Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is one of the most common conditions that results in pelvic pain. It is a lifelong intestinal disorder that prevents the large bowel from functioning correctly. Resulting in abnormal bowel movements which are often uncomfortable and occasionally painful. The symptoms can come and go as they are aggravated by certain activities and foods.

IBS can be categorised by the most common bowel habit:

  • IBS-D - Diarrhoea.
  • IBS-C - Constipation.
  • IBS-M - Both diarrhoea and constipation together.
  • IBS-A - Alternating diarrhoea and constipation.

IBS is quite common, affecting 10-20% of the population and twice as many women as men. Most people are diagnosed before they are 20, and it rarely develops in later life.

Although often painful and inconvenient, IBS is not related to other health problems and does not cause permanent damage to your digestive system. As its effects are not consistently severe, IBS is not included as a disability in the UK Equality Act 2010.

IBS is diagnosed through the symptoms you experience. If you have suffered for 6 months or more, and have been unable to relieve your symptoms by yourself, speak to your doctor for a formal diagnosis. To aid your diagnosis, discuss the regularity and consistency of your bowel movements, and whether all your symptoms affect you regularly or periodically come and go. Make a note of which foods or activities you believe may make your symptoms worse.


What are the Symptoms of Irritable Bowel Syndrome (IBS)?

The most common symptom of IBS is abdominal pain that moves location, usually as a result of abnormal bowel movements. The symptoms can come and go, occasionally being very severe for months at a time. They usually get more severe when you have eaten and before you empty your bowels. In women, they usually get worse when you are on your period. These times where the symptoms of IBS are at their most severe are called 'irritable bowel syndrome (IBS) attacks', and can come on relatively suddenly.

Symptoms of IBS include:

  • Abdominal pains and cramps (both dull and sharp) - These may be relieved by emptying your bowel.
  • Mucus in your stool
  • A change in the way you are able to empty your bowel - Such as straining, not feeling like you have fully emptied, or more of an urgent sensation to go.
  • Diarrhoea and/or constipation
  • Abdominal bloating, tenderness or hardness - More common in women than men.
  • Faecal incontinence
  • Urge incontinence
  • Tiredness
  • Occasional nausea and vomiting
  • Lower backache - Often associated with faecal compaction as a result of prolonged constipation.

Conditions with similar symptoms are other bowel problems; such as diverticular disease, pelvic cancers and coeliac disease. Symptoms are also shared with inflammatory bowel diseases such as Crohn's disease and ulcerative colitis. Your doctor will test you for these other conditions to confirm your diagnosis.

If you are also suffering from the following symptoms, speak to your doctor for urgent advice:

  • unexplained weight loss
  • persistent bleeding from your anus
  • a family history of bowel or any pelvic cancer
  • if you are over 60 years old and have suffered from the symptoms of IBS for more than 6 weeks

What Causes Irritable Bowel Syndrome (IBS)?

The reason IBS develops is not fully understood. However, it is thought to be a result of a lack of coordination between the brain and the digestive system. This means the pattern of contractions and relaxations along the digestive system are disturbed. Allowing food to pass too quickly or too slowly.

Other potential causes are:

  • oversensitive nerves in the intestines
  • hereditary - You are twice as likely to suffer from IBS if a close relative suffers.
  • bacterial infection in the digestive system

The following events are thought to trigger an increase in the symptoms of IBS:

  • stress
  • hormonal changes - Often associated with your period.
  • intestinal hypersensitivity
  • certain mental disorders - Such as depression and anxiety.
  • food intolerance's or sensitivities - Which can cause irritation. IBS is NOT caused by a food allergy.

To read about other causes of pelvic pain, visit the Causes and Diagnosis of Pelvic Pain page.


How to Manage Irritable Bowel Syndrome (IBS)

IBS cannot be cured. However, accurate management of IBS can provide prolonged relief from its symptoms. Around 30% of sufferers report full relief of their symptoms after 10 years of proper management.

Working with your doctor you can define a management plan. It may take several months of different medications and diets to work out what works best for you.

How to Manage Irritable Bowel Syndrome (IBS) with Diet and Nutrition

As IBS is a condition of the digestive system, it is no surprise that changes in your diet influence the symptoms.

