Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is a common long-term condition that affects your digestive system. It causes pain or discomfort in your tummy and a change in your bowel habits. Although there’s no cure for IBS, lifestyle changes and other treatments can make a big improvement to how you feel.

About irritable bowel syndrome

With irritable bowel syndrome (IBS), you’re likely to live with the condition for years and often for life. Your symptoms will usually come and go over this time. They can range from mild to severe enough to affect your daily life. Some people’s symptoms improve over time while others get worse. Sometimes, IBS goes away on its own.

10-12% people in India are thought to have IBS. You can develop it at any age, but it’s most common for symptoms to start before the age of 35. It’s less common for IBS to start later in life. You’re at greater risk of other bowel conditions causing your symptoms over the age of 40. So, it’s important to get any changes checked out. Women are twice as likely as men to report having symptoms of IBS.

Causes of irritable bowel syndrome

It’s not clear exactly why some people develop irritable bowel syndrome (IBS). But there seem to be several changes that happen to your bowel and lead to symptoms.

• Your bowel may be more sensitive than normal and over-react to certain foods or other factors such as emotional stress.
• Your body may be more sensitive to pain coming from inside your bowel. 
• There may be changes to the microbes (bacteria and viruses) living in your bowel. 
• There are changes in how food moves through your digestive tract.

Overall, there seems to be a combination of factors that affect both your brain and your bowel, and the interaction between the two. This is sometimes known as the brain-gut connection. It can explain why things like stress may trigger symptoms.

Although it’s not fully understood why someone might develop IBS, the condition is often associated with:

• a bout of food poisoning or gastroenteritis
• inflammation as a result of another condition such as inflammatory bowel disease
• taking certain medicines that affect your bowel, including antibiotics
• stress, anxiety and depression
• previous traumatic experiences such as abuse

Symptoms of irritable bowel syndrome

The main symptoms of irritable bowel syndrome (IBS) include the following.

• Pain or discomfort in your tummy (abdomen). You may feel this as cramps low down or in the middle of your tummy. The pain may be worse after eating and may get better – or sometimes worse – after you’ve had a poo.
• Changes in bowel habits such as needing to go more or less often than usual. There may be a change in the consistency and appearance of your poo (you may have constipation or diarrhoea or a mix of both). You may also pass small amounts of mucus.
• Your abdomen may look and feel bloated. This can get worse during the day and may improve when you poo or break wind.

You’ll often find your symptoms get worse during times of stress and after eating certain foods, for example fatty foods. IBS can cause other symptoms too. These include:

• feeling very tired
• indigestion
• feeling sick
• backache and other muscle or joint pains
• regular headaches
• problems with your bladder such as needing to pass urine more often and urgently, particularly at night
• difficulty controlling your bowel – for example, leaking faeces when you break wind

These symptoms may be due to problems other than IBS. For instance, IBS shares some symptoms with inflammatory bowel disease (IBD) such as  and . For more details, see our FAQ on the differences between them.

If you’re regularly having bowel symptoms such as those described above, contact your Doctor. If you have other symptoms too – such as bleeding from your bottom or significant weight loss – you should make an urgent appointment with your Doctor. This can be a sign of a more serious problem.

Diagnosis of irritable bowel syndrome

Your Doctor  will usually be able to diagnose irritable bowel syndrome (IBS) by asking you about your symptoms and, if necessary, ruling out any other conditions.

Your Doctor will ask you to describe your symptoms, including when you notice them and what makes it better or worse. This might include any food or drinks linked to your symptoms. They may ask if you’ve noticed any changes in your bowel movements (poo), including how often you need to go, and what it looks like.

For help checking your poo, you can use our infographic.

Your Doctor will want to know how your symptoms affect your daily life. They may also ask you how you’ve been feeling recently – including if you have any stress or anxiety. It can be useful to keep a symptoms diary for two to four weeks to share with your Doctor. There are online and app-based food diaries available or you can try our downloadable symptoms diary. But don’t make any changes to your diet until you have seen your doctor because it might affect test results.

Your Doctor may also want to examine you to rule out other possible causes. This may involve looking at, feeling and listening to your tummy, and examining your bottom (rectum). The doctor may want to check if you’ve lost weight. They may also ask you some questions about your medical and family history.

Your Doctor may ask you to have blood tests to check for coeliac disease, and to provide stool (poo) samples to check for infection and inflammation. They may refer you to a specialist doctor for more tests if your symptoms need further investigation.

Diet and lifestyle changes for IBS

There’s no cure for irritable bowel syndrome (IBS), but changes to your diet and lifestyle may help to improve your symptoms. Your Doctor is likely to talk you through some of these before suggesting any other treatments.

