Is it IBS or a killer condition? Doctor reveals the gut symptoms you should never ignore

We’ve all been there at some point – stomach cramps that make you double over in pain, having to rush to the toilet or spending longer in there than is comfortable.

We’ll often put it down to something we ate, or a stomach bug, and increasingly conclude it’s a bout of IBS. But this seemingly catch-all-acronym is a distinct medical condition – how many of us can actually explain what it is and what causes it? You don’t lose any points if you can’t!

As Ana Carolina Goncalves, Superintendent Pharmacist at Pharmica confirms, ‘Research has not fully established what causes irritable bowel syndrome, but an interplay of various factors is likely.’

So, we asked the experts what current medicine knows about IBS, how it’s diagnosed and how to treat it.

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Dr Deborah Lee at Dr Fox Online Pharmacy explains that even though IBS is fairly commonplace, that doesn’t reduce its impact: ‘Irritable bowel syndrome is a common condition affecting the stomach and intestines and it can significantly reduce the quality of life. Fear of the symptoms – from bloating to constipation diarrhoea – embarrassment and the stigma of the condition can all impair the ability to work, interact socially with friends and family and increase the risk of anxiety and depression. It is often a lifelong condition and living with it can be as severe as living with any other chronic condition such as Inflammatory Bowel Disease (IBD) or Rheumatoid Arthritis.’

Who does IBS affect?

‘According to the NHS, as many as 20% of the UK population, including adults and children, are affected by IBS at some stage in their lives,’ says Dr Lee. ‘It is more common in those under age 50, and twice as common in women as men.’

Women seem to be more affected by IBS than men due to a combination of hormonal factors, increased psychological distress, genetic predispositions, and differences in gut physiology. Conditions often associated with IBS, such as fibromyalgia, migraines, and pelvic pain, are also more common in women.

Goncalves adds, ‘Your genetics could also make you more likely to get IBS, as it tends to run in families. Psychological factors could also be responsible. Stress, depression, and anxiety can make IBS symptoms worse as these conditions often affect your digestive and nervous systems.’

‘Many people will consult their GP with symptoms that are likely to be due to IBS,’ says Dr Lee. ‘1 in 12 GP consultations are for gastrointestinal symptoms, the most common diagnosis being IBS. The major symptoms are abdominal pain, bloating, diarrhoea and/or constipation. It is often the GP, or sometimes a Consultant Gastroenterologist who makes the diagnosis. This means asking about a variety of symptoms, examining the abdomen and doing some tests to rule out other causes.’

Dr Lee says there are 3 main types of IBS:

IBS-C – the symptoms are predominantly constipation.

IBS-D – the symptoms are predominantly diarrhoea.

IBS-M – this is a mixed picture in which the person has both constipation and diarrhoea.

‘The cause of IBS is thought to be a dysfunctional gut-brain axis,’ she says. ‘The stomach and intestines are controlled by the autonomic (involuntary) nervous system – meaning they work on their own, without a person having to think about it. In IBS, this mechanism has gone wrong, and the brain is misunderstanding the nerve impulses. This means stress, anxiety, and different foods can trigger the gut to become over or underactive, resulting in pain, bloating, diarrhoea and/or constipation.’

Katie Murray, Nutritional Therapist at evidence-based gut supplement brand, AltruVita, adds, ‘IBS is what we call a functional gastrointestinal disorder. This means the bowel usually appears normal on medical tests, but it doesn’t always work as it should. Because there isn’t a single test for IBS, diagnosis is often made by ruling out other conditions and carefully considering symptoms.’

This is what can make a true diagnosis tricky. Let’s look at the symptoms.

What to look for

‘IBS causes symptoms like bloating, constipation, diarrhoea, and stomach pain and cramps,’ says Goncalves. ‘You may get sudden urges to use the toilet, or you might have less control over your bowels, especially if you are stressed or anxious. Heartburn, nausea, and a lack of energy are also potential IBS symptoms, although these are less common.’

Emma Thornton, Qualified Nutritionist at avogel.co.uk recognises that IBS symptoms might not be so sudden. ‘Most people don’t pay attention to their bowel movements on a daily basis. It’s only when things start to go drastically wrong that you might begin to pay attention to your digestive habits and notice that something isn’t quite right. There could actually be a long lead up to your major IBS issues, but perhaps you aren’t aware of how often you are a little constipated or experience some looseness, so you get a shock when these things start to happen more regularly.