  • Keep a food diary - Keeping a record of what you eat and any bowel movements you make, will help you notice any changes which help or worsen your symptoms. Make gradual changes to your diet to avoid any sudden aggravation of your symptoms.
  • Eat smaller meals - To reduce pain.
  • Eat regular meals - Eat at least three regular meals a day, at consistent times. Do not skip meals or eat late at night.
  • Eat slowly - Chew your food well to avoid indigestion.
  • If you are bloated and suffer from wind - Eat oats and linseeds. Have 150ml of fluid with each tablespoon of linseeds. Reduce your intake of beans, green veg and sugar free products.
  • If you are constipated - Gradually increase your intake of fibre and linseeds. Have 150ml of fluid with each tablespoon of linseeds.
  • If you have diarrhoea - Drink at least 8 cups of water to avoid dehydration. As well as avoiding fizzy drinks, and more than 3 cups of coffee or tea a day. Avoid drinking more than 2 units of alcohol a day, with 2 alcohol free days each week. Reduce your intake of high-fibre foods, and sugar free products.
  • Reduce your intake of rich and high fat foods - High fat foods can trigger both constipation and diarrhoea. Cook with fresh ingredients as often as possible.
  • Avoid eating too much fresh fruit - Limit your intake to 3 portions (3 x 80g) of fruit per day.
  • Eat probiotics - Often found in yogurts, these introduce the growth of good bacteria in the gut. Try different brands of probiotics to find one that suits you.
  • Avoid the artificial sweetener sorbitol - Which can cause diarrhoea.

How to Manage Irritable Bowel Syndrome (IBS) with Other Lifestyle Changes

  • Relaxation techniques - Its important that you take time to relax. Learn some breathing exercises, and consider taking up yoga and massages.
  • Exercise - Gentle regular exercise, such as yoga, swimming and cycling, can hep relieve your symptoms.
  • Stress managements - Sometimes alongside pain medication, you can be taught coping skills to reduce the impact of IBS on your emotions.
  • Medications - Prescribed medications will aim to return regularity to your bowel movements.
    • To resolve constipation - Laxatives.
    • To resolve diarrhoea - Antimotility medication and Loperamide, which slow bowel activity.
    • To treat stomach cramps and reduce bowel spasms - Antispasmodic medication.
    • Prescribed pain relief - Tricyclic antidepressant (TCA) or a selective serotonin reuptake inhibitor (SSRI).
  • Psychological intervention - If you are not seeing the relief you expect from medications, the National Institute for Health and Care Excellence recommend trying psychological treatments. These include hypnotherapy, psychological therapy or cognitive behavioural therapy.

PLEASE NOTE: Surgery is considered unnecessary and not a valuable treatment method for IBS. There is no possible cure of IBS, and many individuals which have had surgery to relieve their symptoms, have done so unnecessarily as they have found no relief.

To read about other treatments available for pelvic pain, visit our pelvic pain treatment page.


Sources

BDA. (2016). Food Fact Sheet: Irritable Bowel Syndrome and Diet. [online] BDA The Association of UK Dietitians, 2016. [viewed 24/05/18]. Available from: https://www.bda.uk.com/foodfacts/IBSfoodfacts.pdf

Canavan, C. West, J. Card, T. (2014). Clinical Epidemiology. The epidemiology of irritable bowel syndrome. [online] 6, p71-80. [viewed 14/05/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921083/#!po=43.3333

CCFA. (2014). Inflammatory Bowel Disease and Irritable Bowel Syndrome: Similarities and Differences. [online] Crohn's & Colitis Foundation of America, 2014. [viewed 24/05/18]. Available from: http://www.crohnscolitisfoundation.org/assets/pdfs/ibd-and-irritable-bowel.pdf

Chey, w. D. Kurlander, J. Eswaran, S. (2015). Jama.Irritable Bowel Syndrome: A Clinical Review. [online] 313(9), p949–958. [viewed 14/05/18]. Available from: https://jamanetwork.com/journals/jama/fullarticle/2174034

International Pelvic Pain Society. (2018). Endometriosis. [online] The International Pelvic Pain Society, 2018. [viewed 02/05/18]. Available from: https://pelvicpain.org/docs/patients/endometriosis-english-(1).pdf

Longstreth, G. F. (2007). Gut. Avoiding unnecessary surgery in irritable bowel syndrome. [online] 56(5), p608-610. [viewed 14/05/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1942132/

NHS Trust. (2017). Irritable bowel syndrome (IBS). [online] NHS Trust, 2017. [viewed 14/05/18]. Available from: https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/

NICE. (2008). Irritable bowel syndrome. [online] The National Institute for Health and Care Excellence, 2008. [viewed 14/05/18]. Available from: https://www.nice.org.uk/guidance/cg61/resources/irritable-bowel-syndrome-pdf-254878323397

NIH. (2017). Symptoms & Causes of Irritable Bowel Syndrome. [online] National Institute of Diabetes and Digestive and Kidney Diseases, 2017. [viewed 14/05/18]. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/symptoms-causes

Office for Disability Issues (2010). Equality Act 2010: Guidance. [online] HM Government, 2010. [viewed 24/05/18]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/570382/Equality_Act_2010-disability_definition.pdf