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Irritable Bowel Syndrome

By Dr Koyes Ahmed, Family Medicine Consultant, Intercare Health Center

Irritable Bowel Syndrome (IBS) is a common condition of the digestive system, and describes a wide variety of symptoms which can vary from one person to another. IBS affects up to 1 in 5 people at some point in their lives, being twice as common in women as in men, and usually first developing when a person is between 20 and 30 years of age.

Although the cause is not always clear, there are thought to be a number of contributing factors and triggers to IBS, including the following:
– Stress and anxiety
– Diet, e.g. fizzy drinks, caffeine, chocolate, processed foods, fatty/fried food
– Alcohol
– Illness, e.g. after an episode of gastroenteritis

Symptoms of IBS

• Pain and discomfort in different parts of the abdomen, which may be like ‘spasms’ or cramps
• Bloating and swelling of the abdomen
• Changes in stools
• Reflux
• Nausea or vomiting
• Feeling full after a few mouthfuls
• Mucus (slime) from the back passage.
• Irritability of the bladder
• Lethargy (lack of energy) and poor quality sleep

If you have any of the following symptoms however, they may suggest a more serious cause and it is important to consult your doctor immediately:
– unintentional and unexplained weight loss
– rectal bleeding
– a family history of bowel or ovarian cancer
– if you are over 60 years old, a change in bowel habit to looser and/or more frequent stools for more than 6 weeks
– a lump you can see or feel in your abdomen

Diagnosis
IBS is often diagnosed clinically, which means your doctor will take a history and may examine you, and based on this, the diagnosis will be made. There is no single test which can diagnose IBS, although your doctor may carry out some tests to rule out other conditions before reaching their diagnosis, but this will vary from person to person.

Managing IBS
General Advice
• eat regular meals
• do not skip meals or eat late at night
• take your time when eating meals
• sit down to eat and chew your food well
• take regular exercise – for example, walking, cycling or swimming
• make time to relax.

Helpful hints
• keep a food and symptom diary to see if diet affects your symptoms. Remember symptoms may not be caused by the food you have just eaten, but what you ate earlier that day or the day before.
• give your bowels time to adjust to any changes that you make.

Make dietary changes according to your symptoms
For symptoms of wind and bloating:
• Limit fresh/dried fruit to 3 portions a day and fruit juice to 1 small glass a day. (Remember to make up the recommended ‘5 a day’ with vegetables).
• Try reducing your intake of resistant starches, e.g. pulses, maize, oven chips, crisps, garlic, processed or ready meals containing potatoes or pasta
• Oats and golden linseeds may also help with symptoms of wind and bloating.

The low-FODMAP diet
FODMAP stands for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols, and these are a group of carbohydrates found within food. It has been recently found that having a low-FODMAP diet may help some people with IBS, and it is worth discussing this with your doctor who may also refer you to a dietician.

Examples of foods to avoid in a low-FODMAP diet include:
• Certain fruits, such as apples, cherries, peaches and nectarines.
• Some green vegetables, such as peas, cabbage, broccoli and Brussels sprouts.
• Artificial sweeteners.
• Foods high in lactose, such as milk, ice cream, cream cheeses, chocolate and sour cream.

Probiotics
Probiotics are dietary supplements which contain so-called ‘friendly bacteria’, which manufacturers claim can help improve digestive health. Some people find taking these supplements regularly does indeed relieve their IBS symptoms, although there is little evidence to support this. If you do want to try a probiotic, it should be taken for at least 4 weeks to see if the symptoms improve, and if one brand doesn’t work, it may be worthwhile trying another. However, always check the manufacturer’s instructions when taking one of these supplements.
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Other treatments
As IBS can involve many factors and has many associations, there are a number of other treatments available. These include psychological treatments (psychotherapy, CBT, hypnotherapy) and complimentary therapies (acupuncture, reflexology), but if you need any more information or would like to discuss these further, it is best to consult with your doctor who will be able to advise according to your needs.

If you have any further questions or would like to be assessed, please book an appointment with Dr Koyes Ahmed or one of the other Family Medicine Consultants at Intercare Health Center.