In IBS, the function of the gut is upset, but all parts of the gut look normal, even when looked at under a microscope. IBS has various expressions. Up to 1 in 5 people develop IBS at some stage in their life. IBS can affect anyone at any age, but it commonly first develops in young adults. IBS is slightly more common in women than it is in men.

Pain and discomfort may occur in different parts of the tummy or abdomen. Pain usually comes and goes. The length of each bout of pain can vary greatly. The pain often eases when one passes stools (faeces) or wind. Many people with IBS describe the pain as a spasm or colic. The severity of the pain can vary from mild to severe, both from person to person, and from time to time in the same person.

Bloating and swelling of the abdomen may develop from time to time. One may pass more wind than usual.

• Some people have bouts of diarrhoea, and some have bouts of constipation.
• Some people have bouts of diarrhoea that alternate with bouts of constipation.
• Sometimes the stools become small and pellet-like. Sometimes the stools become watery or more loose. At times, mucus may be mixed with the stools.
• There may have a feeling of not emptying the back passage (rectum) after going to the toilet.
• Some people have urgency, which means they have to get to the toilet quickly. A morning rush is common. That is, they feel an urgent need to go to the toilet several times shortly after getting up. This is often during and after breakfast.

• Belching.
• Poor appetite.
• Feeling quickly full after eating.
• Bloating of Abdomen.
• Bladder symptoms (an associated irritable bladder).
• Tiredness. Backache.
• Muscle pains.
• Nausea (Feeling sick) / (Senastion of vomiting).
• Headache.
Some people have occasional mild symptoms. Others have unpleasant symptoms for long periods. Many people fall somewhere in between, with flare-ups of symptoms from time to time. Some doctors group people with IBS into one of three categories:
• abdominal pain or discomfort
• bloating
• constipation.
Those with abdominal pain or discomfort, and the other symptoms have mainly urgency to get to the toilet, and diarrhoea.
Those who alternate between constipation and diarrhoea.
However, in practice, many people will not fall neatly into any one category, and considerable overlap occurs.
It is important to remember that passing blood is not a symptom of IBS. One should tell a doctor if one passes blood.

There is no test that confirms the diagnosis of IBS. A doctor can usually diagnose IBS from the typical symptoms.

However, a blood sample or stool (faeces) test is commonly taken to do some tests to help rule out other conditions such as Crohns’s disease, Ulcerative Colitis, Coeliac disease, cancer of ovary, gut infections etc. The symptoms of these other diseases can sometimes be confused with IBS. Tests done commonly include:

Full blood count (FBC) – to rule out lack of iron in the blood (anaemia), which is associated with various gut disorders.

Erythrocyte sedimentation rate (ESR)/C Reactive protien (CRP) – which can show if there is inflammation in the body (which does not occur with IBS).

A blood test for coeliac disease.

In women, a blood test to rule out cancer of the ovary, called CA-125.

A stool test to look for a protein called faecal calprotectin. This may be present if you have Crohn’s disease or ulcerative colitis, but is not present in IBS.

More tests such as gastroscopy (a look into the bowel with a special telescope)/ colonoscopy (Look inside ones colon) are needed. However, they may be done if symptoms are not typical, or if you develop symptoms of IBS in later life (over the age of about 50) when other conditions need to be ruled out.

Cause
• Abnormal contractions of muscles in the intestinal walls
• Develops after gastrointestinal infection
• Stress, Anxiety or Depression are often part of (IBS)
• Peristalsis becomes irregular and uncoordinated Disrupting normal digestive process
• Over eating or binge eating, known to aggravate (IBS)
• Toom much fat in diet
• Eating too quickly, eating irregularly, smoking

The cause is not clear. It may have something to do with over activity of part or parts of the gut. The gut is a long muscular tube that goes from the mouth to the back passage (anus). The small and large bowel (also called the small and large intestine) are parts of the gut inside the tummy (abdomen). Food is passed along by regular squeezes (contractions) of the muscles in the wall of the gut. Pain and other symptoms may develop if the contractions become abnormal or overactive. The area of over-activity in the gut may determine whether constipation or diarrhoea develops.

The cause of over-activity in parts of the gut is not clear. One or more of the following may play a part:
1. Over-activity of the nerves or muscles of the gut. It is not known why this may occur. It may have something to do with over-activity of messages sent from the brain to the gut. Stress or emotional upset may play a role. About half of people with IBS can relate the start of symptoms to a stressful event in their life. Symptoms tend to become worse during times of stress or anxiety

2. Intolerance to certain foods may play a part in some cases. However, this is thought to be only in a small number of cases.

3. Infection and germs (bacteria) in the gut. IBS is not caused by an on going gut infection. However, in some cases, the onset of symptoms seems to follow a bout of a gut infection with diarrhoea and being sick (vomiting), called gastroenteritis. So, perhaps a virus or other germ may sensitise or trigger the gut in some way to cause persisting symptoms of IBS.

