Irritabel bowel syndrome: symptoms, diagnsosis and treatment

In his latest online article, highly-renowned consultant gastroenterologist Dr Simon Smale gives a comprehensive overview of irritable bowel syndrome (IBS). He explains the symptoms, diagnosis and treatment of IBS. He also explains how it is linked to diet, and the menstrual cycle and menopause.

What are the symptoms of irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a chronic disorder characterised by abdominal pain and change in bowel habits. Disturbances in the gastrointestinal microbiome have been identified in patients with irritable bowel syndrome. In all patients with symptoms consistent with a diagnosis of IBS the presence of “red flags” or symptoms that may suggest another pathology should be specifically sought and excluded. Red flags include a new change in bowel habit lasting for more than 6 weeks in a person aged 60 years or older, rectal bleeding, unexplained weight loss and a history of ovarian or bowel cancer within the immediate family. 

What tests are done to diagnose IBS?

Several routine tests are done if a patient presents for the first time with symptoms of IBS. A full blood count is done to exclude anaemia, coeliac serology, inflammatory markers and a faecal calprotectin. Other diseases can have symptoms similar to IBS, and it is important to rule out these conditions. These include inflammatory bowel disease, occult neoplasia (cancer) and coeliac disease.

If a patient doesn’t have any of the red flag symptoms mentioned above, there is no need for invasive tests such as an endoscopy.

Is diet a factor?

Diet is one of the many factors that can contribute to IBS. A lack of sleep, poor-quality sleep, lack of exercise, and stress are three factors that are inextricably linked to IBS. If a patient focuses on getting a good night’s sleep regularly, relaxing, and getting exercise as well as avoiding dietary triggers, many of the symptoms of IBS can be alleviated.

What drugs are available to treat IBS?

There are various drugs available that can help alleviate the symptoms of IBS. They are broadly broken down into 3 categories:

• Bowel sensitivity – some treatments focus on reducing the sensitivity of the bowel.
• Bowel motility – some medications focus on reducing bowel motility (contraction of muscles in the bowel.
• Stool consistency – some drugs focus on improving the consistency of the stool.

Your doctor will create a treatment plan tailored to your individual needs and symptoms.

Are IBS symptoms linked to periods and menopause?

IBS is more commonly found in women than men, and some women report that their symptoms are worse at different times of their cycle. Several studies have been done investigating the links between periods/menopause and IBS. Results have shown that their symptoms of IBS are worse just before and during their period and that symptoms generally improve once women reach the menopause, although this is not universal.

Some studies have also suggested that gut motility is increased when oestrogen and progesterone levels are at their highest, during the luteal phase of the menstrual cycle. Some women find that modulating these hormones with HRT can have a significant impact on the severity of their IBS symptoms.

Dr Simon Smale is a revered consultant gastroenterologist based in North Yorkshire, with over 25 years of experience. If you would like to book a consultation with Dr Smale, you can do so today via his Top Doctors profile.