9 signs of irritable bowel syndrome (IBS)
Evidence-based, reviewed by Lucy Whigham Registered Dietitian. Updated 31/03/2022
Treat IBS at IBScoach.org
Irritable bowel syndrome (IBS) is a digestive condition that affects up to 1 in 7 people in the UK and 800 million people across the world.
It is characterised mainly by changes in bowel movements and pain or discomfort in the abdominal region.
There are three sub types of Irritable Bowel Syndrome:
IBS with constipation as one of the main symptoms (IBS-C)
IBS with diarrhea as one of the main symptoms (IBS-D)
IBS with a mix between constipation and diarrhoea (IBS-M)
If you have IBS, you might have noticed that diet, stress, poor sleep, and rigorous exercise can act as triggers and worsen the condition. This is due to the brain-gut axis being affected and a heightened sensitivity of the intestines to stress which is common in people with IBS.
Also, dietary factors such as food and drink high in FODMAPs, and changes in gut bacteria commonly trigger IBS symptoms.
In this article we will discuss the most common symptoms of IBS and what treatments are available. If you suspect you have IBS, you can take a free Dietitian’s assessment online.
1. Pain and Abdominal Cramps
Abdominal cramping in IBS can feel like a sudden flutter of tightness and muscle spasms in the abdominal area, often accompanied by moderate to severe pain.
Remember, although cramps and spasms can be physically painful, they do not cause damage to the intestines.
Pressure on the intestinal walls from gas, fluid and digested food can trigger spasms in the muscles in the large intestine. Muscles in the intestine work to move food along the gut but can fire out of sync or suddenly contract causing pain.
Studies show that people with IBS have Visceral Hypersensitivity in the gut. This means the nerves in the intestines are hypersensitive.
This sensitivity reduces the pain threshold and increases intensity of sensations like abdominal pain and cramping.
2. Diarrhea
If you have diarrhea predominant IBS (IBS-D) you will likely experience frequent episodes of loose or watery stools.
Remember, although diarrhea can be uncomfortable and disturbing, it does not cause physical damage to the intestines.
However, there are red flags to look out for which you must have checked by a medical professional.
Red Flags
√ Blood in your stool
√ Rectal bleeding
√ Unintended weight loss
√ Symptoms started over 50 years of age
√ Fever
√ Vomiting
√ Anaemia
If you are unsure, always seek advice from a medical professional.
3. Constipation
Transit time of food through the digestive system usually takes between 24 to 72 hours under normal conditions.
People with constipation predominant IBS (IBS-C) are likely to experience altered transit time and may go days without a complete bowel evacuation.
The stool itself is likely to appear dry, cracked or like rabbit droppings, and the person may spend extended time on the toilet without a bowel movement.
Constipation can be caused by multiple factors including slow gut motility, a lack of fibre, a diet too high in fat, foods high in FODMAPs, and inadequate fluid intake.
4. Excess Gas
Certain food and drink such as ingredients high in FODMAPs, and fizzy soda, beer, and carbonated water can lead to an increase in gas in the intestines.
High FODMAP foods are indigestible in the small intestine and so pass to the large intestine where our population of gut bacteria break it down through fermentation.
One of the by-products of fermentation is the release of gas into the intestines. This can cause the sensation of bloating.
As the gas moves along the intestine it must escape through the anus as wind.
Everyone produces a certain amount of gas each day, however, people with IBS may have a noticeable increase of gas production.
Reducing certain high FODMAP foods is an effective way to reduce flatulence.
5. Bloating
The symptoms of bloating range from moderate abdominal discomfort, to severe abdominal tightness and a visibly bloated stomach.
Bloating usually occurs after a meal and can be occasional, frequent, or daily.
As bloating is related to intestinal gas, other symptoms include increased flatulence (wind) and burping.
However, some people with IBS have normal gas production but the hypersensitive nerves trigger the gut walls to expand (distend) a disproportionate amount even to moderate amounts of gas production.
Remember, bloating doesn’t cause physical damage and it can be treated and prevented with diet and lifestyle.
Bloating is mainly caused by an increase in gas (as well as fluid and digested food) in the intestines.
