Overview

Irritable bowel syndrome is a group of symptoms that affect the stomach and the intestines, known as the gastrointestinal tract. The common symptoms are abdominal pain, frequent diarrhoea or constipation, cramps and bloating due to gas. It is a chronic (long-term) condition which is managed by taking medications and making lifestyle changes. Irritable bowel syndrome does not cause any tissue damage or increase the risk of having colon cancer.

Stress is a normal human mental response to changes or challenges. It occurs when we are in a situation where we feel we are not in control or we cannot manage. In some situations, stress can be positive keeping us alert, motivated, and ensuring we face the challenge. 

Stress becomes a problem when its intensity, or duration, becomes unmanageable for us.¹

Irritable bowel syndrome is termed a neurogastrointestinal (GI) disorder, also known as gut-brain interaction disorder.¹

Irritable bowel syndrome

Irritable bowel syndrome is a disorder that affects the gastrointestinal tract, which is the stomach and the intestines. IBS does not affect the bowel tissues or increases the risk for colorectal cancer. Most of the symptoms are managed by making changes to diet and lifestyle, and by reducing stress.²

Irritable bowel syndrome is categorised according to the type of stool (poop) that you have. Irritable bowel syndrome with constipation (hard and lumpy stool), irritable bowel syndrome with diarrhoea (loose and watery stool), irritable bowel syndrome with mixed bowel habits (may have hard and lumpy stools or watery stools).

Symptoms

Symptoms of irritable bowel syndrome may not appear all of the time. You may experience symptoms sometimes and at other times not have any symptoms. Some of the common symptoms are: 

• Abdominal pain
• Abdominal cramps are relieved by passing stool
• Bloating sensation
• Diarrhoea or constipation
• Mucus in the poop
• Always have the feeling to empty the bowels even after passing the stool
• Weight loss
• Rectal bleeding
• Iron deficiency anaemia
• Vomiting without any other identifiable cause

Causes

The exact cause of irritable bowel syndrome is not known. However, when someone has a neurogastrointestinal disorder (GI), the gut and brain do not coordinate to help the digestive system to work properly. There can be various reasons for this, due to factors such as:

• The abdominal muscles: The abdominal muscles help the food to pass through the digestive tract. If muscle contractions last longer than normal, they may cause gas, bloating, and diarrhoea. If muscle contractions are weaker, it may lead the food to pass slowly and cause hard and dry stools
• Nervous system: When the brain and intestine do not coordinate properly, it may cause changes in the digestive process that result in abdominal pain, diarrhoea, or constipation
• Severe infection: Irritable bowel syndrome can occur after severe diarrhoea caused by bacteria or a virus
• Stress:. Stressful or traumatic events, including those experienced in childhood, may trigger or exacerbate IBS³
• Gut bacteria: People suffering from irritable bowel syndrome have altered bacteria in their gastrointestinal tract. The amount of gut bacteria present in people with irritable bowel syndrome is different than in people not affected⁴
• Food intolerance: Food intolerances and allergies rarely cause irritable bowel syndrome but certain food reactions can make IBS symptoms severe

Risk factors

Irritable bowel syndrome can affect anyone, but the chances of developing the condition is increased when the following risk factors are present: 

• Under 50 year of age
• Assigned female at birth (AFAB) 
• Family history of irritable bowel syndrome
• Anxiety, stress, or any other mental health issues⁵
• Severe digestive tract infection
• Lack of sleep
• Intolerance to certain food or food allergy
• History of substance abuse⁶

Diagnosis

• Blood test: A complete blood test evaluates the blood cells, platelets, proteins, hormones and other certain minerals. It can help to rule out other causes of symptoms, such as coeliac disease
• Stool test: This test helps to find any gastrointestinal issues, infections, and even cancer. A stool test shows any bacteria, viruses, and parasites present in the stool (poop)
• Hydrogen breath test: It is a non-invasive test which measures the hydrogen gas level in the breath the person exhales. This test helps in diagnosing some of the common digestive conditions, such as irritable bowel syndrome, lactose intolerance, and SIBO (small intestine bacterial overgrowth)⁷
• Colonoscopy: It is an examination where it uses a flexible tube with a lighted camera at the end and is inserted through the anus and rectum into the colon, the images of the inside of the large intestine is shown on the screen
• Flexible sigmoidoscopy: This procedure is used to examine the lower part of the large intestine. The healthcare provider inserts through the anus and rectum a long flexible tube with a camera attached. This allows them to view the inside of the large intestine
• Upper endoscopy: A gastroenterologist uses an endoscope, a flexible long tube with a camera attached at the end to view the upper part of the digestive tract. The tube passes through the oesophagus, stomach and the duodenum (upper part of the small intestine)^7,8

Impact of stress on irritable bowel syndrome

Our mental health can significantly affect our physical health. Because of the connection between the nervous system and the colonic function, stress plays an important role in the severity of IBS symptoms. Stressful events can trigger the condition, or exacerbate symptoms.¹

Management and treatment

The treatment plan for IBS can include changes in food and daily routine, taking medication for constipation or diarrhoea, and accessing mental health support that includes coping strategies for stress. 

Although these interventions may not cure IBS completely, they can help you to manage the symptoms and reduce their frequency and severity. 

Diet changes

A dietitian can help you to modify your diet according to the symptoms that you experience and the foods that trigger or exacerbate the symptoms.² Some of the changes that can help are: 

• Increase fibre rich foods like vegetables, fruits, grains, and nuts if you have a tendency towards constipation
• Increase your water intake. Aim to drink at least 2 litres of water daily, which helps to avoid constipation; it also helps you to rehydrate if you are experiencing diarrhoea
• If you are lactose-intolerant, you will be advised to reduce dairy products, like cheese and milk. Be sure to regularly include non-dairy food products that are rich in calcium in your diet, like broccoli, spinach, and salmon
• Decrease your intake of food that can produce more gas and contribute to feeling bloated. Examples include carbonated (fizzy/sparkling) or alcoholic drinks, although you may also find that certain foods increase bloating

Activities

The following activities may support your digestive health, and help you to manage stress:

• Regular exercise
• Yoga, meditation, and other relaxation techniques
• Getting enough sleep: a good night's rest is a powerful medicine for decreasing stress. Aim to get at least 7-8 hours of rest every night

Therapy

Therapy can help you to explore your triggers for stress, anxiety, and depression. Learning how to notice and manage these can help to reduce your IBS symptoms.

• Cognitive behavioural therapy (CBT): a goal-oriented psychotherapy (talk therapy), which helps you to observe, explore, and regulate your emotional responses⁹
• Hypnotherapy: also known as hypnosis, a trained hypnotherapist guides you into deep state of focus and relaxation¹⁰
• Biofeedback: an alternative approach that teaches to improve physical and mental health¹¹

Medications

Doctors may prescribe medication according to the symptoms and severity. Antidepressants are prescribed if the patient is suffering from anxiety and depression, medication to ease the constipation, medication to firm the stools.

FAQs

Can stress and anxiety cause bowel problems?

Stress and anxiety can activate the nervous system, which in turn releases hormones that affect the digestive system. This can trigger symptoms such as diarrhoea, constipation, abdominal pain or cramps, and gas.

What is the best diet for irritable bowel syndrome?

Including more fibre rich food in diet helps to decrease the symptoms of irritable bowel syndrome.

How is irritable bowel syndrome treated?

Irritable bowel syndrome is mainly treated by making changes in the diet and lifestyle, according to the symptoms medicines are prescribed.

What triggers irritable bowel syndrome?

Certain food can trigger the symptoms, or make them worse. Stress can also worsen the symptoms, giving irritable bowel syndrome its other name of “nervous stomach”.

Summary

Irritable bowel syndrome is a group of symptoms that affect the stomach and the intestines (known as the gastrointestinal tract). Common symptoms include abdominal pain, frequent diarrhoea or constipation, cramps, and bloating gas. 

IBS is a chronic condition which is managed by taking medications and making lifestyle changes. Stress plays an important role in the severity of IBS symptoms because of interactions between the nervous system and the functioning of the colon.