What is IBS?
Irritable bowel syndrome (IBS) is a medical condition consisting of a wide range of gut symptoms including bloating, diarrhoea, constipation, gas, tummy pain, cramps and spasms.
You might get all or just some of these, and your symptoms may come and go. But it’s often a lifelong condition with personal triggers that you’ll need to get to know in order to manage it.
IBS can be painful, feel embarrassing if your symptoms flare up at times you’d rather they didn’t, can affect your sleep, and lead to you feeling anxious and fatigued. If it goes untreated or carries on for a long time with a lot of flare-ups, it can mean you may need time off work, or end up avoiding social or stressful situations.
It’s a very common condition, affecting around 1 in 10 to 1 in 20 people. Experts believe the true figure may be even higher as some people don’t see a doctor about their symptoms. But with self-care, lifestyle changes and treatments to ease your symptoms – and knowledge of what to ask a doctor – you can learn to deal with it and get on with your life.
Here’s what you need to know about spotting IBS symptoms, getting a diagnosis and effective treatments, including psychological support.
What are the symptoms of IBS?
IBS symptoms include a range of gut issues. You might find you get 1 of the following symptoms more than others:
- stomach pain or cramps (usually worse after eating and relieved when you poo)
Other symptoms of IBS
- farting (flatulence)
- back ache
- feeling tired and having no energy (fatigue)
- feeling sick (nausea)
- passing mucus from your bottom
- sudden urges to poo that you can’t control (bowel incontinence)
- needing to poo urgently
- straining or finding it difficult to poo
- urinary symptoms like needing to pee urgently or while sleeping at night
The different types of IBS
There are 4 different types of IBS, based on the kind of symptoms you have:
- IBS-C: constipation is the symptom you get the most
- IBS-D: diarrhoea is your most common symptom
- IBS-M: a mixture of diarrhoea and constipation
- IBS-U: unspecified (your symptoms are varied)
What causes IBS?
The exact cause of IBS is still unknown, but it’s likely to be a mix of your family history (genetics) and environmental factors.
8 triggers and risk factors for IBS
Being female: Women with IBS usually outnumber men 2 to 1.
Being in your 20s: IBS can start at any age, but the most common time to have it is between your 20s and 30s.
Certain foods and drinks: 9 out of 10 people with IBS say particular foods and drinks can make their symptoms flare up.
Genetics: People with a parent or sibling with IBS have an almost 3-fold increase of getting IBS. Scientists think some people inherit genes that make it more likely, but they still haven’t identified which ones.
Infections: Having any stomach infections, including a bad tummy bug (gastroenteritis) or food poisoning with bacteria such as salmonella, shigella and campylobacter, can put you at risk of developing IBS afterwards. Food poisoning usually causes short-term symptoms that clear up, but if they don’t fully go away or they keep coming back, it could be a sign of post-infectious IBS or another condition, so see a doctor if you’re not sure.
Stress, anxiety and depression: If you’ve ever felt stomach-churning symptoms in stressful situations such as job interviews, exams, first dates or emotional shocks, you know there’s a big connection between your gut and your emotions.
Your gut has its own nervous system (the enteric nervous system) that the brain communicates with via the brain/gut axis. This is a two-way communication channel linking the emotional and cognitive centres of your brain with your gut functions. So, if your emotional health needs some TLC, chances are you’ll feel it in your gut too.
Certain medicines such as antibiotics: The balance of bacteria in your gut can be disrupted by antibiotics. They not only wipe out the bugs that cause infections but also the ‘good’ bacteria that help to protect your gut. Research suggests that antibiotics may trigger IBS and it’s thought that this disruption of bacteria could be the reason. Some IBS symptoms are similar to common side effects of antibiotics, but they should usually go away after you’ve finished the course. If they don’t clear up, see a doctor to find out if there could be another cause.
How does IBS affect my body?
There’s still a lot of research needed to find out exactly how IBS affects your body when it’s triggered by risk factors like the ones above. Some theories include that IBS is caused by or associated with:
- increased pain sensitivity in your internal organs, such as your intestines (known medically as visceral sensitivity)
- changes in your gut microbiome (the trillions of bacteria, viruses and fungi that live in your gut and play a very important role in your health, including helping digestion)
- abnormalities in your autonomic nervous system – this system controls your digestive system, as well as your breathing, heart rate, sensation and body temperature
- faulty processing of pain signals in your gut
- slow or fast movement of food through your digestive system (also known as gut motility)
What to do next
If you’re having symptoms and you’re not sure if you should see a doctor, using the Healthily Smart Symptom Checker can help you work out if you need to see a doctor or if self-care is best.
If you suspect your gut symptoms are IBS, it’s best to book an appointment with a doctor, but in somes cases, medicines and remedies you can buy from a pharmacy may help relieve your symptoms.
Pharmacy and doctor-prescribed IBS treatments
IBS remedies can be bought from pharmacies and supermarkets to ease a flare-up of your symptoms including constipation, diarrhoea, bloating and wind.
Your doctor may also recommend some of them if diet and lifestyle advice hasn’t worked for you, and they have other medicines that may help that are available on prescription only.
IBS medicines and remedies
- laxatives: there are different types of laxatives that can help relieve constipation
- antispasmodics (muscle relaxants): these include peppermint oil and mebeverine, which relieve muscle spasms and tummy cramps. Hyoscine butylbromide also relieves cramps and is available from pharmacies and supermarkets
- anti-diarrhoea treatments: these are medicines that slow down how fast food travels through your gut, allowing your poo to harden and become more solid. Popular medicines include loperamide. Read more about these in our in-depth article on diarrhoea
- anti-wind medicines: simeticone is a type of medicine that can help relieve trapped wind and bloating. It works by causing the small gas bubbles in your gut to form bigger bubbles, which then allows this trapped air to get out of your body more easily. When combined in a tablet with loperamide, it prevents farting. Read more about how to get rid of trapped wind and how to stop flatulence
Other medicines your doctor can prescribe
- Low-dose tricyclic antidepressants: These antidepressants, such as amitriptyline, can help relieve pain if you have IBS – your doctor can prescribe a low dose on a trial basis to see if they help you. If tricyclics can’t be used, your doctor may prescribe a different type of antidepressant such as citalopram. Both of these are ‘off-label’ when used for IBS, but they’re recommended in national guidelines for IBS.
- Linaclotide: If you’ve had severe constipation lasting more than 12 months, you can be prescribed a course of linaclotide, which works by increasing the amount of fluid in your intestines to ease the passage of poo.
Amitriptyline is not recommended if you are pregnant unless your doctor feels that the benefits clearly outweigh the risks. There is evidence that amitriptyline may pose a small risk of harm to your baby. If you are planning to become pregnant or find out that you are pregnant whilst taking this medication, speak to your doctor and midwife as soon as possible.
Red flag symptoms
- you’ve lost weight without meaning to
- you’re bleeding from your bottom or there’s blood in your poo
- if you’re over 60 and you’ve noticed a change in your bowel habits such as looser poo and/or more frequent pooing, lasting for more than 6 weeks
If you have IBS symptoms and a family history of bowel or ovarian cancer, this may mean you’re at higher risk of these cancers, so see a doctor.
How is IBS diagnosed?
Unfortunately, there’s no single test for diagnosing IBS.
A doctor will usually start your appointment by asking about your symptoms, including how they’re affecting your daily life. They’ll also want to know what your diet is, how active you are and if you’ve had any recent stress or episodes of depression.
They’ll examine your tummy checking for any tenderness and lumps. They may also do a rectal exam, where they insert a gloved finger inside your bottom to check for any abnormalities.
Tummy pain, bloating or a change in your bowel habits for at least 6 months can lead to a diagnosis of IBS. A doctor will usually be able to diagnose IBS if you have tummy pain which is associated with the following:
- the tummy pain happens around the time you poo
- an increase or decrease in how many times you poo
- changes in the form or appearance of your poo (for example, it’s hard, lumpy or watery)
And if you also have at least 2 of the following symptoms:
- straining, urgency or not being able to pass all of the poo out of your bottom
- a bloated tummy which sticks out or is hard to the touch
- your symptoms get worse after eating
- passing mucus from your bottom
You may need to do some tests, including:
- blood tests to check for conditions such as anaemia and markers for inflammation in your body (such as C-reactive protein)
- poo tests to look for traces of blood and check for other conditions like IBD
- blood tests to rule out other conditions that cause IBS-like symptoms like coeliac disease. Read more about these conditions in the section, ‘What else could it be?’
IBS treatment and relief
If you’re diagnosed with IBS, then your doctor may be able to classify it as one of the 4 types of IBS and, as a starting point, they’ll give you diet and lifestyle advice that will help control your symptoms.
8 IBS self-care tips
- Eat 3 regular meals a day and don’t skip meals or eat heavy meals late at night.
- Don’t drink more than 2 units of alcohol a day and have 2 alcohol-free days a week.
- Drink 8 cups of fluid a day (ideally water or decaffeinated teas or coffees).
- If you’re constipated, try self-care measures like going to the toilet whenever you need to and eating and going to the toilet at regular times. You could even try resting your feet on a low stool when you got to the toilet, as this could make it easier to poo. Ideally, your knees need to be raised above your hips. Read more about natural ways to relieve constipation and when to worry about constipation.
- Consider a 4-week trial of probiotic supplements to see if they benefit your symptoms. Probiotics are ‘friendly’ live bacteria and studies suggest they may help relieve IBS symptoms like bloating. Read more about how probiotics can help.
