown bread and grains. Unfortunately, it’s about the worst thing you can do and it’s worth avoiding all cereal grains for three months to see if it makes a difference – so no wheat, oats, or any other grain. While these foods don’t actually cause IBS, evidence shows they can aggravate it in up to 55 per cent of sufferers. Other than that, specific foods aren’t usually linked – people tend to worry about food intolerances, but unless you have noticed one particular food that causes problems, there’s probably no need to avoid anything else.

5 Don’t be afraid of laxatives
They can be very helpful for constipation, but often people are reluctant to take laxatives because they’ve heard they can damage the bowel or make it lazy. There’s no evidence for that, and you could be depriving yourself of a very helpful treatment. Likewise, if you have diarrhoea-type IBS, don’t be worried about taking the appropriate medication for that. Talk to your GP about the right treatment – anti-spasmodics can be helpful for easing spasm in the bowel, irrespective of whether you have constipation or diarrhoea. If you want to take a natural laxative, try senna.

6 IBS isn’t all in the mind
There’s still a myth that IBS is a psychological condition. But while stress can aggravate symptoms, it is certainly not all in the mind. Doctors sometimes think people with IBS are depressed, but they’re often distressed because of their debilitating symptoms. Having said that, while it may sound contradictory, low-dose tricyclic antidepressants are among the most effective treatments. When taken for IBS, they’re not working on the head – the gut has lots of nerves, so the antidepressants probably have an effect there.

7 Hypnotherapy can help
My colleagues and I pioneered gut-centred hypnotherapy, in which patients are encouraged to picture the gut as a smooth-flowing river. The advantage of hypnosis is that while other treatments only target individual symptoms, this can tackle all of them, including the non-colonic symptoms. Hypnotherapy has been found to reduce sensitivity and contractions in the gut and it also eases other symptoms such as tiredness and gynaecological pain. It helps 70 per cent of patients but unfortunately there’s a long waiting list for gut-centred hypnotherapy, so it’s a good idea to find other ways to manage your condition.

8 Give probiotics a go
They can alter gut flora and boost immunity, and studies have shown they can reduce bloating and ease constipation in IBS, so it’s well worth trying a supplement or a probiotic yogurt to see if it eases your symptoms.

9 Find what works for you
Many people with IBS experience it throughout life, so it’s best to think about improving symptoms rather than curing them. It’s a question of finding the right way to manage the condition. Exercise helps some people because it’s de-stressing, while for others it can make things worse. With trial and error, it is possible to ease your IBS symptoms.

Red flag symptoms
Some of the common symptoms of IBS are similar to those that may signal a more serious illness such as bowel cancer, so always see your GP if you notice the following:
- Rectal bleeding – 25 per cent of people with IBS experience this due to straining, but it should always be checked out;
- Weight loss;
- Any IBS symptoms for the first time if you’re over 50.
- For more information about IBS symptoms, visit www.ibs-relief.co.uk.

Expert:
Professor Peter Whorwell is director of the South Manchester Functional Bowel Service, a leading centre for IBS treatment. He also led the development group that put together the first guidelines on IBS for doctors.

[Compiled by Charlotte Haigh]