In this article I will explain what are the symptoms of IBS and also what are the causes of IBS. These are two confusing topics which you will need to understand in order to control your condition.
If you have IBS you will be experiencing a range of digestive symptoms and these may differ from someone else you know with the condition.
Similarly, you may be looking for answers about why you have this problem in the first place. Causes are not yet fully understood but we have managed to link several possible suspects in the research.
HOW TO GET AN IBS DIAGNOSIS
The symptoms and causes of IBS may sound wooly but there is a specific criteria for an IBS diagnosis.
The IBS Criteria;
You must be experiencing abdominal pain at least 1 day a week for the past 3 months (1). In addition, this abdominal pain will be related to at least 2 of the following;
- Opening your bowels
- A change in stool frequency
- A change in stool appearance
To make a diagnosis, you must also have a set of specific tests carried out. These tests will rule out other possible health conditions. You can find out about these tests here.
WHAT ARE THE SYMPTOMS OF IBS?
1. BLOATING SYMPTOMS IN IBS
It wont surprise you to find that bloating is a common symptom of IBS. Bloating is caused by trapped or excess gas that leads to more pressure in your digestive tract.
You can read more about the causes of bloating here.
2. STOMACH PAIN AND CRAMPING SYMPTOMS IN IBS
IBS causes abdominal pain at least 1 day / week (2).
This symptom is thought to be caused by hypersensitivity in the gut. Therefore, your gut may be communicating to your brain that you are in pain in response to just normal digestion.
3. EXCESS GAS
Gas production is a normal part of digestion. However, if you are suffering with excess gas then this is more of an IBS symptom. It is caused by changes in gut bacteria and food intolerances.
3. DIARRHOEA IS A SYMPTOM OF IBS
Diarrhoea in IBS is caused by food intolerances and a hypersensitivity. Things like FODMAPs, caffeine, nicotine, alcohol and stress can cause diarrhoea.
The definition of diarrhoea: “Diarrhoea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual)” (3).
4. LOOSE STOOLS
You may not fit the strict definition for diarrhoea, but still have IBS predominant diarrhoea (IBS-D). You would fit this criteria if your IBS symptoms included mostly stool types 5-6 (see below chart).
5. CONSTIPATION
Constipation is considered a sign of IBS. There is no real accurate definition of constipation unfortunately. For this one you need to look at your stool type and movement.
A stool type of 1-3 indicates constipation.
6. FATIGUE
If you feel exhausted then this may be a symptom of your IBS (4).
When you feel tired with IBS, the causes are likely due to a combination of factors. Regular pain, bloating, constipation and diarrhoea will all make you feel fatigued.
You may also feel quite stressed and low in mood about your symptoms. Stress and a low mood have also been linked to fatigue.
7. LOW MOOD AND ANXIETY
Through the gut-brain axis, we know that mental health is linked to IBS.
So, it is not surprising that you may feel lower in mood or suffer with anxiety. In one paper, it was even suggested that people with anxiety and depression are twice as likely to suffer with IBS.
WHAT CAUSES IBS?
You will be frustrated to find that the exact cause of IBS is currently unknown. Research does show that IBS causes could be multifactorial.
Have you ever been told ‘it is all in your head’? As nasty as this comment is, there may actually be some truth in it. Because, when we look at IBS pain symptoms, research suggests that it could be due to a sensitive nervous system.
Having a hypersensitive nervous system would cause pain signalling to your brain when nothing out of the norm is going on in your gut (5, 6).
The following issues are thought to be potential other causes of IBS;
PSYCHOLOGICAL FACTORS
When your body is under stress, it releases hormones, such as cortisol, which can lead to digestive symptoms (8).
Stress is thought to play a large role in IBS pain symptoms. It is known that chronic stress can increase gut permeability and modify how the pain signalling in the body works (9).
Take the time to consider what caused your IBS may help you to manage it going forward.
HOW IS IBS TREATED?
As much as I want to tell you about the ‘treatments of IBS’ there are none. In fact, IBS is a chronic condition with no cure, so the term ‘treatment’ is misleading. Although you may be disappointed at this, there are multiple management options available.
Below I have listed out different, scientifically proven IBS management methods. Although each one is proven by science to improve symptoms, I would suggest using them all. IBS is a multifactorial condition and requires this approach.
THE LOW FODMAP DIET
‘FODMAPs’ stands for fermentable oligosaccharides disaccharides monosaccharides and polyols. It has been shown to have up to a 70% effective rate at managing IBS symptoms (10).
FODMAPs are different types of carbohydrates which can be found in various foods.
FODMAPs make their way through the gut, to the large bowel, where they are broken down by gut bacteria.
This process is known as fermentation and produces gas and draws water into your large bowel.
In those with IBS, FODMAPs can cause stomach distension and bloating, resulting in pain, loose stools and excess gas (11, 12).
You firstly follow a diet low in fermentable carbohydrates for 4-6 weeks. This controls your symptoms by avoiding fermentable carbohydrates.
PROBIOTICS
After the initial reduction phase, you go on to the reintroduction process. This is a structured process which allows you to pinpoint your triggers and tolerance levels
Probiotics have been shown to help manage IBS symptoms in multiple studies.
If you take a probiotic regularly you may find you have a reduction in IBS pain, flatulence and bloating. Probiotics can also help normalise stool patterns (13, 14, 15).
Exactly how probiotics help IBS symptoms of pain is unclear at present. But, research is starting to suggest a role for gut bacteria in the the gut – brain axis (3).
For recommendations on which probiotics to try, see my previous article on probiotics in IBS.
PSYCHOLOGICAL TREATMENTS
Given that there is a psychological element in IBS, it comes as no surprise that psychological therapies can help.
Cognitive behavioural therapy (CBT), hypnotherapy and mindfulness are all shown to have some benefit for those with IBS symptoms (16).
YOGA
Doing yoga twice a week has been shown to improve your symptoms as much as the low FODMAP diet (17).
FIBRE
If you have IBS-C then taking a fibre supplement can help to relieve symptoms.
But, be careful that you take the correct type of fibre supplement, only Psyllium, methylcelluose, calcium polycarbophil and wheat dextrin have been shown to reduce symptoms (18).
MEDICATIONS
There are a range of medications that can help with IBS pain symptoms, to get advice on these, speak to your doctor or pharmacist.
PEPPERMINT OIL
You will likely have heard that peppermint is good for digestion and may even have tried peppermint tea in the past.
But, you should be taking peppermint oil to get the full benefit. This oil is an extract from the mentha plant. Interestingly, it has been used for many years as a digestive aid and in more recent times, studies looking at its effectiveness in IBS have been carried out.
In one study, individuals with mild symptoms of IBS were given 180mg of peppermint oil 3 times a day for 4 weeks. This resulted in a reduction in IBS related pain (19).
When you take peppermint oil for your IBS pain, it works by blocking calcium channels in your body (20).
Studies on peppermint oil capsules range from 225mg twice a day to 187mg four times a day (21). So it may be worthwhile starting with a lower dose and working your way up.
BOTTOM LINE
Irritable bowel syndrome is a condition which has multifactorial causes. Symptoms can vary in type and intensity between people and testing is required for diagnosis.
IBS is a chronic condition with no cure but you can manage symptoms by pin-pointing triggers through the low FODMAP diet, targeting gut microbiota and changing lifestyle habits.
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