AUSTRALIAN GASTROENTEROLOGY INSTITUTE
(educational arm of the Gastroenterological Society of Australia)
Website: www.gesa.org.au... Copies reviewed January 2006

Irritable Bowel Syndrome

• Irritable Bowel Syndrome (IBS) is a very common problem, and symptoms of this type are experienced by nearly one in seven people.
• This sheet explains IBS, its causes, and ways to control the symptoms.
• For further information please contact your doctor.

WHAT IS IBS?

Your bowel is a muscular tube which stores and digests food. Irritable bowel is a disorder which affects the nerves and muscles of the bowel. This causes abdominal pain and irregular bowel movements.

IS IT SERIOUS?

IBS can be very distressing to those who suffer from it, but never leads to a more serious condition. It should NOT be confused with colitis or bowel cancer, and does not cause either.

WHAT ARE THE SYMPTOMS?

Symptoms vary and can come and go. Attacks can last for days, weeks or months. Some of the following symptoms are commonly present:

• Abdominal pain - often relieved by having a bowel motion or passing wind.
• Diarrhoea or constipation (commonly these alternate).
• A feeling of incomplete emptying of the bowel.
• Mucus in the bowel motion.
• A feeling of fullness, or bloating of the abdomen.

Blood in the bowel motion is not a symptom of IBS. If you notice this, contact your doctor as soon as possible.

WHAT CAUSES IBS?

• In the majority of cases, the cause is unknown. In many people who have IBS, the bowel appears to be oversensitive. In some, the bowel reacts excessively to normal contraction, and this causes pain. In others, strong contractions cause pain or discomfort.
• In either case the bowel habit can become erratic.

WHAT TRIGGERS ATTACKS?

In many cases the reasons why attacks come and go are not known. In some cases factors such as stress, diet and infection can bring on or aggravate symptoms.

STRESS:

• In some people the oversensitive bowel reacts excessively to the normal stresses of everyday living.
• In others, the lifestyle they lead may expose them to more stress than usual, producing symptoms.
• In either case, worrying about the symptoms can create a vicious cycle making the symptoms worse.

DIET:

• Often, meals make symptoms worse because food normally stimulates the bowel.
• Certain foods may be a contributing factor, and the importance of this varies from person to person. Not enough fibre (roughage), or too much fat, or sugars may worsen symptoms. Insufficient fibre is usually associated with constipation.
• Certain sugar-like substances found in some beverages, sweets and some fruits, may provoke bloating and diarrhoea in some people.
• Intolerance to milk products in some individuals can also aggravate symptoms.

INFECTION:

• A bowel infection or a bout of gastroenteritis can trigger symptoms. The symptoms may persist, or even begin, long after the infection has cleared from the bowel.
• In these cases it is believed that infection can cause minor alterations to the nerves in the bowel wall, causing it to become oversensitive.
• There is no evidence that the presence of Candida within the bowel causes IBS symptoms.

MEDICATIONS:

Medications such as iron tablets, pain-killers, antibiotics, antacids and others, can also affect the function of the bowel and produce symptoms such as constipation and diarrhoea.

WHEN SHOULD I CONSULT MY DOCTOR?

Many people with IBS do not require medical attention, however, you should see your doctor without delay if you have any of the following:

• Blood in your bowel motions
• If you are over the age of 40 and your symptoms have come on recently.
• Weight loss
• Family history of bowel cancer or
• If you are worried about your symptoms.

WHAT MIGHT MY DOCTOR DO FOR ME?

• Your doctor will ask about your symptoms and carry out a full physical examination. In most cases your doctor will be able to reassure you, but this check may identify the need for tests or referral to a specialist.
• You may need to have an examination of your bowel lining. This is called a sigmoidoscopy. A sigmoidoscopy involves a thin tube being inserted into the lower colon through the rectum, so the area can be viewed.
• Sometimes, further investigations such as colonscopy or barium enema (bowel x-ray) are necessary to rule out the possibility of other disorders, in particular bowel cancer.
• Colonscopy is an examination performed under sedation, of the lining of the bowel, using a thin flexible instrument.
• Both colonscopy and barium enema need special preparation of the bowel to ensure it is clean and empty at the time of examination.
• Blood tests and tests on your bowel motions may also be necessary to rule out other disorders.

It is important to remember that these tests are frequently arranged by your doctor to rule out other disorders, and that tests are expected to be normal in patients with IBS.

WHAT TREATMENTS ARE AVAILABLE?

• Reassurance is important. Once a diagnosis of IBS has been made, your doctor will help you understand how your symptoms come about and will reassure you that IBS does not lead to more serious conditions.
• Your doctor will advise individual treatment for you. This will depend on your symptoms, and will help you to identify any factors which make your symptoms worse.
• If any contributing factors can be identified, these may need to be avoided or reduced by simple changes in lifestyle.
• Your diet may need to be modified. You may need to increase the amount of fibre (roughage) in your diet, eg. high fibre foods including wholegrain cereal, unprocessed wheat bran and wholemeal bread. These foods should be gradually introduced into the diet. You may also need to limit the amount and type of fatty and sugary foods that you eat.

Other special diets are not usually needed.

• In some cases your doctor may advise medications to control constipation or diarrhoea. Medication may also be given for abdominal discomfort, resulting from cramps, spasms or bloating.
• Drug treatment will not cure IBS, and is best used for periods when symptoms are particularly troublesome.
• If constipation is your main symptom, an increase in fibre in your diet, and taking plenty of fluids can help. If this does not produce an improvement, safe and inexpensive laxatives such as Epsom salts can be effective.
• Your doctor may also discuss ways of coping with stress, if this is found to be a factor in your case. Relaxation courses are available, often based in hospitals and community centres.
• Regular exercise, such as a short walk everyday, and taking time to unwind are other useful ways of reducing stress.

CAN IBS BE CURED?

It is important to remember that some symptoms may persist or recur from time to time, despite treatment, and that IBS does not cause more serious disorders.

If you develop new or different symptoms you should consult your doctor.

AUSTRALIAN GASTROENTEROLOGY INSTITUTE

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