Irritable bowel syndrome (IBS) is a common but often misunderstood digestive disorder that affects the lives of millions of people worldwide. Many people live with unpleasant symptoms such as abdominal pain, bloating or embarrassing changes in bowel habits, without knowing what is causing their symptoms. If you are struggling with similar problems, it is important to know that you are not alone, and help is available.
This article has been written to provide an easy-to-understand, medically sound explanation of IBS. We provide a detailed overview of the possible causes of the condition, the diagnostic process, and the treatment and lifestyle strategies that can significantly improve your quality of life. Our aim is to dispel misconceptions and fears surrounding the condition and to provide practical advice so that you can take control of your health. Armed with the right information, you will be able to discuss your options with your doctor with greater confidence. The Endomedix Gastroenterology Centre Our specialists are committed to helping you with the very latest diagnostic procedures and personalised treatments.
What exactly is irritable bowel syndrome (IBS)?
Irritable bowel syndrome is a functional gastrointestinal disorder. This means that although the symptoms (abdominal pain, cramps, bloating, diarrhoea, constipation) are real and often very unpleasant, conventional diagnostic tests – such as colonoscopy or imaging procedures – do not reveal any visible organic changes, inflammation or damage to the intestines.
The essence of IBS lies in a disruption of communication along the gut-brain axis. This is a complex, two-way connection between the digestive system and the central nervous system. If this communication does not function properly, it can lead to disturbances in bowel function. The gut can become overly sensitive to normal stimuli, such as gas formation during digestion or tension in the gut wall. This is known as visceral hypersensitivity. The brain interprets these normal signals as pain or discomfort, which triggers cramps and other symptoms.
It is important to emphasise that IBS is a chronic but benign condition. It does not lead to more serious conditions, such as bowel cancer or inflammatory bowel disease (IBD), and does not damage the bowel. Nevertheless, the symptoms can significantly impair the quality of daily life.
The main types of IBS
IBS is classified into several categories based on the predominant characteristics of the stools, which helps the doctor to select the most appropriate treatment.
- IBS with diarrhoea (IBS-D): Patients report frequent, urgent, loose or watery stools, often accompanied by abdominal cramps and pain.
- IBS with constipation (IBS-C): It is characterised by fewer than three bowel movements a week, hard stools that are difficult to pass, as well as straining and a feeling of incomplete evacuation.
- Mixed-type IBS (IBS-M): In this case, periods of diarrhoea and constipation alternate. One day the patient suffers from constipation, whilst in the following days they are plagued by diarrhoea.
- Unclassified IBS (IBS-U): Sometimes the symptoms do not clearly fit into any of the above categories.
The complex causes of IBS: what does the science say?
The exact cause of IBS remains unclear to this day, but research has identified a complex interplay of several factors that may contribute to its development.
Physiological factors
- Changes in bowel movement (motility): Contractions of the muscles in the digestive system are responsible for moving food through the system. In IBS, these contractions may be stronger and last longer than normal (causing diarrhoea) or weaker and slower (leading to constipation).
- Visceral hypersensitivity: As mentioned earlier, this condition means that the nerve endings in the bowel are overly sensitive, even to normal stimuli. A quantity of gas or bowel movement that would go unnoticed by the average person can cause significant pain or bloating in a patient with IBS.
- Gut-brain axis dysfunction: Disruption of communication between the brain and the gut plays a central role in the development of IBS. Stress and anxiety, for example, can amplify pain signals coming from the gut.
- Low-grade inflammation: Although IBS is not considered an inflammatory bowel disease, some studies have shown that the intestinal mucosa of affected patients may contain an increased number of immune cells, suggesting a mild, chronic inflammatory condition.
- Impaired intestinal barrier function: The intestinal wall is protected by a layer of cells which prevents harmful substances (such as bacteria and toxins) from entering the bloodstream. In IBS, this protective barrier can become „permeable”, which may trigger an immune response and symptoms.
The role of the gut microbiota
The human gut is home to several trillion microorganisms, which together make up the gut microbiome. This complex ecosystem plays a key role in digestion, the functioning of the immune system and the maintenance of general health. Research suggests that the composition and diversity of the gut flora in patients with IBS may differ from that of healthy people (this is known as dysbiosis). This can affect bowel movements, gas production and pain perception.
It is also important to mention the possibility of small intestinal bacterial overgrowth (SIBO), a condition in which bacteria typically found in the large intestine proliferate in large numbers in the small intestine. The symptoms of SIBO (bloating, diarrhoea, abdominal pain) overlap considerably with those of IBS, and according to some estimates, it can be detected in a significant proportion of patients with IBS.
Psychological factors and stress
Stress, anxiety and depression do not cause IBS, but they can significantly worsen the symptoms. Through the gut-brain axis, psychological state directly influences bowel function. When under stress, the body switches to „fight-or-flight” mode, which can speed up or slow down digestion. Chronic stress can also make the digestive system more sensitive to pain.
Genetic predisposition and other factors
Research suggests that IBS may run in families, which could indicate a genetic predisposition. In addition, so-called post-infectious IBS can develop following a previous episode of severe gastroenteritis (infectious diarrhoea).
How is IBS diagnosed?
As there are no clear biological markers, the diagnosis of IBS is based primarily on symptoms. Doctors use the internationally accepted Rome IV criteria, which include the following:
Recurrent abdominal pain which has occurred on at least one day per week on average over the past 3 months, and is accompanied by at least two of the following:
- The pain is related to bowel movements (it improves or worsens afterwards).
