Irritable bowel syndrome (IBS) – how to manage it

Spot IBS symptoms and find solutions to ease them with our guide and lifestyle tips.

What are the symptoms of IBS?

What causes it?

When to see a doctor

How is IBS diagnosed?

What’s the treatment?

Watch this video to find out what Caroline's IBS symptoms are, how she deals with flare ups and the IBS trigger foods she avoids.

My IBS symptoms and how I got them under control

IBS can be painful, feel embarrassing if your symptoms flare up at times you’d rather they didn’t, can and lead to you feeling anxious and fatigued. But with self-care, lifestyle changes and treatments to ease your symptoms, you can learn to deal with it and take back control of your life.

Irritable bowel syndrome (IBS) is a medical condition consisting of a wide range of gut symptoms including bloating, diarrhea, constipation, cramps and spasms. 

You might get many of just a few symptoms, which may come and go, and can last for months or weeks at a time. IBS is often a lifelong condition with personal triggers that you’ll need to get to know to manage it. 

IBS is common and thought to affect up to 20% of adults worldwide. Experts believe the true figure may be higher as some people don’t see a doctor about their symptoms. 

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: 

- [diarrhea](https://www.livehealthily.com/health-library/symptoms/diarrhoea)
- [constipation](https://www.livehealthily.com/health-library/conditions/constipation)
- [stomach pain or stomach cramps](https://www.livehealthily.com/health-library/symptoms/how-do-i-know-my-stomach-pain-is-serious) (usually worse after eating and relieved when you poop)
- [bloating.](https://www.livehealthily.com/health-library/symptoms/what-causes-bloating-in-your-stomach)

Other symptoms include: 

- farting ([flatulence](https://www.livehealthily.com/health-library/symptoms/flatulence))
- backache
- feeling tired and having no energy (fatigue)
- feeling sick ([nausea](https://www.livehealthily.com/health-library/symptoms/feeling-sick-nausea))
- passing mucus from your bottom
- sudden urges to poop that you can’t control ([bowel incontinence](https://www.livehealthily.com/health-library/conditions/incontinence-bowel)) 
- urinary symptoms like needing to pee urgently or while sleeping at night.


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## What causes it?

The exact cause of IBS is still unknown, but a mix of different factors could contribute to symptoms, including: 

- __how your brain and gut work together__  – in people with IBS, food can move too slowly or quickly through the digestive tract, causing changes in bowel habits 
- __your genes__ – people with a parent or sibling with IBS are almost 3 times as likely to develop IBS. Scientists think some people inherit genes that increase risk of the condition, but they still haven’t identified which ones 
- __certain foods and drinks__ – 9 out of 10 people with IBS say particular foods and drinks can make their symptoms flare up 
- __infections__ – gastric infections including a bad tummy bug ([gastroenteritis](https://www.livehealthily.com/gut-infection/gastroenteritis)) or food poisoning with bacteria such as salmonella, shigella and campylobacter can put you at risk of developing IBS 
- __stress, anxiety and depression__ – they can cause IBS symptoms as the emotional and cognitive centers of your brain are linked with your gut function
- __inflammation__ – If you have a more serious condition like [inflammatory bowel disease](https://www.livehealthily.com/inflammatory-bowel-disease) (IBD), you're more likely to develop IBS. 


## When to see a doctor

If you’re having symptoms of IBS, it’s best to see a doctor so they can check the cause and rule out other conditions. 

You should seek urgent medical attention if you:

- have lost weight without meaning to
- are bleeding from your bottom or notice blood in diarrhea
- have a swollen stomach or a hard lump there 
- are short of breath, have a fast-beating or pounding heart (palpitations), and pale skin. 


## How is IBS diagnosed?

Unfortunately, there’s no single test for diagnosing IBS. A doctor will usually ask about your symptoms, including how long you’ve had them and how they affect your daily life. 

They’ll also want to know how often you get symptoms and if there’s anything obvious that’s triggering them, for example certain foods. So it can help to keep a symptom diary for a few weeks beforehand that you can share with your doctor. 