4. Oversensitivity to pain. People with IBS feel more pain when their gut is expanded (dilated) than those without IBS. They may have a lower threshold for experiencing pain from the guts

Many people are reassured that their condition is IBS, and not something more serious such as colitis. Simply understanding about IBS may help you to be less anxious about the condition, which may ease the severity of symptoms. Symptoms often settle for long periods without any treatment. In some cases, symptoms are mild and do not require treatment.
There are many different treatments that may be tried for IBS. All will have an effect on some people, but none will help in every person with IBS. No treatment is likely to take away symptoms completely, but treatment can often ease symptoms and improve the quality of life.
If symptoms are more troublesome or frequent, one or more of the following treatment options may be advised:

1: lifestyle changes

Exercise Regular exercise is known to help to ease symptoms.
Managing stress levels. Stress and other emotional factors may trigger symptoms in some people. So, anything that can reduce one’s level of stress or emotional upset may help.
Keeping a symptom diary. It may help to keep a food and lifestyle diary for 2-4 weeks to monitor symptoms and activities. Note everything that we eat and drink, times that we were stressed, and when we took any formal exercise. This may identify triggers, such as a food, alcohol, or emotional stresses, and may show if exercise helps to ease or to prevent symptoms. If one is advised to try a particular treatment, it may be sensible to keep a symptom diary before and after the start of the treatment. For example, before changing the amount of fibre that we eat, or taking a probiotic (explained later), or starting medication. One may wish to jot down in the diary the type and severity of symptoms that one has each day for a week or so. The diary should be kept going after one starts treatment. One can then assess whether a treatment has improved one’s symptoms or not.

2: dietary changes

A healthy diet is important for all of us. However, some people with irritable bowel syndrome (IBS) find certain foods of a normal healthy diet can trigger symptoms or make symptoms worse.
Dietary counsel for IBS
Current guidelines about IBS include the following points about diet, which may help to minimise symptoms:
• Have regular meals and take time to eat at a leisurely pace.
• Avoid missing meals or leaving long gaps between eating.
• Drink at least eight cups of fluid per day, especially water or other non-caffeinated drinks. This helps to keep the stools (faeces) soft and easy to pass along the gut.
• Restrict tea and coffee to three cups per day (as caffeine may be a factor in some people).
• Restrict the amount of fizzy drinks to a minimum.
• Too much alcohol should not be consumed.
• Consider limiting intake of high-fibre food.
• If one has diarrhoea, sorbitol, an artificial sweetener found in sugar-free sweets (including chewing gum) and in drinks, and in some diabetic and slimming products, should be avoided
• If one has a lot of wind and bloating, increasing one’s intake of oats (for example, oat-based breakfast cereal or porridge), should be considered.


Fibre
The advice about fibre in treating IBS has changed somewhat over the years. Fibre (roughage – and other bulking agents) is the part of the food which is not absorbed into the body. It remains in the gut, and is a main part of stools. There is a lot of fibre in fruit, vegetables, cereals, wholemeal bread, etc. Some research studies have shown that a high-fibre diet helps symptoms in IBS. In some people, perhaps particularly those with constipation, a high-fibre diet definitely helps. If one keeps a symptom diary, one can work out which is true for them. Then fibre intake can be adjusted accordingly.
What seems to be the case is that the type of fibre is probably important. There are two main types of fibre – soluble fibre (which dissolves in water) and insoluble fibre. It is soluble fibre rather than insoluble fibre that seems to help ease symptoms in some cases. So, if fibre intake is increased, one should have more soluble fibre and try to minimise the insoluble fibre. Dietary sources of soluble fibre include oats, ispaghula (psyllium), nuts and seeds, some fruit and vegetables and pectins. A fibre supplement are also available from pharmacies. This seems to be the most beneficial type of supplement.
Insoluble fibre is chiefly found in corn (maize) bran, wheat bran and some fruit and vegetables. In particular, bran as a fibre supplement should be avoided.

The low-FODMAP diet
Recently, it has been discovered that a low-FODMAP diet may help some people with IBS.

FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are a group of carbohydrates found within foods, which may make IBS symptoms worse. 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.
• It is difficult to cut down on so many foods, and keep eating a healthy diet.

Individual food intolerance
Some people with IBS find that one or more individual foods can trigger symptoms, or make symptoms worse (food intolerance or sensitivity). It may be possible to identify one or more foods that cause symptoms. This can be a tedious process, and often no problem food is found. However, some people say that they have identified one or more foods that cause symptoms, and then can control symptoms by not eating them.
The foods that are most commonly reported to cause IBS symptoms are:
• Rye.
• Barley.
• Wheat (in bread and cereals).
• Dairy products.
• Onions.
• Coffee (and other caffeine-rich drinks such as tea and cola).

