Irritable bowel syndrome: symptoms, causes & treatment

An irritable bowel, also known as an irritable colon, is a functional disorder of the digestive system. It is one of the most common gastrointestinal complaints and occurs in highly varied forms. Specialists use the term “syndrome” when multiple typical complaints occur at the same time and standard examinations reveal no organic changes. This means that irritable bowel syndrome (IBS) is diagnosed by exclusion. Although the complaints can be severe, standard examinations are unable to detect changes in the intestines. Recurring or persistent complaints affecting the bowel are typical of irritable bowel syndrome. These include changes in bowel movements, ranging from diarrhoea to constipation. The progression of irritable bowel syndrome varies greatly from person to person: for some people, the complaints subside on their own, while for others, they persist on a permanent basis.

It’s important to note that irritable bowel syndrome is not dangerous. It does not lead to lasting damage, nor does it cause serious illnesses of the digestive tract. Nevertheless, many people find irritable bowel syndrome stressful. The symptoms often make everyday life more difficult, with sufferers feeling unwell and less productive.

Irritable bowel syndrome often begins in adolescence or young adulthood. Typically, it progresses in waves, with symptoms appearing for a certain period of time, subsiding and often returning at a later date. The complaints vary in severity and from person to person. The signs of an irritable bowel relate to bowel movements and are usually accompanied by other digestive complaints. Typical symptoms of irritable bowel syndrome include:

• Stomach ache: an irritable bowel usually causes pain and general discomfort in the abdomen. Cramp-like or diffuse sensations that often subside after bowel movements are typical.
• Diarrhoea: some people with irritable bowel syndrome suffer from soft to watery stools, combined with a sudden urge to defecate that is difficult to control.
• Constipation: with IBS, stools are often hard and lumpy and can only be passed through straining. Sufferers often feel they have still not fully emptied their bowels.
• Bloating: flatulence is a very common symptom of irritable bowel syndrome. Many sufferers also complain of bloating.
• Mucus in stools: irritable bowel syndrome can involve visible mucus leakage in the stool.
  

Complaints often change over time and do not always appear in the same form. In addition to typical bowel problems, many people with irritable bowel syndrome report additional symptoms such as back pain or persistent tiredness. Similar symptoms also occur with other illnesses, so it is important to have a medical examination. This will give you a clear diagnosis and the right support for your complaints.

The exact cause of irritable bowel syndrome is still unclear. Studies show that it involves the interaction of different factors. Experts point to a complex process involving the intestine, nervous system, immune system and psychological influences. The possible causes of an irritable bowel include various internal and external factors:

Changes in the body

• Impaired gut–brain axis: with irritable bowel syndrome, the interaction between the gut and brain changes. This impairment can influence our perception of pain and management of digestion.
• Hypersensitive intestinal nerves: for many people, the nerves in the intestine become particularly sensitive. Even normal movement or stretching of the intestines can cause pain or discomfort.
• Disorders of the intestinal muscles: the intestinal muscles do not always work consistently. This can lead to diarrhoea, constipation or alternating occurrences of both.

Other influencing factors

• Changed intestinal flora: studies have found differences in the microbiome – i.e. our entire ecosystem of intestinal bacteria – of people with IBS and that of healthy people. These changes affect digestion and the immune system.
• Intolerances: some sufferers have difficulty tolerating certain foods, although they do not have a traditional allergy or intolerance. Experts refer to these cases as functional food intolerances.
• Intestinal infection: some people develop an irritable bowel after acute gastroenteritis.
  

Often, several of these factors work in combination. This can make diagnosis and treatment more difficult. It is also often unclear whether a particular factor has triggered the irritable bowel itself or has merely developed as the illness progresses.

Irritable bowel syndrome is diagnosed when the following criteria are met:

• Complaints such as abdominal pain, flatulence or changes in the stool persist for at least three months.
• The symptoms lead to a noticeable reduction in quality of life.
• There is no evidence of other illnesses that could explain the complaints.

There is no special test that directly diagnoses irritable bowel syndrome. Instead, IBS is diagnosed by exclusion. That means doctors will look for other possible causes. This usually starts with a detailed discussion about the complaints, any known intolerances and pre-existing illnesses. This is followed by a physical examination of the abdomen, along with blood tests and stool tests. This will rule out things like infection or food intolerances. Depending on the complaint, further examinations, such as a colonoscopy, may follow. This serves to distinguish an irritable bowel from chronic inflammatory bowel disease or other changes in the digestive tract.

It’s important to note that some symptoms are not associated with an irritable bowel. Blood in the stool and fever are warning signs of other serious illnesses. If you have these symptoms, always seek 

There is no standard treatment that cures an irritable bowel. The symptoms can vary greatly, so doctors may consider a variety of treatments. Which treatment methods are useful, and when, depends on the complaints. Doctors often recommend trying out different methods and observing how you respond to them. Over time, many IBS sufferers develop a sense of which factors exacerbate or alleviate their symptoms. The aim is to better control the condition with a healthy lifestyle, an appropriate diet and, if necessary, medication.