You may also have a physical exam to check your stomach for tenderness and lumps.

Further tests might be needed to check for other potential causes of your symptoms, such as a blood test (which can indicate [Coeliac disease](https://www.livehealthily.com/health-library/conditions/coeliac-disease)) or stool test (to look for signs of infection and inflammatory bowel disease (IBD). 


## What’s the treatment?

If you’re diagnosed with IBS, your doctor can give you diet and lifestyle advice that will help control your symptoms, including:

- __getting into the habit of eating and going to the toilet at regular times to help constipation__ – you could even try resting your feet on a low stool when you go to the toilet, as this could make it easier to poop. Ideally, your knees need to be raised above your hips. [Read more about natural ways to relieve constipation](https://www.livehealthily.com/health-library/conditions/constipation#self-care-for-constipation-relief)
- __considering 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 
- __managing stress and learning some [relaxation techniques](https://www.livehealthily.com/mind/8-ways-to-quickly-relieve-stress)__ as stress is an IBS trigger
- __getting regular exercise__ – aim for at least 30 minutes of moderate-intensity exercise a day. Exercise may help reduce gas retention plus help food move through your digestive system, and help limit stress 
- __losing weight if you need to__ – being [obese](https://www.livehealthily.com/losing-weight/obesity) is associated with worse IBS symptoms. If you’re very overweight, get advice from a doctor about how to lose weight and exercise safely 
- __finding out about the low FODMAP diet__ – this involves removing foods from your diet that the gut can’t break down easily, including certain fruit and vegetables, milk and wheat products – ask your healthcare professional for advice.

### IBS and your diet

These tips may help ease your symptoms:

- __drink right to avoid constipation and bloating__ – reduce your intake of caffeine, alcohol and fizzy drinks
- __eat more foods high in soluble fiber__ – if constipation is a problem. Try adding oats and linseeds to your diet
- __don’t go heavy on fatty foods__ – avoid food such as chips, pies, butter, cheese, pizzas, creamy sauces and crisps
- __eat less processed food and cook meals from scratch__ – they have a lower fiber and higher fat content, so are more likely to cause constipation, trapped wind, and bloating
- __cut down on insoluble fiber__ – if you get diarrhea. This fiber type is found in wholemeal and high-fiber flours, cereal high in bran and whole grains such as brown rice
- __avoid sugar-free/zero-calorie sweets, mints, gum,__ and drinks containing the artificial sweeteners sorbitol, xylitol, and mannitol, if diarrhea is your main symptom. They contain FODMAPs (sugars) which ferment in your bowel causing diarrhea, bloating, and gas
- __limit caffeinated drinks such as tea and coffee to 3 cups a day.__ Caffeine can stimulate your colon and have a laxative effect, which may worsen pain and diarrhea. 

### Pharmacy and doctor-prescribed IBS treatments

IBS remedies can help ease a flare-up of your symptoms including constipation, diarrhea, bloating, and wind. 

These include laxatives for constipation; anticholinergics (also called antispasmodics) to relieve muscle spasms and tummy cramps; and anti-diarrhea treatments to slow food traveling through your gut. Ask a healthcare professional for advice on what best suits your symptoms.

Your doctor may also prescribe drug treatments if diet and lifestyle advice hasn’t worked for you, such as low-dose tricyclic antidepressants that can help relieve IBS pain. If tricyclics can’t be used, your doctor may prescribe a different type of antidepressant. 

### What if nothing works?

If dietary and lifestyle changes or medication aren’t working, or your symptoms are seriously affecting you, your doctor may refer you to a gut specialist for further tests. Or you may be referred to a dietitian for more detailed advice about food triggers and medically supervised exclusion diets. 


 ## Where to find out more about IBS

Find support and resources here:

- [the International Foundation for Gastrointestinal Disorders (IFFGD)](https://aboutibs.org/)
- join the [IBS Network charity](http://www.theibsnetwork.org) for information on self-management.


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References

Jo Waters

Jo Wheatley

Carla Hüsselmann

Dr Tamer T Malak

Dr Adiele Hoffman

Dr Ann Nainan

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