- Deal with your stress and learn some relaxation techniques, as stress is a risk factor for developing IBS. One breathing technique that may help calm your digestive system is called belly breathing, or diaphragmatic breathing. You naturally breathe like this when you’re asleep, digesting food or when you’re very relaxed. It helps you tap into the part of your nervous system, which, among other things, keeps digestion smooth and helps you ‘rest and digest’. Read more about techniques to deal with stress and watch this Youtube video to learn how to do belly breathing.
- Take regular exercise – aim for at least 30 minutes of moderate-intensity exercise a day. The theory is that exercise reduces gas retention in your intestine, and it also speeds up gut transit time (how long it takes for food to move from your mouth to your bottom) in people with constipation. Regular exercise is also good for reducing stress and boosting your mental health. Read more about how to make exercise a daily habit.
- If you’re overweight, try to lose weight, as being obese is associated with worse IBS symptoms. If you’re very overweight, get advice from a doctor on how to lose weight and exercise safely.
IBS and food
The Healthily Self-Care App can be customised so you can track your symptoms. Tracking can help you identify any trigger foods, and you can keep a food diary – important information to share with your doctor.
- Drink to avoid constipation and bloating. Drink less caffeine, alcohol, fizzy drinks and gas-producing foods. Read more about why you may feel bloated after eating.
- Eat less fibre. If you get diarrhoea, cut back on insoluble fibre found in wholemeal and high-fibre flours, cereals high in bran and wholegrains such as brown rice. Eat fruits with less fructose too, as high-fructose fruits can make it more likely you’ll get diarrhoea. You could also try the low FODMAP diet, which recommends low-fructose alternatives like pineapple, strawberries and bananas. Read more about what to eat when you have diarrhoea and how to stop diarrhoea quickly.
- Eat more foods high in soluble fibre. If constipation is a problem, add soluble fibre such as oats or linseeds to your diet. Try adding a tablespoon of golden or brown linseeds to your cereal, yoghurt or soup, with 150ml of water. You can also fix constipation with a soluble fibre supplement (try ispaghula). Try increasing fibre gradually to minimise bloating and farting. And be patient as it can take several weeks before your symptoms improve. Read more about the best foods to eat when you're constipated.
- Don’t go heavy on fatty foods – avoid foods like chips, pies, butter, cheese, pizzas, creamy sauces and crisps. Studies have shown that eating fatty foods may be a trigger for IBS in some people, possibly because they may slow down the passage of gases in your bowel leading to bloating, or trigger the need to poo in some people.
- Eat less processed food and cook meals from scratch. Processed foods tend to have a lower fibre and higher fat content, so are more likely to cause constipation, trapped wind and bloating.
- Avoid sugar-free/zero-calorie sweets, mints, gum and drinks containing the artificial sweeteners sorbitol, xylitol and mannitol, if diarrhoea is your main symptom. They contain FODMAPs (sugars) which ferment in your bowel causing diarrhoea, bloating and gas.
- Limit caffeinated drinks such as tea and coffee to 3 cups a day if you have IBS-D. Caffeine can stimulate your colon and have a laxative effect, which may worsen diarrhoea and pain.
Find out more about the low FODMAPs diet
Some foods containing short-chain carbohydrates (sugars) such as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) can trigger symptoms in people with IBS. This is because FODMAPs are poorly absorbed in your small intestine, so they spend longer in your gut, attracting water and being fermented by bacteria. This stretches a sensitive bowel, causing bloating, a swollen tummy, wind and diarrhoea. In people with IBS, it’s the process of drawing water into the bowel and the fermentation of bacteria that causes symptoms.
Foods containing FODMAPs include:
- stone fruits
- artificial sweeteners
If you suspect FODMAPs are causing your symptoms, speak to a doctor. They can sometimes refer you to a dietitian who can advise you about a 6- to 8-week medically-supervised exclusion diet, such as the low FODMAPs diet.
In this diet, FODMAP foods are reduced and then certain foods are gradually reintroduced to try and identify triggers. If you find the diet is helpful and are able to identify which foods worsen your IBS symptoms, you can continue to exclude these from your diet.
Complementary and psychological therapies for IBS
The following are not recommended by The National Institute for Health and Care Excellence (NICE) for IBS specifically, but are used in some parts of the NHS in specific circumstances by gut specialists (gastroenterologists).
Cognitive behavioural therapy (CBT): This talking therapy has been proven to be an effective treatment for IBS.
Gut-directed hypnotherapy: This is a specific type of hypnotherapy designed to help you control your gut. The theory is it works on your gut/brain axis. It uses hypnotic techniques to get you into a deeply relaxed state and then the hypnotherapist uses suggestions and metaphors to influence your subconscious. For example, repetitive suggestions may include: ‘There will be no more pain or bloating and no more discomfort’, or a metaphor such as: ‘The warmth of your hands represents calm and control when they’re placed on your tummy’.
