Pain often occurs in the lower abdomen and may be relieved after bowel movements. The severity ranges from mild discomfort to intense pain that interferes with daily activities.
Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterised by recurrent abdominal pain associated with changes in bowel habits. It affects the large intestine without causing visible damage to the digestive tract. IBS is a chronic condition that requires long-term management to control symptoms and maintain quality of life.
Dr. Chok Aik Yong
MBBS | MRCS (UK) | MMed (Surgery) | FRCS (UK)
Symptoms of IBS
Patients with IBS typically experience various symptoms that may fluctuate in intensity over time and can be triggered by specific factors.
Abdominal Pain and Cramping
Changes in Bowel Habits
Alternating periods of diarrhoea and constipation may occur, sometimes within the same day. Stool consistency and frequency often vary significantly from person to person.
Bloating and Gas
Excessive gas production leads to bloating and abdominal distension. This symptom typically worsens throughout the day and after meals.
Mucus in Stool
Some patients may notice an increase in mucus in their stool. This discharge appears as a clear, white or yellowish substance mixed with bowel movements.
Urgent Need to Move Bowels
Many IBS patients experience a sudden, urgent need to use the toilet. This urgency can be particularly challenging to manage in public or professional settings.
Feeling of Incomplete Evacuation
After a bowel movement, patients may feel that they have not completely emptied their bowels. This sensation often leads to repeated trips to the bathroom.
Causes and Risk Factors
The exact cause of IBS remains unknown, but several factors likely contribute to its development and symptom exacerbation.
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Intestinal Muscle Contractions
Stronger than normal contractions can cause gas, bloating and diarrhoea. Weak contractions can slow the passage of food and lead to dry, hard stools.
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Nervous System Abnormalities
Irregularities in the nerves of the digestive system may cause increased discomfort when the abdomen stretches from gas or stool. This heightened pain response represents visceral hypersensitivity.
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Gut-Brain Axis Dysfunction
The communication pathway between the brain and the gut may be impaired. This affects how the body processes pain signals and regulates digestive motility.
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Post-Infectious Development
IBS sometimes develops after a severe bout of gastroenteritis caused by bacteria or viruses. This type of IBS is known as post-infectious IBS.
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Psychological Factors
Stress, anxiety, and depression do not cause IBS but can trigger or worsen symptoms. Many patients report symptom flares during periods of increased stress.
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Genetic Predisposition
A family history of IBS suggests a possible genetic component. Studies show that IBS tends to run in families, indicating that genetic factors may play a role.
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Food Sensitivities
Certain foods and beverages can trigger symptoms in many patients. Common triggers include dairy products, wheat, citrus fruits, beans, cabbage, and carbonated beverages.
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Hormonal Changes
Women are more likely to develop IBS than men, suggesting hormonal influences. Many women report worsening symptoms during their menstrual periods.
Diagnostic Methods
Clinical Evaluation
A detailed medical history and physical examination are the initial steps in diagnosing IBS. Doctors assess symptom duration, characteristics, and patterns while checking for warning signs that may indicate other conditions. The Rome IV criteria, which involve recurrent abdominal pain associated with defecation or changes in bowel habits, guide the diagnostic process.
Laboratory Tests
Blood tests check for anaemia, infection, and markers for coeliac disease. Stool samples may be analysed for blood, infection, inflammation markers, and parasites. These tests help exclude other conditions rather than directly confirm IBS.
Hydrogen Breath Test
This non-invasive test measures hydrogen and methane gases in the breath after consuming a sugar solution. Elevated levels may indicate carbohydrate malabsorption or small intestinal bacterial overgrowth, conditions that can cause symptoms similar to IBS or that exist alongside it.
Colonoscopy
This procedure allows direct visualisation of the large intestine using a flexible, camera-equipped tube. Colonoscopy is typically recommended for patients with alarming features such as rectal bleeding, weight loss, anaemia, or a family history of colorectal cancer.
Flexible Sigmoidoscopy
A less extensive examination that visualises only the lower portion of the colon. This procedure may be used when the primary concern is limited to this area, eliminating the need for a complete colonoscopy.
