A GP’s Guide to IBS
What is Irritable Bowel Syndrome (IBS)?
The UK NICE guidelines defines IBS as “ a chronic, relapsing, and often debilitating disorder of gut-brain interaction”. It is commonly thought of as a disease of just the gut itself but as you can see from the definition it also involves another important organ; the brain.
What is the gut-brain axis?
To understand the complexities of IBS, you need to understand the gut-brain axis. Your gut is a highly innervated organ and therefore it can be impacted by many different stressors including psychological stress and physical stress such as infection. People with IBS will often find they have a flare of symptoms at times of stress.
What are the signs/symptoms of IBS?
IBS presents as one or more of the following symptoms on-going for more than 6 months:
Abdominal pain
Bloating
Change in bowel habit (constipation or diarrhoea)
How do you test for IBS?
Unfortunately there is not one test that tells you if you have IBS and it is often a diagnosis of exclusion (meaning we rule out other diseases before diagnosis). It is important to rule out other conditions such as coeliac disease, cancer and inflammatory bowel disease. Your GP will typically test for these on blood and stool samples. If there is a lot of uncertainty around the diagnosis you might be referred to the hospital for a colonoscopy (a camera test of the bowel) (1).
How do you manage IBS?
Once you have your diagnosis you can start exploring management options for IBS. The majority of people with IBS will have certain food triggers for their symptoms and a special diet called the low FODMAP diet is used for treating this. The low FODMAP diet was trialed by Monash University in Australia. They designed a low dairy, low gluten and low sugar diet as a temporary treatment for IBS followed by slow re-introduction of certain food groups once your symptoms are better managed. Ideally you would be referred to your local dietician to guide you through this process, however with pressure on NHS resources this is often not available. Fortunately Monash University has designed an easy to use app for your smart phone or device which guides you step by step (2).
The same university has come out with another treatment in recent years called Gut Directed cognitive behavioural therapy (CBT). Gut directed CBT is still a novel therapy and doesn’t yet appear on the national UK guidelines, however the data from the trials in Australia are very positive showing a 70-80% reduction in symptoms long-term. It would be worth trying if you are able to purchase their app which I have linked below (3).
What if diet and CBT isn’t enough for my symptoms?
Sometimes diet and gut-directed CBT won’t be quite enough and you may look to medication to help your symptoms. The type of medication you will be offered depends on the type of IBS that you have:
Pain predominant IBS
If pain and bloating are your main symptoms then you will be offered peppermint capsules and buscopan. These can be purchased over the counter.
Amitriptyline is another treatment for this type of IBS and targets the brain-gut axis. Unfortunately some patients do not tolerate this as it can make you drowsy and also lead to constipation.
Constipation predominant IBS
If constipation is your main symptom then you will be offered osmotic laxitives (laxitives that soften the stool). These include products such as lactulose or laxido.
Diarrhoea predominant IBS
Diarrhoea predominant IBS can be distressing for patients when they’re in social situations as they often have urgency to go to the toilet when symptoms come on. This can be managed with Immodium which is available over the counter. Occasionally your GP might suggest low dose codeine or amitriptyline (1).
What support is available for sufferers of IBS?
IBS symptoms can often be distressing and it is helpful to know that you are not alone. The charity The IBS Network provides a lot of resources for patients including a self-care programme that you can join to give you a deeper knowledge of the condition and make a personalised care plan (4).
References:
