What are the common symptoms?

• The diagnosis of irritable bowel syndrome (IBS) relies primarily on the recognizing a pattern of symptoms - similar to the diagnosis of migraine headaches.
  
  • Alternating diarrhoea / constipation is the key symptom.
  • It is common to describe several days (3-4 days) of constipation followed by 1-2 days of loose bowel motions.
  • It is common to pass several bowel motions in the morning – the first may be before breakfast (immediately after awakening). Subsequent bowel motions may be only 20-30mins apart and are usually looser each time.
  • Urgency - rushing to the toilet - is common.
  • There is often a sensation of incomplete emptying - "a feeling of something still to pass".
  • Abdominal pain,  usually in the lower abdomen, often described as cramping (or griping) in nature - "bent over". Usually there is some increase in pain prior to a bowel motion and some relief after a bowel motion. However the pain can persist for several hours and be unrelated to a bowel motion.
  • Symptoms for several years makes IBS a more likely diagnosis. Symptoms usually start in 20's or 30's but can begin at any age (see below - background information). The severity of symptoms can vary a lot - often related to stressful life events.
  • Irritable bowel syndrome commonly follows a gastroenteritis illness. About ¼ of people with IBS can link the onset of symptoms to an episode of gastroenteritis(or food poisoning). Frequently the type of gastroenteritis is not identified. However a history of sudden onset of vomiting and diarrhoea lasting for a few days makes the diagnosis of gastroenteritis very likely.
  • In this setting the symptoms of IBS usually gradually resolve over 1- 2 years. There may be frequent relapses that can "suggest" more episodes of gastroenteritis but this is simply part of the IBS response to the initial infection. There is no way of speeding up this process of gradual resolution but I often recommend a course of antibiotic (tinidazole for 1 week). Probiotics may also be helpful.
  • It is a frequent observation that new food intolerances develop after the gastroenteritis illness - e.g to milk, bread, fruit, coffee etc.  This usuaklly resolved after 6 months.
  • A proportion of people (up to 10%) have persisting symptoms of IBS.  The risk of developing IBS after an episode of gastroenteritis is higher with a bacterial infection (such as Campylobacter), with more severe or prolonged diarrhoea and with a pre-existing problem with IBS (maybe only mild) or problems with anxiety or depression.

• Abdominal bloating is often part of irritable bowel syndrome but can also be the sole presenting complaint.
  
  • Clothing may feel uncomfortable; the swelling usually increases towards the evening (see subtypes).
  • There is often increased abdominal gurgling and rumbling.
  • Nausea and anorexia may occur particularly in the early morning – commonly better by mid-morning.

Some other symptoms are associated with irritable bowel syndrome.

• These symptoms have an association with IBS but the reasons for this are not known.
  
  • Tiredness.  This is the commonest associated symptom - up to 3/4 of people with IBS report this symptom!  The reason for this association is unclear.  There is an association with chronic fatigue syndrome
  • Painful periods. Pain with sexual intercourse.
  • Bladder symptoms.  Urinary frequency, a sensation of incomplete bladder emptying.
  • Lower back pain.  Sometimes this discomfort comes from the colon but usually it is simply as associated symptom.
  • Fibromyalgia.  Diffuse muscle aches (sometimes with  “trigger points”). Treatment with amitriptyline can help this symptom and also help IBS symptoms.