CT Scan or MRI
These imaging studies provide detailed pictures of the digestive organs. They may be ordered to rule out structural abnormalities, obstructions, masses, or inflammation.
Treatment Options
IBS management is tailored to individual symptom patterns and severity.
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Dietary Modifications
Avoiding trigger foods and following a low-FODMAP diet can help reduce bloating, abdominal pain, and irregular bowel movements. This diet limits specific fermentable carbohydrates that contribute to IBS symptoms and is most effective when implemented under the supervision of a dietitian.
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Fibre Supplementation
Soluble fibre, such as psyllium, can help regulate bowel movements by adding bulk, which is beneficial in cases of diarrhoea. Gradually increasing fibre intake can help reduce the risk of bloating and gas, which some people experience with sudden dietary changes.
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Antispasmodic Medications
Drugs such as mebeverine and hyoscine help relieve abdominal pain and cramping by relaxing intestinal muscles. They are often taken before meals to prevent symptoms triggered by food intake.
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Laxatives
Osmotic laxatives, such as polyethylene glycol, work by drawing water into the intestines, softening stool and making it easier to pass. They are commonly used for IBS-related constipation and are less likely to cause dependency compared to stimulant laxatives.
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Anti-diarrhoeal Agents
Loperamide helps manage diarrhoea by slowing intestinal movement, reducing stool frequency, and improving consistency. It can be taken in anticipation of situations where diarrhoea may be particularly disruptive.
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Probiotics
Certain probiotic strains can help alleviate symptoms such as bloating, gas, and abdominal discomfort. Regular use over several weeks is often needed to assess effectiveness.
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Prevention and Management
Daily management of IBS involves identifying and avoiding personal trigger factors while maintaining healthy lifestyle habits. Regular physical activity stimulates intestinal contractions and reduces stress, with 30 minutes of moderate exercise most days showing beneficial effects. Techniques such as mindfulness meditation, yoga, or progressive muscle relaxation can reduce symptom flares. Adequate sleep supports digestive health and may decrease symptom sensitivity. Keeping a symptom journal helps identify patterns by tracking food intake, stress levels, activities, and associated symptoms. Taking medications as prescribed and attending follow-up appointments allows for treatment adjustments as needed.
Frequently Asked Questions (FAQ)
Can IBS develop at any age?
IBS most commonly develops in early adulthood, with most diagnoses occurring before age 50. However, it can develop at any age, including childhood and later adulthood. New IBS-like symptoms in older adults should be investigated to exclude other conditions.
Can IBS be confused with other digestive disorders?
Yes, IBS symptoms can mimic those of inflammatory bowel diseases (Crohn’s disease, ulcerative colitis), coeliac disease, microscopic colitis, bile acid malabsorption, and some forms of cancer.
What happens if IBS remains untreated?
Untreated IBS does not cause intestinal damage or increase cancer risk but can lead to nutritional deficiencies, anxiety, depression, social isolation, reduced work productivity, pain hypersensitivity, and medication overuse.
Dr. Chok Aik Yong
MBBS|MRCS (UK)|MMed (Surgery)|FRCS (UK)
Expertise lies in managing colorectal diseases, particularly advanced colorectal cancer and inflammatory bowel disease.
- Dr Chok graduated with degrees in Bachelor of Medicine and Surgery from the National University of Singapore. He was conferred the Master of Medicine (Surgery) in Edinburgh (UK) and a member of the Royal College of Surgeons, UK. He subsequently completed his specialist training in colorectal surgery and became a Fellow of the royal college of Surgeons in Edinburgh in 2016.
- Dr Chok was awarded the Health Manpower Development Plan (HMDP) award in 2019 to further advance his colorectal training at Royal Marsden Hospital, one of the top 5 cancer centres in the world. While in London, Dr Chok trained with pioneers in the surgical management of advanced colorectal cancer and inflammatory bowel disease (IBD) and gained extensive experience while appraising the latest clinical and research evidence.
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