As April is National Irritable Bowel Syndrome (IBS) Awareness Month, Dr Subramaniam Ramakrishnan, Consultant Gastroenterologist, discusses IBS including the symptoms and possible treatments.
What is IBS?
IBS is the name given to a condition that causes a combination of abdominal symptoms related to either an alteration of gut function or increased sensitivity of the gut.
What are the different types of IBS?
As clinicians we often try and categorise patients with several combinations of symptoms into different subgroups or describe the most predominant problem that affects a particular patient. For example we classify patients as those who have predominant pain, diarrhoea or constipation or those with alternating symptoms.
How common is IBS?
IBS is one of the most common problems encountered in the general population. Despite most patients not seeking medical advice for symptoms, it is one of the commonest reasons for patients to be seen by general practitioners.
Worldwide it is estimated that between one in ten and nearly in one in four people have this condition but very few seek medical advise. It is more common in women than men. Two in three IBS sufferers are female and one in three are male.
What other conditions may mimic IBS?
There are several other chronic and serious conditions that can mimic IBS-type symptoms.
In people older than 50, these symptoms could point to more serious conditions such as bowel or other abdominal cancers. Some younger people may have to be investigated for cancer if they belong to a high risk group.
In younger people, common conditions that need to be excluded are coeliac disease, inflammatory bowel disease (IBD) such as ulcerative colitis or Crohn's disease. However these conditions may also affect older people.
Other conditions to be considered include lactose intolerance, small bowel bacterial overgrowth or pancreatic insufficiency.
What symptoms are uncommon in patients with IBS that should prompt further tests?
- Unexplained weight loss
- Sudden onset of severe symptoms
- Night time symptoms
- Bleeding from the gut
- Family history of abdominal conditions such as colitis, Crohn's or coeliac
In these situations further tests are recommended in all age groups.
Are there any reliable tests that can differentiate IBS from other long term or serious conditions?
As IBS is so common than other serious or long term conditions, there has been a lot of research to see if there are tests that can reliably differentiate between the two.
There are tests that we could perform in a stool sample that can in many situations reliably separate the two. Your specialist will be able to talk to you more about these tests.
Further evaluation with blood tests, breath tests, scans (CT or MRI) and telescope examinations (gastroscopy, colonoscopy) may be needed to rule out other conditions.
What are the current treatments of IBS?
Current treatments include a combination of diet, medication depending on predominant symptoms and psychological support.
What are the associated conditions with IBS?
A variety of symptoms can be associated with IBS and can affect other areas. Fatigue, tiredness, generalised aches, bladder symptoms are all associated with IBS.
Do symptoms ever go away?
Symptoms are usually variable with periods of worsening and improvement which are helped with different ways of treatment. This is considered a chronic condition and therefore patients usually need support and help throughout their illness.
Does stress cause IBS?
Stress does not cause symptoms but could aggravate both the abdominal and associated symptoms.
What are patients' expectations?
Recent surveys have shown that most patients rate these as their most important expectations:
- Being listened to
- Comprehensive assessment of their symptoms
- Provide additional information about their condition
- Answer questions appropriately
- Provide information about medication and newer studies about IBS