Irritable bowel syndrome

Also called IBS, Spastic colon

A gut that is oversensitive and badly co-ordinated. Real, common, and not a diagnosis of exclusion by default.

What it is

IBS affects perhaps one in five people in the UK. It is real, it is common, and being told there is nothing wrong is both inaccurate and demoralising.

The gut and the brain are wired together closely. In IBS the gut is hypersensitive, so normal amounts of gas and normal movement register as pain, and the muscle contractions become poorly co-ordinated.

It is not a precursor to cancer, and it does not damage the bowel. But before settling on it, coeliac disease and inflammatory bowel disease should be excluded with actual tests.

Signs you might notice

Abdominal pain relieved or changed by opening bowels.

Bloating, and a stomach that changes size through the day.

Diarrhoea, constipation, or both alternating.

Symptoms worse under stress and around periods.

Not present: bleeding, weight loss, night-time waking with symptoms, or anaemia. Any of those means it is not IBS and needs investigation.

How it can affect day-to-day life

Unpredictability is what limits life. People plan around toilets and turn things down without explaining why, because the subject is embarrassing.

The internet has made this worse rather than better. Elimination diets pile up until somebody is eating twelve foods, malnourished, and no less symptomatic.

There is a genuine bidirectional relationship with stress and anxiety, which is not the same as it being caused by them.

Supporting someone well

Eat regularly. Do not skip meals, and do not eat late and rush.

Try the low FODMAP diet only with a dietitian. It is an eight-week diagnostic process with a structured reintroduction, not a permanent way of eating, and doing it alone usually causes harm.

Soluble fibre such as ispaghula for constipation. Avoid bran, which frequently makes IBS worse.

Peppermint oil capsules have reasonable evidence for pain and bloating.

Treat stress as a lever rather than an accusation. Gut-directed hypnotherapy and CBT both have good trial evidence.

Keep a symptom and food diary before assuming a trigger. Memory is a poor guide here.

Where to get help

A GP should test for coeliac disease and check a faecal calprotectin before settling on IBS.

Ask for a dietitian referral for FODMAP work.

Any red flag, bleeding, weight loss, a change in bowel habit over 50, or a family history of bowel cancer, needs urgent assessment.