The technique has been used widely, including within the NHS. A review of 7 trials conducted on its use concluded it was an effective and durable treatment but more research is needed, particularly as to whether it should be used on its own or in combination with other treatments.
A study by the University of Monash found gut-directed hypnotherapy was as effective as a low FODMAP diet in reducing IBS symptoms. However, you will need to find a hypnotherapist trained in this technique. Find a list of therapists at the National Council of Hypnotherapists.
- Biofeedback: This is a method of conditioning your mind as well as your body to regulate your body’s functions. It’s a non-invasive therapy which uses computer-generated electrical signals, is used in many hospitals and is free of side effects.
It’s used to treat incontinence (the inability to hold gas or poo in your bottom) and certain types of constipation – you learn to strengthen and regain control of your anal sphincter muscle, which controls passing poo.
However, a high-grade review of studies found there isn’t enough evidence to recommend biofeedback in IBS, although the reviewers concluded that given the positive results in small studies, it deserves further study.
Watch this space
Lots of supplements are marketed for IBS, but few have a strong evidence base.
Curcumin (found in turmeric) was found in 1 review of studies to be associated with an improvement in symptoms, pain and quality of life, and was also safe and well-tolerated. But the effects were not much more than when taking a dummy pill (placebo). Even so, the researchers said further studies should be encouraged.
What if nothing works?
If dietary and lifestyle changes and medication aren’t working, or your symptoms are seriously affecting you, your doctor may decide to refer you to a gut specialist (gastroenterologist) for further tests and investigations, or to a dietitian for more detailed advice about food triggers and medically-supervised exclusion diets.
What else could it be?
Other conditions that produce IBS-type symptoms include:
- Indigestion – this pain or discomfort in the upper part of your tummy usually comes on soon after eating or drinking something that doesn’t agree with you, and can include other symptoms like heartburn, bloating and nausea.
- Coeliac disease – an autoimmune condition that causes symptoms like diarrhoea, constipation, excessive wind and bloating, plus anaemia or tiredness. Learn more about the causes, symptoms and treatment of coeliac disease.
- Lactose intolerance – with this common condition, your body struggles to fully digest lactose, a type of sugar mainly found in milk and dairy products, which causes symptoms like farting and diarrhoea.
- IBD – there are 2 main types of IBD, Crohn’s disease and ulcerative colitis. They’re both long-term diseases that cause inflammation in the gut and IBS-like symptoms. Read more about the causes, symptoms and treatment options for Crohn’s disease and ulcerative colitis.
- Bile acid diarrhoea – if you have watery diarrhoea, you may have this condition (also known as bile acid malabsorption), which causes watery and smelly poo, cramps, bloating and farting. It’s a type of long-term diarrhoea caused by bile salts not being produced or recycled properly by your liver. Sometimes it’s caused by another gut condition like coeliac disease, but other times no specific cause is found. It usually responds well to medication and diet changes.
- Small intestinal bacterial overgrowth (SIBO) – the medical term for when there’s an overgrowth of bacteria in your small intestine, which then ferments and produces gases. It can follow bowel surgery, be due to abnormal bowel contractions or be a side effect of the long-term use of medicines called proton pump inhibitors (PPIs). It can be treated with antibiotics, although it may come back again.
- Bowel cancer – also known as colorectal cancer, this cancer can cause diarrhoea, constipation, a change in your bowel habits, plus bleeding from your bottom, weight loss, anaemia and tummy pain. 40,000 new cases are diagnosed every year in the UK, many through screening programmes. Read more about bowel cancer’s symptoms, causes and treatment.
Complications of IBS
IBS can lead to a number of complications. These include:
haemorrhoids (piles) – these swellings inside or outside your bottom are caused by straining to poo when you have constipation or long-term (chronic) diarrhoea. In mild cases, they can be treated with remedies from a pharmacy. Ask your pharmacist about creams and cold packs to ease the pain and treatments for constipation and diarrhoea
poor quality of life – people with severe IBS say they have a poor quality of life and have to take more time off work
Where to find out more about IBS
read the NHS leaflet, Irritable bowel syndrome
contact the charity Guts UK for support
join the IBS Network charity for information on self-management
check out this fact sheet from the British Dietetic Association
use the Healthily app to track your symptoms to see if they’re improving or getting worse
Your health questions answered
Is IBS a disability?
Under the UK’s Equality Act 2010, if your IBS affects your ability to do your job on a daily basis, it may be deemed to amount to a disability. The IBS Network charity says this means your employer has a duty to make reasonable adjustments to accommodate you at work.