This pushes the intestines outwards creating the uncomfortable sensation of bloating.
6. Food Intolerance
Whatever food we put into our bodies eventually comes into contact with our resident gut bacteria in our large intestine.
Certain foods contain highly fermentable carbohydrates called FODMAPS which are indigestible in the small intestine, and pass into the large intestine.
Our gut bacteria digest the FODMAPs, and this process rapidly releases gas into the large intestine.
(Other FODMAPs draw extra water into the large intestine which can be the cause of loose, watery stools).
The combination of extra gas, water and digested food puts pressure on the intestinal walls and creates the sensation of bloating and abdominal pain.
The muscles in the intestine which are usually happy to move food along now fire out of sync or suddenly contract causing cramps.
In some people FODMAPs trigger diarrhoea, and in others it can slow the movement of food through the intestine leading to constipation.
General diet also plays a big role in digestion, but this is how FODMAPs trigger symptoms.
FODMAP stands for
Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
And
Polyols
Many foods contain FODMAPs in low, medium, or high quantities, whilst some foods contain no FODMAPs.
Everyone has a personal threshold to each FODMAP. This means that some foods will trigger symptoms in small amounts, and other foods can be well tolerated.
One major goal of IBS treatment is to bring symptoms under control by reducing the foods that trigger symptoms.
7. Depression
As many as 70% of people with IBS meet diagnostic criteria for depression.
Making lifestyle changes that reduce depression and promote wellness can reduce the symptoms of IBS.
8. Fatigue
One of the often-overlooked aspects of IBS management is getting enough quality sleep.
Disturbed sleep can even act as a trigger for worsening the condition. Scientific evidence has suggested that not getting enough sleep increases severity of symptoms the following day.
On the other hand, the worsened symptoms might disturb the attempts for a quality rest which creates a vicious cycle. Sleep disturbances are much more common in IBS patients when compared to the general population.
Another common symptom of IBS is chronic fatigue. It affects over 50% of all patients, according to evidence.
The symptom is most likely related to the disturbed sleep and chronic stress which people with IBS often experience.
9. Stress and Anxiety
When stressed, the body releases adrenaline and cortisol getting us ready for a fight or flight response.
Adrenaline and cortisol are hormones that have a direct effect on our digestive processes.
They can cause a decrease in blood and oxygen flow to the stomach, increased acid secretion, increased gas production, slow or fast transit in the gut causing constipation or diarrhoea, hypersensitivity of the gut, cramping, and an imbalance in gut bacteria.
The stress response can also lead to feelings of anxiety and depression as the adrenaline and cortisol run their course through the body.
It can be a vicious cycle where the symptoms of IBS trigger anxiety, and the anxiety can trigger symptoms of IBS.
Practising daily gratitude, getting a good night sleep, and taking steps to lower stress can all reduce the symptoms of IBS.
What to do if you think you have IBS
IBS can be diagnosed by a medical professional such as your GP or Gastroenterologist. There is a comprehensive free online assessment designed by a leading gut health expert that can tell you if your symptoms are likely to IBS - but you should always confirm results with a medical professional.
Drug free treatment generally focuses on the low FODMAP dietary plan which is proven to reduce symptoms in over 75% of people. A combined approach of dietary treatment and lifestyle changes can achieve very good results.
Getting the right support is important when treating IBS. The IBS Coach app is a science-backed treatment that coaches you through the changes.
IBS Coach offers digital healthcare that would be hard to replicate without seeing a dietitian, a behavioural psychologist and a motivational coach. The app allows you to:
Create personalised low FODMAP meal plans and shopping lists.
Log symptoms (inc. mood, medication and digestive symptoms).
Track your progress and help identify trigger foods.
Reduce stress and anxiety with daily bite-sized articles and fun tasks.
Learn which foods are safe to eat or likely to trigger symptoms.
IBS Coach is an app which coaches you to better digestive health. Apps are effective because they are with you 24/7 and can help you see the progress you are making.
While they’re not for everyone, they hold you accountable and keep you engaged which is a good thing, especially for IBS treatment.