IBS - Irritable Bowel Syndrome in UK
Irritable Bowel Syndrome in UK
What is it
Irritable Bowel Syndrome (IBS) is the most common bowel problem. It accounts for over half of all patients attending specialist bowel clinics. The intestine is a thirty-foot muscular tube. Its job is to break down and absorb food. Contents are propelled by regular waves of contractions of the muscle (peristalsis), squeezing the contents along.
If peristalsis becomes uncoordinated, the digestive process is disturbed, leading to fermentation (gas), reduced absorption of salts and fluids (diarrhoea), and sluggish bowel movements (constipation). The gut stretches if gas builds up, causing painful spasms (colicky pain). This is IBS.
Who gets it
Descriptions of patients with IBS date back to the mid 1700s. It is estimated that up to 12 million people in the UK are affected by IBS at some time in their lives.
One research study showed the incidence being as high as 65% of the population(1). Women tend to seek help for it more often than men, but it is actually just as common in both sexes. It commonly starts between 15 and 40 years, but it can start at any age.
What are the causes
No single cause of IBS has been found. It has been shown that the intestines are more sensitive to distension (e.g. by gas build up) in those with IBS (2,3,4).
The symptoms are often triggered by stress and anxiety(5): the bowel (like lung and skin) develops from the same forerunner tissue in the embryo as the brain and nervous system, so a physical link between emotion and IBS is not hard to understand.
About 10% of people with IBS initially developed symptoms after an acute bout of diarrhoea. This type of IBS has a good outlook: most patients are free of symptoms within five years (6). Diet itself doesn't cause IBS(7), but spicy, very high fibre and high fat foods may all worsen the symptoms.
What are the symptoms
These vary from person to person, and one, some or all of the following may be experienced.
pain: most sufferers get this. It can start immediately after eating a meal, or within two to three hours. It can be anywhere in the abdomen, and is typically colicky (griping). It is characteristically (though not always) relieved by opening the bowels or passing wind.
Bloating: this is very common. Many sufferers have to loosen their clothing. Some cannot finish their meals because of feeling full early. Loud tummy rumbles (borborygmi) are common.
Constipation and diarrhoea: one or other is nearly always present, and some people can get both. Constipation is commoner in women. Mucus is sometimes passed with the faeces (a sign that the bowel is irritated: rather like a runny nose in hay fever). There may be a feeling that the bowels still have to be emptied, even after passing faeces (tenesmus).
Secondary symptoms: other less common symptoms include nausea, vomiting, belching, back pain, indigestion and heartburn. These are secondary symptoms, and if present on their own without the main symptoms, then IBS is unlikely to be the cause.
Blood in the bowel motion is NEVER a sign of IBS, but it should prompt a swift visit to a doctor for further investigation This is particularly important if you think the blood is mixed with your motion.
What are the risks
The main risk of IBS is of self-perpetuating misery. Anxiety and stress not only cause IBS, but obviously may result from it as well. A self-feeding vicious cycle can be set up which can be very hard to break without outside help of some kind. Left unchallenged, the effects of IBS can be very destructive to social, work and private life, quite apart from the depressing effect on the individual sufferer.
What tests are useful
Though IBS can be positively diagnosed from the symptoms and examination alone, investigations are important to rule out more serious bowel problems that can cause similar symptoms but different investigation results. The doctor may take into consideration the age of the patient before asking for a series of tests.
- A full blood count (FBC) should be normal in IBS
- The erythrocyte sedimentation rate (ESR: a broad measure of inflammation or infection) should be normal
- Liver, kidney and thyroid function should all be normal
Bacteriology and microscopy
- The stool samples should show normal bacteria only
- A barium enema shows up the lining of the bowel. The outline is normal in IBS
- A direct look at the bowel lining is a good