Understanding Irritable Bowel Syndrome (IBS)

If you’ve ever felt like your gut has a mind of its own, and not a particularly cooperative one, you’re not alone. Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder that affects around 1 in 7 adults worldwide.

What is IBS?

IBS is a disorder of gut-brain interaction. This means that there is dysfunctional communication between the gut and brain, causing symptoms such as abdominal pain, nausea, bloating, and diarrhoea. In IBS, routine tests such as colonoscopy typically appear normal, and there are no structural abnormalities, such as those seen in coeliac disease and inflammatory bowel disease. Instead, in IBS, symptoms arise from changes in how the gut functions.

Common Symptoms

IBS doesn’t look the same for everyone. However, the hallmark signs usually involve:

• Abdominal pain, cramping or discomfort: Often related to bowel movements.
• Changes in bowel habits: This could be diarrhoea (IBS-D), constipation (IBS-C), or a mix of both (IBS-M).
• Bloating and distension: That look and feel of being "6 months pregnant" by the end of the day.
• Excessive gas (flatulence).

What Causes IBS?

There is no single "smoking gun" for IBS. Instead, it is usually a combination of factors:

1. Visceral hypersensitivity: A fancy way of saying your gut nerves are extra sensitive. Even normal amounts of gas can feel painful.
2. Motility issues: Changes in the speed or rhythm of the muscles in your gut can mean food may move through your system too fast (diarrhoea) or too slow (constipation).
3. The gut-brain axis: Stress or anxiety can activate brain pathways that trigger changes in motility, secretion, and sensitivity, and that in turn drive GI symptoms. This explains why many people with IBS notice that their symptoms flare when they’re stressed.
4. Post-infectious IBS: Sometimes, a bout of food poisoning or a stomach bug can "reset" the gut environment, leading to short or long-term IBS.
5. Microbiome Changes: An imbalance in the "good" and "bad" bacteria in your intestines.

The Diagnostic Process

One of the biggest myths is that IBS is a "diagnosis of exclusion", meaning doctors only name it after testing for everything else. While doctors do want to rule out other conditions, the process is now much more streamlined.

• Medical History & Symptoms: Doctors use the Rome IV Criteria, which looks for recurrent abdominal pain occurring at least one day a week (on average) in the last three months, associated with changes in stool frequency or appearance.
• Ruling Out "Red Flags": Your doctor will check for symptoms that are not IBS, such as unexplained weight loss, rectal bleeding, or a family history of coeliac disease or inflammatory bowel disease (IBD).
• Tests: You may undergo blood tests (to check for coeliac disease), stool samples (to check for inflammation markers like calprotectin), or scopes (like a colonoscopy).

Common IBS Treatments

The goal of IBS treatment isn't necessarily a "cure," but rather effective symptom management.

Note: Always consult with a healthcare professional or a specialised dietitian before starting a restrictive diet or new supplement regimen.