IBS Pathway

What is IBS?

Irritable Bowel Syndrome (IBS) is a long-term (chronic) disorder of the digestive system. It is called a functional bowel disorder, which means the bowel looks normal on tests but doesn’t work as it should. In IBS, the gut is extra sensitive, and its muscle activity is irregular – yet no visible disease or damage is found in the digestive tract. IBS is often a lifelong, relapsing condition, meaning symptoms can flare up from time to time throughout your life.

IBS does not cause serious physical damage to the bowel or lead to more serious diseases like cancer. However, its symptoms can be distressing and significantly impact your quality of life if not well managed. People with IBS may feel embarrassed or anxious about their symptoms, but it’s important to know that IBS is a common and recognized medical condition.

Symptoms

IBS affects each person differently, but common symptoms include:

• Abdominal pain or cramping, often felt in the lower tummy. The pain is frequently linked to bowel movements – it may improve after you go to the toilet (open your bowels).
• Changes in bowel habits: this can include diarrhoea, constipation, or an alternating pattern of both. Some people have urgent diarrhoea episodes, while others have difficulty or infrequent stools, or a mix of both types (often termed IBS-D (diarrhoea-predominant), IBS-C (constipation-predominant), or IBS-M (mixed symptoms)).
• Bloating and swelling of the abdomen: many people with IBS experience a swollen, gassy tummy, especially later in the day. You might notice your clothes fitting tighter due to bloating.
• Other symptoms: these can include excess wind (flatulence), passing mucus with stools, and a sensation of incomplete bowel movement (feeling like you still need to go even after you've gone). Some individuals also report heartburn, nausea, backache or bladder symptoms – these can happen in IBS and may help support the diagnosis.

Symptoms can vary from mild to severe. They often come and go in flare-ups triggered by certain foods or drinks, stress or anxiety, hormonal changes, or sometimes seemingly out of the blue. It’s useful to learn your personal triggers over time.

If you notice “red flag” symptoms like unexplained weight loss, bleeding from the back passage, nocturnal symptoms that wake you from sleep, or persistent severe pain, these are not typical of IBS – you should alert your doctor, as further tests may be needed to rule out other conditions.

How Common is IBS?

IBS is very common – you are not alone in having this condition. It’s estimated that between 10% and 20% of people worldwide have IBS. In the UK, this equates to roughly 1 in 7 people being affected at any one time. IBS can occur in both men and women, but about twice as many women experience IBS as men. The condition often begins in early adulthood (20s to 30s are common ages to be diagnosed), but it can start at any age, and recent trends show it also affects many older adults.

IBS is one of the most frequent reasons people consult a GP for gastrointestinal problems. The good news is that although IBS is a long-term condition, it can be managed successfully through the right combination of diet, lifestyle changes, and other treatments.

What Causes IBS?

The exact cause of IBS isn’t fully understood, but it’s thought to involve a mix of factors and a

miscommunication between the gut and the brain. Doctors describe IBS as a disorder of gut–brain interaction, meaning the nerves and muscles of your gut are extra sensitive and react strongly to triggers that might not bother others.

Possible contributing factors include:

• Diet: Certain foods (for example, rich or fatty meals, caffeine, gas-producing foods, FODMAPs, etc.) can trigger or worsen symptoms in susceptible people.
• Stress and emotion: Stress, anxiety, or emotional upsets can aggravate IBS symptoms. Many people notice their IBS is worse during stressful times – this is because stress can affect how your gut functions (the “gut-brain axis”).
• Gut infections or antibiotics: IBS sometimes begins after a severe bout of gastroenteritis (food poisoning or a tummy bug), or after taking antibiotics. This is called post-infectious IBS.
• Gut bacteria: The community of bacteria in your intestines (the microbiome) may play a role. Changes or imbalances in gut bacteria have been linked to IBS in some cases.
• Other factors: IBS can run in families (though no single gene causes it), and hormonal changes (for instance, some women find symptoms vary with their menstrual cycle) can influence it.

It’s important to remember that IBS is nobody’s fault – it’s a recognized medical condition with real symptoms. Lifestyle factors can influence IBS, but you did not cause your IBS. Understanding your personal triggers (foods, stressors, etc.) can help in managing the condition.

Diet and Lifestyle First

There is no single cure for IBS, but there are many treatments to control symptoms. The NHS and NICE guidelines emphasize starting with diet and lifestyle changes as the first line of treatment. Every person’s IBS is different, so it may take some trial and error to find what works best for you. Below are links to an overview of evidence-based strategies:

• General Health Eating
• Beyond General Healthy Eating
• Specialised Diets (e.g. Low FODMAP)
• Regular Physical Activity
• Stress Management and Relaxation
• Over-the-Counter Aids and Supplements (Peppermint, Probiotics, etc.)

While optimizing your diet and lifestyle is key (and should be an ongoing foundation of your management), some people with IBS will explore additional treatments, especially if symptoms remain troublesome.

Treatment should be tailored to your specific symptoms and how severe they are.

Below are links to other evidence-based options that may be used in IBS management – often in combination with the diet and lifestyle measures discussed above.

• Medications
• Psychological Therapies
• Complementary and Alternative Therapies
• When to Seek Specialist Help

• Diagnosis and Testing
• Symptoms
• Diet and Nutrition
• Lifestyle and Stress