Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is more common than any other gastrointestinal disease, and can be extremely distressing for those affected.

What are the symptoms of IBS?

IBS is characterised by abdominal cramping or pain accompanied by diarrhoea, constipation or a combination of both in an alternating pattern.

When diarrhoea is the predominant symptom (IBS-D), the sufferer needs to go to the toilet urgently and frequently (often at least three times per day), where loose, watery stools are passed.

On the other hand, when constipation predominates (IBS-C), bowel movements are passed infrequently (e.g. every second day), often only after much straining.

In some people, the constipation and diarrhoea patterns alternate (IBS-A).

Other gastrointestinal symptoms may include bloating, burping, flatulence, abdominal tenderness, louder than normal rumbling sounds from the intestinal tract, and the sensation that you have not completely emptied your bowels after you’ve been to the toilet.

Additional symptoms that may affect other parts of the body may include headaches, anxiety, bad breath and fatigue.

Often the symptoms appear fairly shortly after eating, and tend to be relieved when gas or a bowel movement is passed. They may be worse than usual during times of stress and/or during the premenstrual phase of a woman’s monthly cycle.

Most people with IBS are affected over an extended time, sometimes experiencing changes in their predominant symptoms or going through periods in which their symptoms are in remission.

People with IBS are more likely than others to also be affected by anxiety and other mood problems and/or conditions associated with chronic pain (including chronic fatigue syndrome and fibromyalgia). Many also experience disruptions to their work or social lives, which can be just as debilitating as the gastric symptoms.

What causes IBS?

During normal bowel function, the muscles of the intestines contract in a coordinated manner called peristalsis, gradually propelling the contents of the bowel towards the rectum, ready to be excreted. Along the way, nutrients and fluids are absorbed from the stool until only the wastes remain.

In IBS, peristalsis is disrupted, resulting in the characteristic abdominal pain and cramping, and causing the movement of the faecal matter to occur too quickly (resulting in frequent, watery or poorly formed stools) or too slowly (resulting in infrequent, dry, hard stools).

The reasons that this occurs are not completely understood.

However, it may be linked to abnormalities in gut levels of the neurotransmitter serotonin, which is best known for its role in helping to maintain stable moods and is also involved in maintaining normal intestinal movement.

In some people, the onset of IBS follows a gastrointestinal infection or bout of food poisoning (often accompanied by the use of antibiotics to address the infection), suggesting that disruption of the friendly bacteria (microflora) that inhabit the bowel may also be involved.

Dietary factors are also often implicated in IBS, with many sufferers experiencing food intolerances or finding their symptoms triggered or exacerbated after eating certain foods. Common culprits include wheat and other gluten-containing grains, dairy products, artificial sweeteners, caffeine, soft drinks, alcohol and fatty foods. However some researchers believe that the underlying issue is an inability to metabolise a group of sugars collectively known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols), which are found in a wide variety of foods, including wheat, rye, legumes, fruit and vegetables.

From the perspective of traditional Chinese medicine (TCM), IBS is commonly associated with congestion or stagnation in the Liver organ-meridian system, often accompanied by disruption of Spleen function.

In TCM, the Liver is considered responsible for the smooth movement of Qi (energy), Blood and body fluids throughout the body. It also governs aspects of nervous system function, including those involved in bodily functions over which we have no control, such as peristalsis and the movement of the bowel.

Disharmony of the Liver can therefore lead to constipation, diarrhoea or a combination of both, and may also have knock on effects for aspects of digestion governed by the Spleen organ-meridian system, leading to digestive problems such as diarrhoea, abdominal pain, nausea and burping.

How do I treat IBS?

Scientifically-researched herbal treatment for IBS

According to scientific studies, several different forms of herbal medicine may provide symptomatic relief for medically-diagnosed IBS.

When treating patients with symptoms characteristic of IBS, Chinese herbalists have long used a formula called Tong Xie Yao Fang, which contains the herbs Atractylodes, Peony, Citrus Peel and Fang Feng. These herbs are traditionally believed to work together to calm the Liver, improve the movement of Qi and relieve diarrhoea.

When taken together, research suggests that these herbs may benefit medically-diagnosed IBS-D by improving the texture and consistency of the stool and helping to relieve bloating, abdominal pain and mental stress.

Other research suggests that when taken for at least eight weeks, Turmeric – which has been used medicinally in both TCM and Ayurvedic medicine for thousands of years – may help to improve quality of life for people with medically-diagnosed IBS and reduce its prevalence.

For people with medically-diagnosed IBS-A, the Western herbal medicine Globe Artichoke may help to regulate bowel function and have antispasmodic effects on the digestive tract while also reducing other symptoms.

Probiotics support healthy bowel function

Taking a probiotic supplement helps to maintain healthy digestion and bowel function, and may help relieve flatulence and abdominal discomfort while also improving the consistency of bowel movements and the time it takes the faecal matter to travel through the bowel.

Probiotics may also help to restore proper bacterial balance to the intestines after infection and/or the use of antibiotics and certain other medications.

Diet and lifestyle recommendations for IBS

  • A low-FODMAP diet may help you manage your IBS symptoms and improve your quality of life, but needs to be implemented carefully in order to ensure that all your nutritional requirements are covered, so is best done under the guidance of your healthcare professional. Your healthcare professional can also help you identify any other foods that are triggering or aggravating your symptoms
  • Cut down on sweet, spicy and greasy foods, which from the perspective of TCM, may disturb the functioning of the Spleen and Stomach meridians and cause symptoms typical of IBS
  • Take steps to manage emotional distress, anxiety, frustration and irritability. Not only is IBS sometimes triggered or exacerbated by these and other forms of stress, but in TCM these emotions are believed to contribute to Liver Qi stagnation, and may further disrupt Spleen and Stomach function and cause Dryness in the Intestines, which in turn may result in constipation
  • Regular exercise alters serotonin levels, helps to maintain balanced moods, and aids regularity for those experiencing constipation, so aim to be active for at least half an hour on most days of the week
  • Maintaining adequate fluid intake helps keep the bowel moving in constipation and prevent dehydration when you’re experiencing diarrhoea, so aim to drink at least two litres of water per day

When should you see your doctor or other health professional about IBS?

  • The symptoms of IBS closely resemble those seen in some other gastrointestinal diseases, some of which are serious, so if you suspect you have the condition, it’s important to see your healthcare professional for an accurate diagnosis
  • Seek medical advice urgently if you observe blood or mucus in your faeces or on the toilet paper or if your stool looks as though it contains coffee grounds
  • Medical attention is also warranted for:
    • Diarrhoea that persists for more than 6 hours in infants under 6 months, 12 hours in children under 3 years, 24 hours in children aged 3-6 years or 48 hours in adults and children over 6 years
    • An uncontrollable need to defecate
    • Diarrhoea or abdominal pain that interferes with your sleep
    • Bowel problems associated with weight loss or fever
    • Symptoms of dehydration, such as excessive thirst and decreased urination
  • Experiencing diarrhoea episodes over a long period of time reduces your ability to absorb nutrients from your food and may put you at risk of nutritional deficiencies. Omitting certain food groups from your diet may also have detrimental effects on your nutritional status. If you’re concerned you may be affected, talk to your healthcare professional, who may recommend a multivitamin or other supplements to help offset your nutritional losses