‘Most people are unaware of what is healthy when it comes to their toilet habits, which means less obvious IBS symptoms may go unnoticed. You might be convinced you’ve suddenly developed IBS when, in reality, the signs could have been there for a while.’

Dr Lee says anyone with abdominal pain should be considered for a diagnosis of IBS. ‘Usually, they will have been experiencing bouts of pain at least 1 day a week for a protracted period of at least 6 months. The pain may be cramping, aching, or burning and they often feel an associated need to open their bowels (poo). Often there is excess gas (farting), the tummy feels distended and tender, and there may be a lot of mucous in the poo. Sometimes, after having a poo, the person feels their rectum isn’t empty. The poo may be loose and watery or hard and lumpy, or alternate between the two. Things may spontaneously resolve, only to recur again a few days or a week or so later.’

But what else could it be? ‘There is a long list of differential diagnoses for IBS,’ says Dr Lee. ‘The doctor needs to have considered and ruled out these other conditions – so to some extent, IBS is a diagnosis of exclusion. Remember that IBS is very common – these other diagnoses are not. For example, a GP will see on average 1 case of bowel cancer per year.’

It’s a long list! A doctor will start by asking lots of questions about the patient’s history. ‘This will include details of the diet, and any foods that make symptoms worse,’ says Dr Lee, so it’s important that you keep a food diary. ‘The Bristol Stool Chart may be used to classify the types of stool being passed during an episode,’ Dr Lee continues. ‘They will the examine the person, including the abdomen and the rectum – meaning inserting a gloved finger gently into the rectum.

‘They need to look for any red flags that might indicate a different diagnosis. IBS does not cause gut inflammation and does not increase the person’s risk of developing other conditions such as IBD or bowel cancer.’

What are the red flags? Dr Lee says these would include:

• Unintentional weight loss
• Rectal bleeding
• Blood in the stools – including a positive faecal immunochemical test (FIT test)
• A change in bowel habit in anyone over the age of 60 years
• Raised faecal calprotectin (a protein that is a marker of GI inflammation)
• Iron deficient anaemia
• Persistent bloating in a woman aged over 50
• An abdominal or rectal mass
• A close family history of bowel cancer, ovarian cancer, coeliac disease or IBD

Doctors will likely perform some tests to rule out serious causes of stomach problems including a blood test, to rule out anaemia and check platelets and inflammatory markers – such as ESR and CRP, and Coeliac serology, which tests your autoantibodies to gluten. They will check faecal calprotectin, which helps doctors assess whether the gut is inflamed, and perform a FIT test to rule out blood in the stool.

Quality of life

If a diagnosis of IBS does come back, don’t despair. Though it can be a lifelong condition, there are ways to manage the symptoms and give your body the best chance at avoiding painful episodes.

‘Once the diagnosis has been made, the person can be reassured they do not have bowel cancer or anything more serious,’ says Dr Lee. ‘IBS is a condition of a disordered gut-brain axis. Stress, illness and medication can set off gut symptoms, and this is likely to be a recurring pattern. IBS does not increase the risk of bowel cancer and will not lower life expectancy.

‘The mainstay of treatment is to learn to manage the condition by lowering stress, recognising triggers, and eating the right foods. Each sufferer will find they need to eat and avoid eating certain specific foods to keep their gut as healthy as possible and avoid precipitating a flare up. This may mean seeing a dietician and having professional help. The most important principle is to eat a healthy, balanced diet – for example, the NHS Eatwell Diet. It’s also important to drink plenty of fluids so as not to become dehydrated.’

‘Triggers for IBS symptoms can be highly individual, so identifying your particular triggers can be beneficial for long-term management of the condition,’ adds Goncalves. ‘You should try to drink at least 1.5 litres of fluids every day. Staying hydrated is important for your overall health and helps with digestion. This can be plain water or non-caffeinated drinks like peppermint tea, as caffeine can be a trigger for IBS symptoms. Fizzy drinks like sparkling water or sodas can also be a trigger due to their carbonation, so you should limit how many of them you drink.

‘Generally speaking, eating a balanced diet of complex carbohydrates, lean proteins, and a small amount of healthy fat can help to manage IBS symptoms. You should include some fibre in your diet to help with digestion – oats, beans, and pulses are good sources of soluble fibre that are not too difficult for your body to digest. You could also try taking probiotics, which contain live bacteria, to see if they help to manage IBS symptoms.