Diet advice

You may find some of the following dietary measures help. What works for you may depend on your main symptoms, particularly whether you mostly get constipation or diarrhoea.

• Eat regular meals and give yourself plenty of time to eat them. Avoid missing meals or leaving long gaps between eating.
• Make sure you’re keeping hydrated by drinking at least eight cups of fluid every day. Try to cut back on fizzy drinks, alcohol and drinks containing caffeine – for example, tea and coffee.
• If you mainly have diarrhoea and bloating, it may help to reduce the amount of fibre you eat. This includes cutting back on high-fibre foods such as brown rice and wholemeal bread.
• If you suffer more with constipation, try gradually increasing your intake of fibre. Aim to include oats, nuts and seeds, vegetables and fruits. Don’t have more than three portions of fruit a day though. You can also try soluble fibre supplements such as ispaghula, although these may sometimes make symptoms worse.  
• Try to limit the amount of processed food you eat. These often contain 'resistant starch' that’s difficult for your body to digest.
• If you have diarrhoea, avoid sorbitol. This is used in some sugar-free sweets, chewing gum and drinks.
• If you have wind and bloating, try incorporating oats into your diet – for example, oat-based cereals. Linseeds (up to a tablespoon a day) can also help.
• You might want to try taking probiotics – for example, probiotic yoghurts and food supplements. These contain helpful bacteria. For more information, see our FAQ on probiotics and IBS.

Avoiding common triggers

If you’re finding that certain foods trigger your symptoms, your Doctor may refer you to a dietician for specialist advice. You may find it helpful to record what you eat, together with your symptoms, to share with your doctor or dietician. You can download our symptoms diary from our section on diagnosis. Common food triggers include dairy products, citrus fruits, caffeine, chocolate, alcohol, onions, tomatoes and eggs.

A dietician may recommend you try an exclusion diet – cutting out certain foods to see if it helps. One particular type of exclusion diet is known as the . FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are all foods that can be hard to digest and may cause IBS symptoms. In the FODMAP diet, you cut out these foods and then gradually reintroduce them to see what you can tolerate. It should only be done under guidance from a health professional such as a dietician.

Some people with IBS also find that a gluten-free diet helps. But don’t cut out any foods until you’ve seen a Doctor or dietician because it may affect the results of any tests you have.

Lifestyle advice

Your Doctor may discuss other changes you can make to your lifestyle. These might include trying to be . Regular exercise may help to reduce your symptoms. Any exercise is beneficial but a good target to aim for is 150 minutes (two and a half hours) of moderate exercise during a week.

Your Doctor may also encourage you to  if you’re overweight or obese.

It’s important to make time for leisure activities and to relax, especially if your symptoms seem to be triggered by stress. If you think depression or anxiety may be a factor, be sure to seek the support you need for these.

Treatment options for irritable bowel syndrome

If diet and lifestyle changes don’t help, your Doctor may suggest other treatments. These include medicines and talking therapies. The treatments you’re offered will depend on your symptoms and what’s causing them.

Medicines

Medicines are available that can help with the symptoms of irritable bowel syndrome (IBS).

• Medicines for constipation include , and other medicines called linaclotide and prucalopride.
• Medicines for diarrhoea (antidiarrhoeal medicines) include antimotility drugs such as loperamide.
• Medicines for tummy pain and wind (antispasmodic medicines) include mebeverine hydrochloride, hyoscine butylbromide and peppermint oil capsules.

Many of these medicines are available over the counter (without a prescription). Ask your pharmacist for advice about what you need. In some cases, your Doctor may prescribe medicines. If the medicines listed above don’t ease your symptoms, your Doctor may also offer you a low-dose antidepressant. This can help with the pain of IBS even if you're not depressed. Your doctor will want to monitor you regularly.

Talking therapies

If you’ve had symptoms for a year or more and other treatments haven’t helped, your Doctor may recommend trying a .

Talking therapies include , hypnotherapy and psychotherapy. These therapies may help you to feel better and cope with your IBS symptoms better. Your Doctor may be able to refer you for talking therapy on the NHS.

Sometimes, you can refer yourself for talking therapy through an NHS service called . Alternatively, you can choose to see a private therapist. If you do this, make sure you check that your therapist is fully qualified and registered with a relevant professional organisation.

Complementary therapies

Many people with IBS try  to help relieve their IBS symptoms. These include acupuncture, reflexology, homeopathy and herbal medicines. There’s little evidence that these therapies work, but some people do find them helpful.

Frequently asked questions