Probiotics
Probiotics are nutritional supplements that contain good germs (bacteria). That is, bacteria that normally live in the gut and seem to be beneficial. Taking probiotics may increase the good bacteria in the gut which may help to ward off bad bacteria that may have some effect on causing IBS symptoms. One can also buy foods that contain probiotic bacteria. These include certain milk drinks, yoghurts, cheeses, frozen yoghurts, and ice creams. They may be labelled as ‘probiotic’, ‘containing bacterial cultures’ or ‘containing live bacteria’.
There is some evidence that taking probiotics may help to ease symptoms in some people with IBS. At present, there are various bacteria that are used in probiotic products. If one wants to try probiotics, one should keep to the same brand of probiotic-containing product for at least four weeks to monitor the effect. Perhaps one can try a different probiotic for at least a further four weeks if the first one made no difference.

3: medication which may help

Antispasmodic medicines for abdominal pain
These are medicines that relax the muscles in the wall of the gut. There are several types of antispasmodics. For example, Mebeverine, fenoverine,hyoscine & peppermint oil. They work in slightly different ways. Therefore, if one does not work well, it is worth trying a different one. If one is found to help then one can take it as required when pain symptoms flare up. Many people take an antispasmodic medicine for a week or so at a time to control pain when bouts of pain flare up. Some people take a dose before meals if pains tend to develop after eating.However it is important to remember that pains may ease with medication but may not go away completely.

Doctoring constipation
Constipation is sometimes a main symptom of irritable bowel syndrome (IBS). If so, it may help if fibre intake is increased as discussed earlier (that is, with soluble fibre). Sometimes laxatives are advised for short periods if increasing fibre is not enough to ease a troublesome bout of constipation. It is best to avoid lactulose if one suffers with IBS.
A new medicine called linaclotide has been shown to have better results for patients with constipation as a main symptom of IBS. It works in a completely different way to other medicines for treating constipation. It is taken once a day and has been shown to reduce pain, bloating and constipation symptoms.

Doctoring bloating
Peppermint oil may help with bloating and wind. For some people peppermint oil also helps with tummy pains and spasms.

Doctoring diarrhoea
An antidiarrhoeal medicine may be useful if diarrhoea is a main symptom. Loperamide is the most commonly used antidiarrhoeal medicine for IBS.
The dose of loperamide needed to control diarrhoea varies considerably. Many people use loperamide as required but some take it regularly. Many people learn to take a dose of loperamide in advance when they feel diarrhoea is likely to be a problem. For example, before going out to places where they know it may be difficult to find a toilet.

Antidepressant medicines
A tricyclic antidepressant are used to treat IBS. In particular, it tends to work best if pain and diarrhoea are the main symptoms. An example is amitriptyline. (Tricyclic antidepressants have other actions separate to their action on depression. They are used in a variety of painful conditions, including IBS.) Other types of antidepressants, called selective serotonin reuptake inhibitors (SSRIs) are also occasionally used for IBS. For example, a tablet called fluoxetine .They may work by affecting the way one feels pain. Unlike antispasmodics, one needs to take an antidepressant regularly rather than as required. Therefore, an antidepressant is usually only advised if one has persistent symptoms, or frequent bad flare-ups that have not been helped by other treatments.

New therapies available
Various other treatments show promise. For example:
Rifaximin is an antibiotic but mainly stays in the gut and very little is absorbed into the body. The theory is that it may kill some germs (bacteria) in the gut that may have some role in IBS. It is taken for two weeks.
A medicine called tegaserod seems to be useful for people with constipation.

4: other types of treatment

Psychological treatments (talking treatments)
Situations such as family problems, work stress, examinations, recurring thoughts of previous abuse, etc, may trigger symptoms of irritable bowel syndrome (IBS) in some people. People with anxious personalities may find symptoms difficult to control.
The relationship between the mind, brain, nervous impulses, and overactivity of internal organs such as the gut is complex. Psychological treatments are mainly considered in people with moderate-to-severe IBS:
When other treatments have failed; or
When it seems that stress or psychological factors are contributing to causing symptoms.
It is recommended that hypnotherapy, CBT (Congnitive behaviour therapy), or psychological therapy should be considered if no improvement in one year.

IBS is a common functional disorder of the gut. A functional disorder means there is a problem with the function of a part of the body, but there is no abnormality in the structure. In most people with irritable bowel syndrome (IBS), the condition tends to persist long-term. However, the severity of symptoms tends to wax and wane. You may have long spells without any symptoms, or with only mild symptoms. Treatment can often help to ease symptoms when they flare up. In some cases, symptoms clear for good at some stage. This is more likely if one’s IBS started after an infection (gastroenteritis). IBS does not shorten one’s expected lifespan, it does not lead to cancer of the bowel, and does not cause blockages of the gut, or other serious conditions Irritable bowel syndrome (IBS) is a common gut disorder. The cause is not known. Symptoms can be vary and can include abdominal pain, bloating, and sometimes bouts of diarrhoea and/or constipation. Symptoms tend to come and go. There is no cure for IBS, but symptoms can often be eased with treatment