Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a common, chronic disorder affecting the large intestine, causing recurrent abdominal pain along with changes in bowel habits. It does not damage the intestine or increase the risk of serious bowel disease, but can significantly affect quality of life.

• Recurrent abdominal pain or cramping, often related to bowel movements
• Bloating and excess gas
• Diarrhoea, constipation, or an alternating pattern of both
• A feeling of incomplete emptying after a bowel movement
• Symptoms often flare with certain foods or during periods of stress

• The exact cause is not fully understood but is thought to involve a combination of altered gut movement, increased sensitivity of the gut to normal digestive processes, changes in gut bacteria, and the gut-brain connection.
• Stress and anxiety often trigger or worsen symptoms, though they are not the sole cause.
• Certain foods — such as those high in fermentable carbohydrates, caffeine, or fatty foods — can trigger symptoms in many people.

• Diagnosed clinically based on a characteristic pattern of recurrent abdominal pain associated with a change in bowel habit, in the absence of alarm features.
• Alarm features such as unintentional weight loss, rectal bleeding, anaemia, or onset after age 50 prompt further investigation to exclude other conditions.
• Basic blood tests may be used to rule out other causes, such as coeliac disease or inflammatory conditions, particularly if the diagnosis is not clear-cut.

Dietary adjustment is often the first step, including identifying and reducing specific trigger foods; a structured low-FODMAP diet, ideally guided by a dietitian, can help identify triggers in some people.

Regular physical activity, stress management techniques, and adequate sleep can help reduce symptom frequency and severity.

Medicine is tailored to the predominant symptom pattern — an antispasmodic for cramping pain, a laxative for constipation-predominant IBS, or an antidiarrhoeal for diarrhoea-predominant IBS, used as needed.

For people with ongoing significant symptoms, psychological approaches such as cognitive behavioural therapy or gut-directed hypnotherapy can be effective, reflecting the important role of the gut-brain connection.

• Identify and moderate personal trigger foods through careful observation or a structured elimination approach.
• Eat meals at regular times and avoid very large meals where these seem to trigger symptoms.
• Manage stress through relaxation techniques, regular exercise, or other approaches that work for the individual.
• Stay well hydrated and maintain adequate fibre intake, adjusted to whether constipation or diarrhoea predominates.