Introduction

The typical symptoms of irritable bowel syndrome (IBS) include abdominal pain, constipation and diarrhea.

IBS isn't dangerous. Most people who have it have a mild form which they can cope with quite well without getting any treatment.

But in some people the symptoms are so bad that it significantly affects their everyday lives and becomes a real problem.

There is no cure for IBS. But over time, many people find out what helps and what makes things worse. And there are a number of different ways to relieve the symptoms.

Symptoms

The typical symptoms of IBS include persistent upper or lower abdominal pain, cramps, and changes in the consistency of stool. It tends to cause constipation in women and diarrhea in men, although some people may have both. Other signs of IBS may include feeling very full, flatulence (gas) or mucous discharge.

Causes

Although the causes of IBS aren't fully understood, there are many theories. For example, oversensitive nerves in the intestine, intestinal muscle disorders and inflammations of the intestinal wall are believed to all play a role. It has also been observed that IBS is more common in people who have had an intestinal infection with fever and severe diarrhea. IBS may be inherited as well. Psychological stress, eating habits and food intolerances are thought to be possible triggers too. But it's often not clear whether these things are causing the IBS or caused by the IBS.

Position of the bowel in the digestive system

Prevalence

It is estimated that about 10 to 20 out of 100 people have IBS. Most people first get it between the ages of 20 and 30. It is twice as common in women as it is in men.

IBS is usually a chronic condition. In other words, many people have it all the time. It often comes and goes in episodes. Phases with mild symptoms or no symptoms are then followed by phases with more severe symptoms.

Diagnosis

Someone is considered to have IBS if

• symptoms such as abdominal pain or flatulence (gas) last for more than three months and their bowel movements have changed – for instance, if they have to go to the toilet more often or less often, or if they have diarrhea or constipation.
• the symptoms have a noticeable impact on your quality of life.
• there is no reason to believe that the symptoms are being caused by another disease.

That's because these kinds of symptoms may have other causes, such as lactose intolerance.

Blood tests and other tests can be used to find out whether the symptoms are being caused by a food intolerance. But some people have both irritable bowel syndrome and a food intolerance at the same time.

Other symptoms such as losing a lot of weight, blood in the stool, fever or pale skin could be signs of something else, like an inflammatory bowel disease such as ulcerative colitis or Crohn’s disease. Another possible cause is diverticulitis – an inflammation caused by stool getting stuck in pockets in the bowel wall. Sudden and severe abdominal pain could also be a sign of gallstones.

If digestive problems are accompanied by signs such as blood in the stool, bowel cancer may be a possible cause. But it is very rare in people under the age of 50. If you discover blood in your stool it's important to see a doctor about it.

Treatment

A balanced diet and enough exercise in everyday life are considered to be essential for a healthy digestion. There are a lot of other tips when it comes to IBS. For instance, people who suspect that a particular type of food makes their symptoms worse can try to avoid eating it for a while. Some people have fewer problems if they eat their meals in smaller portions throughout the day. Keeping a food diary can help you find out how different foods affect the symptoms.

There are also a number of treatment options. It's best to talk to your doctor about what could help and then try a few things out. If you ask different people who have IBS, it becomes clear that something that helps one person may end up making someone else’s symptoms worse. There is also a lack of good research on most of the treatments. But a number of approaches have been shown to at least help some people or for a short while. These include:

• Peppermint oil
• Probiotics
• Anti-cramping medications
• Medications for constipation
• Antibiotics
• Antidepressants
• Psychological treatments such as cognitive behavioral therapy and hypnosis

Medication in particular can have side effects too, so it's worth carefully considering the pros and cons of the various options.

Everyday life

Most people who have a milder form of IBS cope quite well with it. Yet for some the symptoms are so strong that it has a big impact on their quality of life. Some people may suddenly feel an urgent need to go to the toilet. This can make everyday life very difficult because meals and appointments have to be carefully coordinated to get the timing right. As a result, it's nearly impossible to be spontaneous.

People often feel ashamed too, because they have to go to the toilet so much or pass a lot of gas (fart). What's more, IBS isn't always taken seriously by other people – even by some doctors. This can be very hurtful for those affected.

But most people find ways to live with IBS without it affecting their lives too much. It is sometimes the little things that make day-to-day life easier and help you to stop worrying all the time. For instance, bringing along your own food to a party, finding out right away where the bathroom is, or taking an aisle seat at the movies.

Further information

When people are ill or need medical advice, they usually go to their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

There are many places people who have IBS can go to find help, including support groups and information centers. But there are often regional differences in how these services are organized, and they aren't always easy to find. You can use our list to help you find and make use of local services in Germany.

Sources

• Dixon-Woods M, Critchley S. Medical and lay views of irritable bowel syndrome. Fam Pract 2000; 17(2): 108-113. [PubMed: 10758070]
• Ford AC, Vandvik PO. Irritable bowel syndrome: dietary interventions. BMJ Clin Evid 2015. [PMC free article: PMC4520224] [PubMed: 26226510]
• Håkanson C, Sahlberg-Blom E, Ternestedt BM. Being in the patient position: experiences of health care among people with irritable bowel syndrome. Qual Health Res 2010; 20(8): 1116-1127. [PubMed: 20463359]
• Layer P, Andresen V, Pehl C, Allescher H, Bischoff SC, Claßen M et al. S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM): AWMF-Registernr.: 021-016. Z Gastroenterol 2011; 49(2): 237-293. [PubMed: 21287438]
• Lovell RM, Ford AC. Effect of gender on prevalence of irritable bowel syndrome in the community: systematic review and meta-analysis. Am J Gastroenterol 2012; 107(7): 991-1000. [PubMed: 22613905]
• Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol 2012; 10(7): 712-721. [PubMed: 22426087]
• National Institute for Health and Clinical Excellence (NICE). Clinical practice guideline - Irritable bowel syndrome in adults: diagnosis and management. April 2017. (NICE Clinical Guidelines; Volume 61).
• Rønnevig M, Vandvik PO, Bergbom I. Patients' experiences of living with irritable bowel syndrome. J Adv Nurs 2009; 65(8): 1676-1685. [PubMed: 19493148]

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.