Overview

Irritable bowel syndrome (IBS) is a common long-term gut condition that causes belly pain together with diarrhea, constipation, or both. It is a disorder of gut-brain interaction: the bowel looks normal on tests, but it is more sensitive and moves differently.

IBS does not damage the bowel and does not lead to cancer. Symptoms often come and go, and a mix of diet changes, daily habits and treatment helps most people keep them under control.

Symptoms

• Belly pain or cramps that often ease or change after a bowel movement
• Bloating, gas and a swollen feeling in the belly
• Diarrhea, constipation, or switching between the two
• Mucus in the stool
• A feeling that the bowel has not fully emptied
• Warning signs that need further tests: blood in stool, weight loss without trying, symptoms that wake a person at night, fever, anemia, or symptoms starting after age 50

Causes & Risk Factors

• Oversensitive gut nerves and changes in how the gut moves
• Changes in gut-brain signaling, often made worse by stress and anxiety
• A previous bout of gastroenteritis or food poisoning (post-infection IBS)
• Changes in the balance of gut bacteria
• Certain foods high in fermentable sugars (FODMAPs), such as onions, garlic, beans, wheat and some fruits
• Being female and younger than 50
• Poor sleep, irregular meals and low physical activity

Complications

• Lower quality of life and missed work or study
• Anxiety and low mood linked with ongoing symptoms
• Hemorrhoids or anal fissures from constipation or frequent diarrhea
• Poor nutrition from very strict diets followed without guidance
• IBS itself does not cause bowel inflammation, bowel damage or cancer

Diagnosis

Doctors diagnose IBS from the symptom pattern using the Rome IV criteria: belly pain on at least 1 day a week, on average, over the last 3 months, linked to at least two of these: bowel movements, a change in stool frequency, or a change in stool form. Symptoms should have started at least 6 months before diagnosis. Basic tests usually include a blood count and a blood test for celiac disease, and for diarrhea a fecal calprotectin or CRP test to rule out inflammatory bowel disease. Colonoscopy or other tests are arranged when warning signs are present.

Treatment

• Regular meals, enough water and regular exercise
• Soluble fiber such as psyllium, especially for constipation
• A low-FODMAP diet in 3 steps: cut back for 2 to 6 weeks, reintroduce foods one by one, then personalize, ideally with a dietitian
• Antispasmodic medicines or peppermint oil capsules for cramps
• Medicines for constipation or diarrhea, based on the IBS type
• Low-dose gut-brain medicines (neuromodulators) for ongoing pain
• Gut-directed psychological therapy, such as cognitive behavioral therapy or hypnotherapy

Prevention

• Keep a food and symptom diary to find personal triggers
• Eat slowly and at regular times, and avoid large, late or very fatty meals
• Limit fizzy drinks, caffeine and chewing gum if they worsen bloating
• Manage stress with walking, good sleep and relaxation
• In Ramadan, break the fast with a light meal and spread fiber and water between iftar and suhoor
• Avoid starting strict diets without medical advice

The Internal Medicine department at AlHayat Medical Center diagnoses and manages IBS and arranges further tests when needed.

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