Irritable Bowel Syndrome (IBS)

The principal symptoms of irritable bowel syndrome are abdominal (tummy) pain, abdominal bloating and some disturbance of bowel habit.

The pain can be anywhere in the abdomen and can even be in different places at different times. It is more common on the left hand side but many people get it on the right. The pain can be very severe and many women say it is as bad as that of childbirth. Patients often describe it as colicky, stabbing or gripping in nature. In some patients it can occur every day, in others, it is more intermittent.

Bloating is a particularly troublesome feature of IBS and can be extremely intrusive. In some patients they just feel bloated, in others their abdomen actually swells (distension) and they have to loosen clothing. Some women actually have to change their dress size according to their distension and in some people their girth can increase by as much as 6 inches. Bloating characteristically increases during the course of the day and tends to subside at night although in some people it can be more persistent.

The disturbance of bowel habit can vary considerably. Some people suffer constipation, others get diarrhoea and some alternate between the two. The constipation can range from opening the bowels every other day to only going once every one to two weeks. In contrast the diarrhoea can just be a couple of loose stools a day or in other people they may go more than ten times a day. In some people the diarrhoea is accompanied by extreme urgency and a surprising number of people have accidents (incontinence). The stools can be very variable ranging from pellets to porridge-like or even watery consistency. Patients frequently say that they feel a sense of incomplete emptying after they have opened their bowels. Patients should not be alarmed by seeing undigested peas or sweetcorn in their stools, this does not mean there is something seriously wrong. It is also not uncommon to pass mucous, which looks a bit like jelly, from the anus with or without stools.

In addition to the pain, bloating and bowel disorder many patients suffer from a range of other symptoms which accompany IBS. These include low backache, lethargy (tiredness), nausea (particularly in the morning), thigh pain, bladder symptoms such as frequency and some women experience pain on intercourse (3). It is important to recognise that these symptoms are usually part of IBS and do not necessarily indicate other serious disease. It is especially important that IBS patients don't get unnecessarily investigated for these problems. On some occasions they can have unnecessary surgery which will, of course, not help if the problem is coming from the bowel rather than, for instance, the back. A particular problem in females with IBS is that their symptoms can be mistaken for a gynaecological problem. As a consequence, they may be referred to a gynaecological clinic which can sometimes result in unnecessary investigation and treatment (13, 20, 23, 56). Not surprisingly, if their problem is mainly due to IBS then they are unlikely to derive benefit from any gynaecological interventions. Similarly, we have shown that IBS patients can also be inappropriately referred to urological (bladder) clinics if their bladder symptoms are especially severe (62).

IBS often runs in families suggesting that there is a genetic component to the problem. IBS never leads to cancer of the bowel.