Irritable Bowel Syndrome (IBS): Symptoms & Causes

Irritable bowel syndrome (IBS) is a common, long-term gut condition. It causes repeated belly pain, bloating, gas and changed stools. The nerves linking your gut and brain are extra sensitive — your bowel is not damaged. IBS does not cause cancer, and diet, lifestyle changes and medicines keep it under control.

IBS is a condition where the bowel looks normal but behaves badly. The usual pattern is belly pain and bloating, with stools that swing between loose and hard. Doctors group it with the "disorders of gut-brain interaction".

That is why tests come back normal. IBS is unpleasant, but it does not shorten your life.

Symptoms come and go. Most people with IBS have:

• Belly pain or cramps, often eased by passing stool
• Bloating and a feeling of fullness
• Wind and gas that build through the day
• Changed stools — loose and urgent, or hard to pass
• Mucus in the stool
• A feeling of not fully emptying your bowels

Symptoms often flare for days or weeks, then settle. They can be a mild nuisance or bad enough to disrupt work, travel and sleep.

Doctors sort IBS by the stools passed on bad days.

No single cause has been found. Several things usually come together.

• A sensitive gut. Your gut nerves react more strongly than usual, so normal gas hurts.
• Gut-brain signals. Think of a two-way conversation between gut and brain that runs all day. In IBS it gets out of step.
• Gut bacteria. The gut's bacterial mix differs in many people with IBS.
• A bout of gut infection. IBS often starts after severe food poisoning or diarrhoea.
• How fast your gut moves. Fast transit gives loose stools; slow gives hard stools.
• Family pattern. IBS runs in some families, so genes may play a part.

These factors feed each other, which is why IBS is treated as a whole picture, not one tablet.

No blood test, scan or camera test proves IBS. Your doctor diagnoses it from your symptom pattern, after checking for warning signs.

Most doctors use a checklist called Rome IV:

• Belly pain on average at least 1 day a week, over the last 3 months
• The pain first started at least 6 months ago
• The pain comes with two or more of these: it relates to passing stool, or your stool frequency or form changes
• No other condition explains your symptoms

With no warning signs, you usually do not need a colonoscopy or a long list of tests. Extra testing mostly adds worry and delay.

Your doctor may still order blood counts, a coeliac test, stool tests for infection or parasites, or a breath test.

Other conditions can look like IBS, which is why a proper diagnosis matters.

IBS is not a Western problem. How common it is depends on how cases are counted: about 3 in 100 Indian adults where the modern criteria are applied strictly, and closer to 7 in 100 under looser ones.

The pattern here is different. People often report bloating, wind and changed stools rather than pain, and since the standard checklist puts pain first, IBS can be missed.

Two beliefs cause trouble here:

• Amoebic cysts in stool. Finding amoebic cysts does not prove amoebic dysentery. Amoebae turn up just as often in healthy people, and anti-amoebic treatment does not help.
• Milk intolerance. Cutting out milk is common advice, but self-reported milk intolerance is a poor guide to real lactose intolerance. Get it tested before you give up milk and lose the calcium.

There is no single IBS diet. What helps one person can trigger another. Start with these:

1. Keep a diary. For 2 to 3 weeks, note what you ate and how you felt. Patterns will appear.
2. Eat at regular times. Skipping meals and very heavy meals both provoke symptoms.
3. Go easy on the usual culprits. Tea, coffee, colas, alcohol, fizzy drinks, very spicy or fatty food, and sorbitol. Rajma, chana, cabbage and onions also cause wind.
4. Limit fresh fruit to about 3 portions a day, and drink around 1.5 litres of fluid daily.
5. Choose the right fibre. Soluble fibre such as oats, ispaghula husk and linseeds eases constipation. Adding a lot of fibre can make bloating worse.
6. Try a low FODMAP diet only with a dietitian. It cuts hard-to-digest sugars, but on your own it can leave you short of nutrients.
7. Move and sleep. Regular exercise and a steady sleep routine reduce flares more than most people expect.

If you try a probiotic, give it a month. If nothing changes, stop.

No medicine works for everyone. Everything here is something a doctor or pharmacist advises — do not buy and self-treat. Antispasmodics, low-dose antidepressants and rifaximin are prescription-only in India: they cannot be bought without a valid doctor's prescription.

• Antispasmodics relax gut muscle and ease cramps. Mebeverine and otilonium are common examples.
• Peppermint oil capsules help cramps and bloating in some people, but they can bring on heartburn. Ask a pharmacist first if you get acid reflux.
• Anti-diarrhoeal medicines such as loperamide slow the bowel and reduce urgency. Use them only on advice.
• Fibre supplements and laxatives such as ispaghula husk or polyethylene glycol help constipation-predominant IBS. Drink plenty of water with them.
• Low-dose antidepressants. Amitriptyline and similar drugs calm gut pain signals. They treat pain here, not depression. Dry mouth and drowsiness are common.
• Probiotics. They help some people, but no single strain is proven best.
• Rifaximin, an antibiotic, is sometimes prescribed for bloating and loose stools.

Gut-directed hypnotherapy and cognitive behavioural therapy also have good evidence.

If diet and pharmacy medicines are not helping, ask about seeing a dietitian or gut specialist.

No. Stress alone does not cause IBS, but it clearly makes it worse. Flares often follow a stressful stretch.

That is why relaxation, better sleep, cognitive behavioural therapy and gut-directed hypnotherapy help. Anxiety and low mood often sit alongside IBS, and treating them can ease bowel symptoms too.

IBS is not dangerous, but its symptoms overlap with conditions that are. See a doctor without delay if you have:

• Blood in your stool, or black, tarry stools
• Weight loss you did not plan
• Diarrhoea that wakes you from sleep
• A recent change in your bowel habits that does not settle
• A low haemoglobin count on a blood test
• Symptoms that began after age 50
• A close family history of colon cancer, coeliac disease or inflammatory bowel disease
• A lump or swelling in your abdomen

Also see a doctor if nothing improves after a few weeks of diet and lifestyle changes.

For sudden severe belly pain with a hard, tender abdomen, heavy rectal bleeding or fainting, get emergency help at once. In India, call 112, or 108 for an ambulance.

If constant worry about your symptoms is taking over your days, call Tele-MANAS on 14416 or 1800-891-4416, a free Government of India helpline open 24 hours.

IBS is common, long-term and not dangerous, but it can disrupt daily life. It is diagnosed from your symptom pattern, not a test. Diet, lifestyle and stress care come first; medicines need a doctor's or pharmacist's advice. See a doctor promptly for blood in your stool, unplanned weight loss, or a bowel-habit change that does not settle.