What is Irritable Bowel Syndrome?

First thing’s first, let’s dispel any misconceptions about IBS. Firstly, it's not infectious. The exact cause is still unknown, but we know that it manifests in different ways and symptoms for each individual who suffers from it.

In terms of symptoms, IBS affects your gut and digestive system, resulting in pain and discomfort, particularly (but not exclusively) after eating.

“IBS is identified by a problem in the interaction of three major organs: your brain, your gut (which maintains an extensive network of nerves) and your microbiome (which is a collection of bacteria that lives inside your bowel)”, explains gastroenterologist, Dr Ahmed Albusoda. “From the minute you look at the food you are about to eat, your body begins to digest. Your brain tells your stomach to relax and prepare itself. You start producing chemicals to start accommodating the food, and the stomach dilates itself to make room for it.”

IBS can be described as a disruption in the effective communication between these three organs. “Some IBS has more to do with the brain’s management of the pain system, while other forms have more to do with the functioning of your gut or microbiome,” Dr Albusoda adds.

IBS symptoms

IBS can manifest in different ways, meaning that symptoms and their seriousness or regularity will vary from person to person. Even though you may suffer with IBS, it is likely that you will go through waves of flare-ups. People with IBS will go through what Dr Albusoda describes as “relapsing and remitting” periods of being symptomatic.

The NHS identifies the most common symptoms of IBS as:

• Stomach pain
• Cramps (usually worse after eating or doing a poo)
• Bloating
• Diarrhoea
• Constipation

“There are three main types of IBS,” explains Dr Albusoda. “IBS diarrhoea, IBS constipation, and IBS mix type – where your bowel habits are a mix of the two. That, paired with abdominal pain, leads to diagnosis.”

IBS diagnosis

Because IBS can present itself so commonly and mildly, diagnosis can be tricky. Primarily, it can be hard to tell whether you are showing symptoms of the condition or have had a bad reaction to something you ate.

However, Dr Albusoda tells us when it's time to seek clinical help and visit your GP: “If you have symptoms three to four times a week persisting over at least three months, combined with abdominal pain and some changes to the bowel, then that is IBS.”

When going to your doctor, they will also normally perform general health checks like a blood test to rule out other potential causes. IBS can easily be confused with allergies or reactive diseases to certain types of foods, such as gluten intolerance. Once these are ruled out, diagnosing IBS becomes more straightforward.

IBS and stress

It is widely believed that stress can cause IBS but this isn't exactly true. “Stress can make the IBS worse, and stress can trigger IBS,” says Dr Albusoda. “But it doesn't necessarily cause IBS.” About 15% of us are susceptible to the bowel syndrome; but undue stress can aggravate IBS symptoms.

But let’s unpack this a little more. Each of us has something called the sympathetic nervous system, which is a network of nerves that triggers our “fight-or-flight” reaction in moments of stress or anxiety. But we also have a parasympathetic nervous system, also known as the “rest-and-digest” system, which helps our body to relax after this stress.

When our bodies go through fight or flight during moments of conscious or subconscious stress, we release adrenaline and the stress hormone, cortisol. NICE has reported on studies showing that cortisol can actually aggravate the bowel and lead to increased IBS symptoms. Meanwhile, increased background stress also minimises the body’s counteractive response, the “rest and digest” system, and can help IBS symptoms to persist.

IBS treatments

According the NHS, there is no single treatment or medicine that helps everyone’s IBS – the key, then, is to get to know your body and your IBS triggers.

For example, if you find your IBS is stress-induced, you can seek professional help like therapy, or try other anti-anxiety regimes like breathwork, meditation and other mindful practices that make you feel less anxious.

Sometimes IBS is more reactive to the food you eat, so it can be helpful to try and investigate how your body responds to different foods you consume, and make new dietary adjustments accordingly.

You can find more information on how to reduce IBS symptoms like bloating, diarrhoea and cramps on the NHS website.

What is it like to have IBS?

For 23-year-old Aliah*, who was diagnosed in November 2020, her IBS is stress-induced and flares up when in uncomfortable situations or environments: “At first I thought it was my diet, but then realised my symptoms only happened when I was at university. I’ve realised that it depends on the type of stress too, for example it gets extra bad when I’m having dating issues.”

Before deciding to seek medical help, Aliah suffered from many of the common symptoms that she saw on the NHS website. “I had stomach pain, needed the toilet a lot more – up to 3-5 times a day when it would flare up – and had alternating experiences when going to the toilet,” she recalls.

When it comes to coping with her symptoms, which are now more under control, Aliah found that focussing on her mental health and anxiety proved most effective: “Things like peppermint oil [which can sometimes reduce stomach cramps], dietary changes and medication did not seem to help much at all in my case.

“But trying to relax and also going on antidepressants did help me to a certain extent. It definitely made me feel less stressed which had a positive effect – but honestly I think a healthier mindset made the most difference in my case.”

Antidepressants are not a recognised form of treatment for IBS – Aliah was prescribed them by her doctor in accordance with conversations regarding her mental health.

Irritable bowel syndrome (IBS) and Irritable Bowel Disease (IBD)

Irritable Bowel Disease (IBD) is considered to be a more severe bowel condition than IBS, which can either manifest as Crohn's disease or Ulcerative Colitis, which involves the chronic swelling and inflammation of your digestive organs. It is important to note that IBS cannot lead to a form of IBD – your symptoms cannot worsen and progress into one of these conditions.

You can, however, suffer from both IBS and IBD. It is essential that you receive the right diagnosis to differentiate whether you have one or the other, or both at the same time. Symptoms that can indicate if you have IBD, and should therefore go to the doctor, include:

• Persistent diarrhoea
• Blood in your stools
• Abdominal pain
• Weight loss
• Fatigue

For further information and advice on Irritable Bowel Syndrome, consult the NHS help page, here.

*Name changed