Irritable Bowel Syndrome (IBS) is a group of abdominal symptoms that cannot be ascribed to any serious problems such as cancer, gallstones, diverticular disease, inflammatory bowel disease (ulcerative colitis, Crohn's disease, Coeliac disease), appendicitis, gastritis (including Helicobacter pylori), peptic ulcers, liver disease and haemorrhoids. In other words, it is only diagnosed once other conditions have been excluded.

Symptoms

Nausea, indigestion, belching, variation in appetite, bloatedness, abdominal pain/discomfort, constipation, diarrhoea or alternating constipation/diarrhoea, feeling of not emptying rectum fully after passing motion, flatulence, passage of mucus with stool, explosive stool, urgency to evacuate bowel.

Passing blood in the stool is not a symptom of IBS.

Signs

• Abdominal distension.
• Increased resonance of abdomen. This is shown by placing a hand on the abdomen and tapping with a finger or patella hammer. This sign can give clues as to the presence of a fermentative process in the gut, e.g. yeast overgrowth or insufficient digestive enzymes.
• A spastic colon may be palpable in the left iliac fossa (lower, left side of abdomen).
• There may be a general tenderness over the abdomen.

Causes

The first consideration is to check that the diagnosis of IBS is correct.

• Stress is thought to be a common cause of IBS. However, it can also be the result of the disease.
• Candidiasis (Candida albicans) of the gut lumen.
• Protozoal parasites and worms.
• Insufficient beneficial bacteria in the gut.
• Digestive enzyme deficiency.
• Food allergies/intolerances.
• 'Leaky gut' (permeable gut syndrome).

Tests

Live blood and coagulated blood analysis can diagnose the majority of causes. As part of the assessment, food allergy/intolerance tests are also necessary. If symptoms persist, blood tests for food allergies, a comprehensive digestion and stool analysis (CDSA), or a Gut Fermentation Test may be of benefit.

Treatment

Once established, the cause is treated. This always involves individual patient assessment.