Irritable Bowel Syndrome
IBS is one of the most common gastrointestinal conditions, affecting 10-15% of the population. With proper diagnosis and personalised management, most patients achieve significant symptom improvement.
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Understanding IBS
Irritable Bowel Syndrome is a functional gastrointestinal disorder characterised by recurrent abdominal pain associated with changes in bowel habits. Unlike inflammatory bowel disease, IBS does not cause visible damage to the bowel or increase cancer risk.
IBS results from complex interactions between the gut and brain (the "gut-brain axis"), involving altered gut motility, visceral hypersensitivity, changes in gut microbiome, and psychological factors. Understanding these mechanisms guides effective treatment.
Common Symptoms
IBS Subtypes
IBS-D (Diarrhoea-predominant)
Characterised by frequent loose stools, urgency, and often morning diarrhoea. May be associated with anxiety.
IBS-C (Constipation-predominant)
Infrequent, hard stools with straining. Often associated with bloating and abdominal discomfort.
IBS-M (Mixed)
Alternating between diarrhoea and constipation. Symptoms may vary day to day or week to week.
IBS-U (Unclassified)
Meets IBS criteria but stool patterns don't fit clearly into other subtypes.
Common Triggers
Identifying and managing triggers is key to controlling IBS symptoms. Triggers vary between individuals.
Dietary
- FODMAPs (fermentable carbohydrates)
- Fatty or fried foods
- Caffeine and alcohol
- Artificial sweeteners
- Large meals
Lifestyle
- Psychological stress
- Anxiety and depression
- Poor sleep
- Lack of exercise
- Irregular eating patterns
Other
- Hormonal changes (menstruation)
- Post-infectious (gastroenteritis)
- Antibiotic use
- Food intolerances
- Small intestinal bacterial overgrowth
Alarm Symptoms
These symptoms are NOT typical of IBS and require investigation to exclude other conditions.
Rectal Bleeding
Blood in stool is not a feature of IBS and requires investigation.
Unexplained Weight Loss
Significant unintentional weight loss needs further evaluation.
Onset After Age 45
New symptoms in older adults warrant colonoscopy.
Nocturnal Symptoms
Symptoms waking you from sleep suggest organic disease.
Diagnosis
IBS is diagnosed based on symptom criteria (Rome IV) after excluding other conditions. Testing may be needed to rule out alternative diagnoses.
When Colonoscopy is Needed
Colonoscopy may be recommended to exclude inflammatory bowel disease, microscopic colitis, or colorectal cancer.
- Presence of alarm symptoms
- Age over 50 without prior screening
- Family history of colorectal cancer or IBD
- Symptoms not responding to treatment
Other Tests
Blood Tests
Full blood count, inflammatory markers, coeliac serology, thyroid function.
Stool Tests
Calprotectin (to exclude IBD), stool cultures, ova and parasites.
Breath Tests
Hydrogen breath tests for lactose intolerance or SIBO (small intestinal bacterial overgrowth).
Food Intolerance Testing
Structured elimination diets may identify specific triggers.
Treatment Approach
IBS management is highly individualised, combining dietary changes, lifestyle modifications, and targeted medications based on predominant symptoms.
Dietary Management
- Low FODMAP diet (guided by dietitian)
- Identify and avoid personal triggers
- Regular meal patterns
- Adequate fibre intake (adjusted to tolerance)
- Limit caffeine and alcohol
- Probiotics (strain-specific)
Medications
For Pain/Spasm
Antispasmodics (mebeverine, hyoscine), peppermint oil capsules.
For IBS-D
Loperamide, bile acid binders, rifaximin (for bloating/SIBO).
For IBS-C
Osmotic laxatives, linaclotide, prucalopride.
Neuromodulators
Low-dose tricyclic antidepressants or SSRIs for pain modulation and gut-brain axis.
Psychological Therapies
CBT, gut-directed hypnotherapy, mindfulness - evidence-based for IBS.
Take Control of Your IBS
Living with IBS doesn't have to mean constant discomfort. Dr. Prem provides comprehensive evaluation and personalised treatment plans to help you regain control and improve your quality of life.
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