Irritable bowel syndrome (IBS) is a condition which causes the intestines (bowels or gut) to be over sensitive. This can cause a variety of abdominal and bowel symptoms. There is no cure, but most people can, with the help of their doctor, learn to control and live with their irritable bowel.

• Abdominal pains, especially on the left side or across the lower abdomen
• Bloating and fullness of wind
• Constipation
• Diarrhoea
• Alternating between constipation and diarrhoea
• A sensation of having to rush to the toilet
• Difficulty opening the bowels, or feeling as though they have not emptied adequately
• Feeling sick (nauseous)

These are the main symptoms that occur, and it seems that the bowel is more sensitive to outside events. Thus, in the way that someone with sensitive skin comes out in a rash when stressful events occur, a person with irritable bowel syndrome finds that when they are stressed it is their bowels that "come out in sympathy".

This means that symptoms may be worse when under psychological stress or when being physically stressed, for example by an infection, exhaustion or other conditions. The problem may also be irritated by certain foods and drinks (which vary from person to person).

Nobody really knows why IBS exists and, as there are such a variety of manifestations, it may be that there is more than one cause. We do know that it is very common, affecting as many as one person in five.

There is little to find, apart from the symptoms. Physical examination, X-Ray tests, and blood tests show no major problems. It is really a question of the doctors excluding more serious causes for the symptoms.

They will be more likely to do this if you:

• are over 45 years old
• have a family history of cancer of colon, breast, ovary, or womb
• have noticed bleeding from the back passage, weight loss, or loss of appetite.

The tests, which may well involve seeing a specialist, are likely to include the following:

• Examination of your tummy (abdomen)
• Examination of the back passage (rectum) with a finger
• A look up the back passage with a sort of telescope (sigmoidoscope and/or colonoscope)
• An X-Ray of the bowel (Barium enema or CT colonography)

There are a number of treatments, and in medicine this usually means that the perfect answer has yet to be found. It is usually a case of experimentation between the doctor and the patient to find what suits that particular individual. This is also true of the diet. Broad generalizations can be made, but over time the person develops an understanding of what upsets them and what does not. Usually people do find that they can keep their symptoms at bay.

The treatments include:

• Eat more fiber, possibly adding medicinal fiber supplements.
• Drugs to reduce spasm in the wall of the bowel may reduce pain.
  • Some of these have a direct effect on the muscle in the wall of the bowel, for example mebeverine.
  • Some of these work by mimicking the effects of the nervous system on the bowel.
  • Others include peppermint oil in a concentrated form. (It needs to be strong to be effective, but the stomach cannot tolerate it very strong, and thus the modern slant on this old fashioned treatment is that it is in a capsule which takes a strong concentration of the peppermint oil beyond the stomach before releasing it.)
• Drugs that reduce the rate of sequential contraction of the bowel may make pain and diarrhoea less likely, for example loperamide.
• Drugs which are used for diarrhoea, such as codeine, can be helpful, but are used less because they can be addictive.
• When all else fails, a small dose of a medication usually used to treat depression can be effective. This seems to work in a much smaller dose than is used for depression, and may in part work by mimicking the nervous system to the bowel.

• Eat a healthy diet, with plenty of fiber, fruit and vegetables
• Exclude any foods which always upset you
• Take regular exercise
• Avoid unnecessary stress
• It may help to learn relaxation techniques, in fact this is good general advice for us all

• IBS Network - IBS support and advice

Books

IBS Relief, by Dawn Burstall RD, Michael Vallis PhD, Geoffrey Turnbull MD

A doctor, a dietician, and a psychologist provide a team approach to managing Irritable Bowel Syndrome.

The Good Gut Guide, by Stephanie Zinser

Help for IBS, Ulcerative Colitis, Chron's Disease, Diverticulitis, food allergies and other gut problems.