‘While some fibre is beneficial, especially if you experience constipation, eating too much fibre can cause diarrhoea or bloating and stomach cramps. You may also want to avoid vegetables like broccoli, cabbage, and cauliflower because they are harder to digest and can make symptoms worse. It’s also best to avoid overly fatty, seasoned, or spicy foods, as these can irritate your stomach.’

It's clear you’ll need to adapt your diet depending on the type of IBS you have. Dr Lee advises that those with diarrhoea and bloating need to reduce their fibre intake, as well as reduce their intake of caffeine, carbonated drinks, alcohol and other gas-producing foods such as cruciferous vegetables. She suggests that diarrhoea may be treated with loperamide.

Those with constipation on the other hand need to gradually increase their fibre intake, not just eating high fibre foods but adding fibre to meals such as sprinkling ispaghula husk on cereal. Dr Lee says that for constipation, laxatives may be needed, although NICE (National Institute for Health and Care Excellence) recommends lactulose should be avoided.

‘If things are not progressing well, the patient may need to follow a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet,’ she says. ‘There is a long list of high FODMAP foods which includes: some fruits (apples, cherries, peaches, and nectarines); artificial sweeteners; most lactose-containing foods; legumes; and some green vegetables (broccoli, Brussels sprouts, cabbage, and peas). This is hard to follow and often needs the help of a dietician.’

There are some other treatments you could try. Dr Lee suggests mebeverine hydrocholoride or peppermint oil for abdominal pain. She says some patients choose to take a probiotic supplement, though the effectiveness of this has not been proven. ‘The most successful forms contain bifidobacterium, acidophilus or lactobacilli. NICE suggests they try this for 12 weeks and after this discontinue if there has been no benefit.’

Additionally, Dr Lee says antidepressants are often used to reduce bowel spasms, such as low dose amitriptyline. If this is ineffective SSRIs such as fluoxetine or citalopram may be used. Her non-pharmaceutical management techniques include getting seven hours of good quality sleep every night and doing the recommended 30 minutes a day (150 minutes a week) of moderate-intensity exercise (MIT). ‘This is any exercise that makes you slightly sweaty and out of breath and includes brisk walking, jogging, cycling, swimming or dancing.

‘Finally, for many reasons IBS sufferers are advised not to smoke,’ says Dr Lee. ‘Smoking has been shown to make IBS symptoms worse and also damages the gut microbiome.’

Katie Murray summarises: ‘Identify your personal triggers with a food diary as reactions sometimes appear a day or two later – a nutritionist can help spot patterns and guide you. Temporarily follow a low FODMAP plan to ease symptoms by reducing fermentable foods – which should be done with professional guidance so foods can be reintroduced systematically. Keep hydrated, manage stress, get good sleep and regulate the digestive system with exercise. Add a good quality probiotic like AltruVita’s ProfBiotic Complex + into the diet to help rebalance the gut and AltruVita's Healthy Gut Supplement to help balance gut flora, calming inflammation and supporting immunity.’

IBS dos and don’ts!

Dr Deborah Lee shares this helpful NHS advice for IBS sufferers:

Do

Eat a healthy balanced diet

Keep a food and symptom diary to help work out which foods trigger symptoms

Drink at least 1.5 L of fluid per day (8-10 glasses) – this should be water or decaffeinated tea/coffee or herbal tea

Find ways to relax

Get regular exercise

Try probiotics for at least one month

Don’t

Skip meals – eat at regular intervals

Eat too quickly – this makes you swallow air and encourages indigestion

Eat too many spicy, high fat or processed foods

Eat more than 3 portions of fruit per day

Drink any more than 3 cups of caffeinated tea, coffee or other caffeinated drinks in a day

Drink large amounts of alcohol or fizzy drinks

Eat or drink anything containing the artificial sweetener sorbitol

Alternative approaches

There are certain instances where symptoms can be suddenly triggered by your lifestyle and diet. These include lifestyle changes, important events, drastic detoxing and unfamiliar foods. Emma Thornton, Qualified Nutritionist at avogel.co.uk suggests these holistic remedies for IBS:

1. Lifestyle changes

If you make or experience a sudden change in your life, this can have an effect on your digestive system. For instance, starting a new job can be a very stressful time as you adapt to new surroundings, meet new people and take on new responsibilities. This can all have an effect on your gut, causing nervous irritation that makes you run to the loo.

