Professor Nick Read, medical advisor for the (charity) IBS Network, gives his insight into Irritable Bowel Syndrome and how best to manage it.

How are your bowels? Are they stubborn or lazy? Or are they so loose you need always to be near a toilet? Perhaps they are ambivalent and swing from diarrhoea to constipation and back again? Do you have abdominal pain? Does you stomach tend to bloat? If the answer to any of these questions is yes, then the chances are that you have Irritable Bowel Syndrome (IBS)...

‘But,’ you might exclaim, ‘we all get bowel upsets; it is just part of life.’ That’s true. The difference between the bowel symptoms that we all experience and IBS is an order of magnitude. IBS is diagnosed when the combination of abdominal discomfort and bowel upset is so persistent, so severe and so worrying that it disrupts everyday life. Although IBS is the most common cause of bowel disturbance, affecting 15% of the population, it comes as a bit of a shock to realise that it has no definitive cause. It is a medically unexplained illness. Scans and X-rays reveal no abnormality. Blood tests are quite normal. IBS was invented by gastroenterologists in the 1970s to provide a diagnosis for those people who suffered from persistent but unexplained symptoms of abdominal discomfort and bowel disturbance.

Like other medically unexplained illnesses, such as chronic fatigue syndrome, fibromyalgia, chronic back pain and functional dyspepsia, IBS affects more women than men. The ratio is about two to one. IBS tends to come in early adult life and fade away as people get older. It is frequently associated with anxiety and depression and it tends to wax and wane according to what is happening in a person’s life. People with these medically unexplained illnesses share the same psychological features and tend to suffer from the same spectrum of symptoms. So are they individual expressions of both mind and body to life situations? Is IBS all in the mind? ‘No.’ The symptoms are not imaginary. When the function of the bowel is examined, it is abnormally sensitive and reactive to whatever goes into it. This might explain why people with IBS are so intolerant of foods.

Stress is probably the most frequent cause of bowel sensitivity. This is so familiar that gut expressions are used to express emotions. ‘I can’t stomach it’ and ‘gutted’ are all in common usage. Allergy and inflammation can do it as well. IBS can be instigated by an attack of food poisoning, but this is more likely if you are anxious or depressed or have something going on in your life at the time of the gastroenteritis. A connection is established between the symptoms and the context so that the bowel symptoms are, in effect, ‘recruited’ to express the unresolved emotional tension. Similar observations have been made for chronic fatigue syndrome following viral illness and for persistent abdominal pain following hysterectomy. But you don’t have to have abdominal trauma or infection to get IBS: the symptoms induced by the stress itself may also persist if whatever has happened is not dealt with. Split from the event that caused it, the symptoms are consolidated as an unexplained illness which must be taken to the doctor.

But GPs are not trained to understand illnesses like IBS. They have neither the time nor the aptitude to understand the meaning of unexplained illness or the relationship with what has happened. Their skill is in the identification and treatment of ‘organic’ diseases that have a definite pathology and cause. Doctors treat symptoms of IBS with drugs, but while these may be useful to rectify disturbances in bowel habit, they can make other symptoms worse. For example, treating diarrhoea with Imodium or Lomotil can tend to exacerbate abdominal pain and bloating. Treatments for constipation can increase bloating and flatulence.

There is no definitive treatment for IBS, although patients do find some treatments particularly helpful. It would seem prudent, for example, to avoid those fatty, gassy or spicy foods that irritate the sensitive bowel. Gassy foods include pulses (lentils, beans and peas), fruits such as bananas, pears and apples, cereals, and some vegetables. Psychological treatments, such as relaxation, bowel-directed hypnotherapy, counselling and psychotherapy, are very useful, but may be difficult to access. Many patients with IBS find complementary therapies helpful. They are tailor made to the individual and offer a focus of belief that inspires confidence. Among the specific remedies that some patients find helpful are peppermint, ginger and aloe vera.

For IBS, it is more important to understand the patient than the illness. Successful treatment often facilitates an understanding of how his or her lifestyle, life history and life situation can affect the way the bowel works. Although diet is often implicated, specific allergy is rare.

This year, the IBS Network, a registered national charity (www.ibsnetwork.org.uk), has created for its members a self management programme that provides patients with the necessary information and skills to manage IBS themselves. It gives provides detailed information about how the gut works, the nature and causes of IBS, the role of diet and stress and various treatment options. It also enables the acquisition of key skills such as dietary control, stress management, and how to have an informed and productive consultation with health professionals.

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