Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a functional disorder of the digestive system.

It means that there is a problem caused by changes in the functioning of the intestine.
People with a functional disorder have unpleasant symptoms, but the organs of the digestive tract are not damaged.
IBS is not a disease, but rather a group of symptoms that occur together.

Irritable bowel syndrome has significant negative effects on health and quality of life, yet only 30% of people with IBS see a doctor.

Irritable bowel syndrome affects twice as many women as men.

There are different subtypes of IBS.

  1. IBS-D: primarily diarrhoea
  2. IBS-O or RDS-C: primarily constipation
  3. IBS-A or RDS-M: constipation and diarrhea alternate
  4. IBS-PI: post-infectious IBS

Irritable bowel syndrome mainly affects the colon (large intestine, part of the colon).
The main function of the colon is the absorption of water and nutrients from the partially digested food.
Everything that is not absorbed is slowly pushed through the intestine to the rectum (rectum) and excreted by the body as feces.
The intestinal muscles work with contractions and relaxation to rid themselves of the waste products of the body and push the undigested food through the colon.
These muscles must work together with other muscles in the body to squeeze excretion from the anus.
If the muscles of the colon do not function in a timely manner during digestion or if the coordination between the muscles of the rectum and the pelvis is interrupted in any way, the contents of the colon cannot be moved quickly.
If this is the case, the person may experience abdominal cramps, flatulence, constipation and diarrhoea, which may be signs of irritable bowel syndrome.

Many young people suffer from IBS. It is estimated that between 6% and 14% of all adolescents have IBS and it appears to affect more young women than young men.
The good news is that irritable bowel syndrome, while it can be annoying, embarrassing, and really painful, is not a fatal condition.


Causes of irritable bowel syndrome

The exact cause of irritable bowel syndrome is not known.
Specialists believe that there are problems in the communication between the brain and the gastrointestinal tract that cause this condition.
A complex combination of factors, including psychological stress, hormones, the immune system, and some chemicals called neurotransmitters, appear to interfere with the signals that run from the brain to the gut.
The poor communication leads to abnormal muscle contractions or spasms, which often cause pain and cramping. Spasms can speed up the passage of the stool (thus causing diarrhea) or slow it down, thus leading to constipation or bloating.

People with IBS have a very sensitive gut.
It is not known why the gut reacts so strongly to the elements that cause these syndromes. People with IBS may start with symptoms caused by one or more of the following factors:

  • Meals (even if no specific foods are related to IBS).
  • Stress can affect bowel movements and the way a person feels pain (stress can also have the same effect on a person who does not have IBS).
  • Trapped intestinal gases that provoke flatulence.
  • Hormonal changes, such as in the menstrual cycle.
  • Some medications such as antibiotics.
  • Genetic factors. IBS is more likely to affect people who have a family member who already has this condition.

How does stress affect irritable bowel syndrome?

Stress can stimulate the spasms (sudden and unwanted contractions of a muscle) of the colon in a person with IBS.
The colon has many nerves that connect it to the brain. These nerves control normal colon contractions.
In people with IBS, the colon can be extremely sensitive to stressful situations.
The symptoms of IBS can also increase stress levels in a person.

Some options for stress management include:

  • Participation in a therapy for stress reduction and relaxation, such as meditation,
  • seek advice and support,
  • perform a regular physical exercise program with walking and yoga,
  • avoid stressful life situations as much as possible,
  • Get enough sleep.

What are the symptoms of irritable bowel syndrome?

Pain and discomfort can occur in different areas of the abdomen. As a rule, the complaints come and go. The length of each pain attack can vary significantly. The pain often subsides after bowel movements and air outlets.
Many people with IBS describe the pain as a spasm or colic.

The severity of pain can vary from mild to highly individual and depends on the time of day or situations.
Over time, bloating may develop.
More air and intestinal gases can escape than usual.


  • Some people only have attacks of diarrhea, while others only suffer from constipation.
  • Some patients have attacks of diarrhea, alternating with periods of constipation.
  • Sometimes the feces become small and subtle like globules.
  • In some cases, it may be watery.
  • Sometimes mucus occurs along with the feces.

After going to the toilet, you may feel that the rectum has not emptied.
Some people have an urge to defecate, which means they need to go to the toilet quickly.
In the morning, they often have to rush to defecation, that is, shortly after waking up, there is an urgent need to go to the toilet. This often happens during or after breakfast.

Sometimes other symptoms appear:

  • Nausea (feeling malaise)
  • Headache
  • Belch
  • Anorexia
  • Fatigue
  • Back pain and pain in the legs up to the knees
  • Bladder problems

Some people have mild and only occasional symptoms. Others have unpleasant symptoms over a long period of time. Many people have relapses with occasional exacerbations of symptoms.

Note: Blood in the stool is not a symptom of irritable bowel syndrome.

What are complications of irritable bowel syndrome?

The complications of functional diseases of the gastrointestinal tract are relatively limited. The symptoms are often caused by food. Patients who change their diet and reduce the amount of food can lose weight.

Fortunately, weight loss is uncommon in functional diseases, so in this case another non-functional condition is suspected.
Symptoms that awaken the patient from sleep are more likely to be caused by non-functional diseases.
Usually, the functional diseases interfere with the everyday activities of the patient. For example, patients who suffer from diarrhea in the morning can not leave the house until the diarrhea stops.
If the diarrhea is constant, they can only go where a toilet is available.

Patients who experience pain after eating might skip lunch. Very often, patients associate the symptoms with certain foods such as milk, fat, vegetables, etc. Regardless of whether this connection exists, these patients should follow a strict diet.
Milk is a food that is most often avoided. However, this is usually unnecessary and comes at the expense of an adequate calcium intake.
The impairment of daily activities can also create problems in interpersonal relationships, especially with the partner.
However, the majority of patients with functional disorders tend to live with their symptoms and rarely visit a doctor for diagnosis and therapy.

Diagnosis of irritable bowel syndrome

Irritable bowel syndrome can be diagnosed based on the symptoms.
In most cases, only a few examinations are required. The doctor arrives at the diagnosis of irritable bowel syndrome when a person has the typical symptoms and other possible causes are excluded.
Which tests are carried out depends on several factors: age, severity of symptoms and response to initial treatment.

For example:
In a young woman of 20 who has the typical symptoms of IBS, routine blood tests may be the only necessary tests. Irritable bowel syndrome is more common in young girls. Therefore, if the symptoms are typical of irritable bowel syndrome, further investigations are not necessary.

In a 55-year-old man who has recently started to experience symptoms, further testing is needed. People over the age of 50 are less likely than young people to develop the symptoms of irritable bowel syndrome for the first time. It is therefore more likely that these symptoms are caused by another condition, for example Crohn’s disease or ulcerative colitis.

If you feel better after an initial treatment, further examinations may be missing.

Depending on the symptoms, the examination results and the response to treatment, the situation can be analyzed in more detail by further investigations.

Instrumental investigations are:

  • Medical history and physical examination.
  • Blood test for celiac disease, which may be considered in case of diarrhea.
  • Complete blood count, which provides information about the type and number of red blood cells, white blood cells and platelets, indicates the erythrocyte sedimentation rate and thus confirms the presence of inflammation in the body.
  • Stool tests, which include testing for blood in the stool (testing for occult blood), infections (stool culture), or parasites (eggs and parasites).
  • Thyroid function tests and imaging equipment examinations such as colonoscopy are rarely performed.

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