It can also have the reverse effect as ongoing stress causes your digestive system to effectively ‘switch off’, as your blood supply is sent to your heart and brain to power you through the challenging times.

If you try to eat when your body is focussing its efforts elsewhere, this can be a shock to your digestive system and cause issues, as your gut is not prepared for an onslaught of food and has not produced the essential enzymes or mechanisms required for proper digestion. Poorly digested food will ferment and cause gas if it is not shifted, causing you bloating and discomfort.

What can help?

A.Vogel’s Stress Relief Daytime (jandevrieshealth.co.uk). This is a fast-acting remedy to relieve stress, which can help you to relax so that you can enjoy a meal and give your body a chance to handle your food properly.

Digestisan (amazon.co.uk). This contains herbs which are useful for indigestion symptoms caused by stress or eating too quickly. Its extracts of dandelion and artichoke help to relieve flatulence and abdominal discomfort created by wind. 

2. Important events

Short-term anxiety or nerves can trigger IBS symptoms in the same way that stress can, so your sudden flare-up of symptoms might be related to an upcoming event such as an important exam or a work party. If this is the case, a vicious cycle can develop if your anxiety is caused by worrying over a bout of diarrhoea, but your diarrhoea is actually caused by your anxiety!

I would recommend avoiding caffeine and big meals before these big events so you don’t have to worry about uncomfortable or embarrassing symptoms presenting themselves at the wrong time. Taking medication to stop your bowel moving will only cause further problems for your digestive system, so this is not the way to go!

What can help?

Silicol gel (avogel.co.uk). If your nerves are causing diarrhoea, this will calm and soothe the lining of your gut and relieve inflammation, thus alleviating diarrhoea – without causing constipation!

Biotta Breuss juice (realfoods.co.uk). This will help to replenish nutrients lost through a bout of diarrhoea. It can even be heated to make a delicious and nutritious soup, which will be gentle on your stomach if you’re feeling queasy and will allow you to replenish some nutrients in time for your big exam.

3. Drastic detoxing

A significant change in diet can also have a huge impact on your body and can result in a sudden flare-up of IBS symptoms. For example, if you decide to undergo a drastic detox in January and subject your gut to a bout of cold, acidic fruit smoothies then this is bound to give your system a shock. This could be to blame for your stomach pains and discomfort.

Fresh fruit is a far more natural option and requires chewing, unlike a liquid diet. Chewing is essential for activating the production of digestive enzymes and priming your stomach to receive food!

What can help?

A balanced diet. The key to a healthy diet is balance, and for many people a flood of cold, raw food is going to have a negative effect on digestion. Extreme measures are never a good option! Cutting out a few junk foods and reducing caffeine intake is a safer option for unburdening your digestive system.

4. Unfamiliar foods

Even small changes to your diet can impact your digestion and might be the reason behind your sudden IBS symptoms. Suddenly switching from warm foods to lots of cold foods, for example, can be a shock to your system.

If you go on holiday to somewhere hot and snack on ice cold food and drinks all day when your body is used to a colder climate and warmer foods, this could cause some issues. Or suddenly eating spicy food when your stomach isn’t used to it can irritate your gut and trigger stomach pain or diarrhoea.

If you’re planning to switch up your diet, for example including more brown bread and pasta instead of white, this extra roughage may make itself felt if you’re not used to it. This can be the same for new vegans or vegetarians introducing more plant-based foods to their diet than they’re used to.

So, before beginning a brand new diet, it’s important to get your bowel moving and make sure you begin on a clean slate, as it were. As mentioned, your digestive system can become overwhelmed with unfamiliar foods, so it’s important to make sure you keep things moving or else you could be left with a difficult and uncomfortable concoction bubbling away inside you. 

What can help?

Warm foods. They’re easier for your body to digest because you don’t have to use excess energy to heat the food (poo comes out warm, doesn’t it?!). Stick with warm foods (like stewed fruit) to prevent overwhelming your gut.

Avoid spicy foods. Or, if you simply can’t live without them, try a little bit at a time to test how your body reacts and see if that’s what is responsible for your flare-ups.

Silicol gel. It coats the lining of your gut and acts as a trap for toxins and other irritants. If certain foods don’t agree with your digestive system and tend to irritate your gut then Silicol gel will help to heal and prevent this irritation. 

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