- The pain is associated with a change in the frequency of bowel movements.
- The pain is accompanied by a change in the consistency (form) of the stools.
For a diagnosis to be made, it is important that the symptoms began at least six months ago.
The investigation process
It is important that you always consult a doctor if you have abdominal symptoms, so that other, more serious conditions can be ruled out. An experienced gastroenterologist, such as those Endomedix Gastroenterology Centre The specialists, too, begin the examination with a thorough interview.
The doctor will ask about the nature and frequency of your symptoms, as well as your dietary and lifestyle habits. They will pay particular attention to so-called „red flag symptoms”, which may indicate another condition. These include, for example:
- New symptoms appearing in people aged 50 and over
- Significant, unintentional weight loss
- Night-time diarrhoea that wakes the patient
- Rectal bleeding or bloody stools
- Iron deficiency anaemia
- A family history of bowel cancer or inflammatory bowel disease
If there are no alarming symptoms, the doctor may request basic laboratory tests (complete blood count, inflammatory markers, thyroid function, coeliac disease screening) and a stool test. If there are warning signs, or if the diagnosis is uncertain, further investigations, such as a colonoscopy, may be required to rule out any organic lesions. The Endomedix Gastroenterology Centre It offers modern, pain-free examination options to ensure that the examination causes as little discomfort as possible.
Treatment options and tips for alleviating the symptoms of IBS
The treatment of IBS is complex and personalised, as there is no single cure that works for everyone. Treatment is generally based on several pillars: diet, lifestyle, medication and psychological support.
1. Dietary changes
Diet is key to managing IBS.
- Grate coating: Eating soluble fibre (e.g. oats, psyllium husks, apples, carrots) can help to normalise stool consistency and relieve cramps. In contrast, insoluble fibre (e.g. bran, wholemeal products) may worsen bloating and pain in some people.
- Low FODMAP diet: This is one of the most effective dietary interventions for IBS. FODMAPs (fermentable oligo-, di- and monosaccharides and polyols) are short-chain carbohydrates that are difficult for the small intestine to digest. Once they reach the large intestine, bacteria rapidly ferment them, which can cause gas, bloating, cramps and diarrhoea. During the diet, with the help of a specialist (dietitian), foods high in FODMAPs (e.g. wheat, onions, garlic, dairy products, certain fruits) are temporarily eliminated from the diet with the help of a specialist (dietitian), and then gradually reintroduced to assess individual tolerance.
- Gluten-free diet: Although it is important to rule out coeliac disease, some patients with IBS who do not have coeliac disease also feel better on a gluten-free diet. This may be due to the FODMAP content of wheat.
- Keeping a food diary: Make a note of what you ate and what symptoms you experienced. This will help you identify which foods are causing your symptoms.
2. Lifestyle advice
- Regular physical activity: Exercise stimulates bowel function (particularly in cases of constipation), reduces stress and improves your general well-being. Even a 20–30-minute walk a day can make a big difference.
- Stress management: Relaxation techniques such as yoga, meditation, deep breathing and mindfulness have been shown to be effective in harmonising the gut-brain axis and alleviating symptoms.
- Getting enough sleep: Lack of sleep can intensify the sensation of pain and make symptoms worse. Aim for 7–8 hours of restful sleep each day.
3. Medication
Doctors usually prescribe medication to relieve the main symptoms.
- Antispasmodics: They can be used to relieve abdominal pain and cramps (e.g. peppermint oil capsules, butylscopolamine).
- Drivers: In cases of constipation-predominant IBS, osmotic laxatives (e.g. macrogol) are recommended, as they gently increase the water content of the stool.
- Medicines for diarrhoea: In cases of diarrhoea-predominant IBS, medicines containing loperamide may be administered to provide temporary relief from symptoms.
- Probiotics: Certain strains of bacteria can help restore the balance of the gut flora, reducing bloating and pain. However, it is important to note that not all probiotics are the same, so it is advisable to consult a doctor about the most suitable product.
- Antibiotics: If SIBO is suspected, a course of a special, non-absorbable antibiotic (rifaximin) can effectively reduce bloating and diarrhoea.
- Antidepressants: When used at low doses, tricyclic antidepressants and SSRIs can effectively reduce visceral pain and normalise bowel function, regardless of their effect on mood.
4. Psychological therapies
As psychological factors are closely linked to the symptoms, certain therapies can be extremely helpful.
- Cognitive behavioural therapy (CBT): It helps patients to change negative thought patterns and behaviours relating to their symptoms.
- Gut-specific hypnotherapy: By using suggestions given whilst in a relaxed state, it helps to reduce intestinal sensitivity and improve bowel function.
When expert help is needed
Irritable bowel syndrome is a real and debilitating condition, but you don’t have to cope with it on your own. The key to successfully managing your symptoms is an accurate diagnosis and a personalised, comprehensive treatment plan. Do not hesitate to consult a specialist if your abdominal symptoms are persistent and affecting your quality of life.
From Endomedix Gastroenterology Centre Our experienced specialists and dietitians are on hand to help you establish a diagnosis, rule out more serious conditions and develop the most effective treatment strategy. With our modern, patient-centred approach and state-of-the-art diagnostic tools, we are committed to helping you live a full, symptom-free life once again.
