Irritable bowel syndrome, London

What is Irritable bowel syndrome?

Irritable bowel syndrome or “IBS” is a common disorder of the gut characterised by bouts of abdominal pain, bloating and often a mixture of diarrhoea and constipation. On testing, there is no obvious abnormality in the gut such as inflammation, infection or tumour. It most commonly affects adults in their 20’s to 40’s and affects as many as 1 in 3 people in Europe and the US.

Irritable bowel syndrome is usually a diagnosis made by exclusion of any detectable abnormality in the gut and the term IBS tends to used a catch-all, despite people having a range of different symptoms and presentations. Conventional treatments are generally rather limited and it is no surprise that many people seek help and advice from complimentary medical practitioners.

In fact, although there is a lot of overlap, IBS can be broken down into a number of conditions with varying influences which, importantly, need very different treatment approaches. These are as follows:

1. Post-infective Irritable bowel syndrome.

This is one of the commonest forms, usually comprising a tendancy to loose stools and gas, coming on after an acute episode of gastroenteritis (eg travel diarrhoea or food poisoning). In most cases this resolves with time. Specific intolerances are common, especially milk (lactose intolerance). Treatment generally involves keeping the diet simple and non-stimulatory and reassurance that normality will return with time (usually weeks or months but can be years).

2. Constipation-predominantIrritable bowel syndrome.

This is also very common and in most people should be referred to as constipation rather than IBS. Constipation can mean many different things in different people including infrequent bowel actions, passage of hard stools and lack of an urge to go. There is often abdominal pain and particularly bloating and gas. The right treatment depends on determining the cause which can relate to slow transit through a colon, mechanical emptying problems, occasionally general health problems and issues with diet and lifestyle. An increase in fibre, particularly wheat, usually leads to more bloating rather than benefit and appropriate dietary advice in this group is very important.

3. Diarrhoea-predominant Irritable bowel syndrome.

This is perhaps the least well understood variant of IBS in which patients develop loose stools, often without pain but there may be gas and bloating, with no clear trigger. Diarrhoea is common after meals (giving a sense that food goes straight through) and “intestinal hurry” is quite a good description for the condition. There are many causes of diarrhoea predominant IBS , some unknown, but includes stress and anxiety, microscopic inflammation, changes in the bacterial flora and bile related diarrhoea. The role of bacteria is controversial but there is almost certainly a group of people, particularly with bloating as well as diarrhoea, who may have an overgrowth of bacteria in the small bowel and who may benefit from antibiotics and/or probiotics.

4. Mixed or “alternating” Irritable bowel syndrome.

In this group, patients tend to vary between diarrheoa and constipation – ie there is no fixed pattern. This group is perhaps the one in which stress and anxiety plays a bigger part in the cause. Whether this is because stress leads to altered diet and lifestyle (no time to look after yourself!) or a direct effect of the stress, for example on the nerves of the gut, is uncertain. The gut has more nerves than the brain so it is no surprise that stress and anxiety will have a profound impact (just think how most people are when they go for an interview). It is difficult to determine the factors contributing to symptoms in any particular person but it is important to treat each case individually as a different mix of factors is present in everyone. Whilst diet and lifestyle changes are important in most, addressing psychological issues formally may also be important, for example with cognitive behavioural therapy, psychotherapy and, in some cases, antidepressant drugs.


How do I get treatment?

To get further information or treatment, please contact one of our consultants at The London Bridge Digestion centre, on:

tel: +44 (0) 20 7403 3814