An irritable bowel in everyday life: what you can do

Many measures are easy to implement in everyday life and can significantly influence the complaints. These are often small changes that have a big impact:

• Eat slowly and carefully: take time for your meals and chew your food thoroughly. This helps your digestive system.
• A regular eating schedule: structured meals help your intestines get into a regular rhythm.
• Exercise: taking a walk after eating promotes digestion and often alleviates complaints such as bloating and flatulence.
• Recognise individual triggers: pay attention to the foods or situations that exacerbate your complaints. Keep a diary: documenting your symptoms and the measures you take makes it easier to identify your personal triggers.
• Reduce coffee and alcohol: both can further irritate the intestines and exacerbate your complaints.

Treating an irritable bowel with home remedies

Peppermint oil is an effective household remedy for irritable bowels. It relaxes the intestinal muscles, relieving cramp-like pain and flatulence. Combinations of peppermint, caraway and aniseed also have positive effects on pain and bloating.

In addition, many people with irritable bowel syndrome turn to simple self-help measures. Hot water bottles or hot baths, for example, are known to be soothing and helpful in relieving abdominal pain and cramps. 

Medication for irritable bowel syndrome

Depending on the complaint, medication can be used to treat irritable bowel syndrome. Different active ingredients are suitable for different types and forms. These medications often support the treatment of irritable bowel syndrome:

• Antidiarrhoeal agents: these medications are useful for irritable bowel with diarrhoea. They slow down intestinal movement, prolonging the time that stool remains in the bowel and making it firmer.
• Laxatives: laxatives help with constipation. They soften the stool and make it easier to pass.
• Antispasmodics: antispasmodic substances relax the intestinal muscles and help to relieve pain and cramps.
• Probiotics: preparations containing selected bacterial strains are often recommended in the case of irritable bowel. They improve the composition of the intestinal flora and relieve flatulence and abdominal pain.
• Antidepressants: doctors sometimes prescribe antidepressants for acute pain or severe complaints. In low doses, they can reduce sensitivity to pain.

Never take medication for irritable bowel syndrome without medical advice. Seek guidance from a specialist on the best treatment for your condition.

IBS is not considered a purely psychosomatic disorder, but it does demonstrate the connection between the gut and the mind. Mental illnesses such as depression and anxiety often exacerbate the physical symptoms of irritable bowel syndrome. This creates a vicious circle – stress, tension, anxiety and worries make the complaints worse. This, in turn, increases the mental strain. This cycle often intensifies over time and affects both physical well-being and mental stability.

Experts therefore do not see irritable bowel syndrome as a purely intestinal disorder. The nervous system and the mind also play an important role. Acute or prolonged tension affects digestion and makes the intestines more sensitive. This can change intestinal movement and digestion. In stressful periods, this can lead to constipation or flatulence.

Taking steps to reduce stress and manage complaints better is therefore an important part of treating irritable bowel syndrome. These include:

• Psychotherapy: psychotherapy has been proven to help change thought patterns and responses to bodily signals. People affected by IBS learn to cope with stresses such as the fear of diarrhoea, and to manage their issues in everyday life.
• Exercise: regular exercise stimulates digestion and reduces stress. It makes it easier to deal with the symptoms that accompany irritable bowel symptoms such as joint pain and fatigue and boosts general well-being.
• Relaxation: techniques such as progressive muscle relaxation and autogenic training reduce stress levels. This can help alleviate the symptoms of an irritable bowel.

There is no single diet that helps everyone affected by irritable bowel equally. Your diet should be tailored to your complaints, depending on your symptoms and personal intolerances. 

One approach that has received particular attention in recent years is the FODMAP diet. An irritable bowel is often associated with an increased sensitivity to certain carbohydrates. FODMAPs are carbohydrates that are hard to digest and which ferment in the intestine, often exacerbating flatulence, abdominal pain and diarrhoea. Studies show that a diet low in FODMAPs improves these symptoms in many cases. Foods that are particularly rich in FODMAPs include:

• Onions and garlic
• Pulses such as beans, lentils and chickpeas
• Cereals that contain gluten such as wheat, rye, spelt
• Milk and dairy products with a high lactose content
• Fruits such as apples, pears and raspberries
• Sugar substitutes such as sorbitol or mannitol

Rather than maintaining a strict list of banned foods, it is better to consciously identify which foods exacerbate your complaints.

However, you should not follow the FODMAP diet on your own, nor should you adhere to it strictly in the long term. It is a multi-stage process (elimination, test and individualisation phases) and requires professional support. Without guidance, there is a risk that you could leave out many food types unnecessarily. This can lead to an unbalanced diet, nutrient deficiency and lack of diversity in beneficial intestinal bacteria. Specialised nutrition counselling will help you develop a balanced diet that suits you.

Don’t be afraid to seek help if you have an irritable bowel. Your first point of contact should be your general practitioner. If necessary, they will refer you to a specialist in illnesses of the gastrointestinal tract. This will give you a reliable diagnosis along with measures that are appropriate for your situation. Depending on your symptoms, it can be a good idea to seek specialist nutrition counselling so you can adapt your diet to suit your individual needs. Eating a balanced diet and consciously reducing stress can help you to control irritable bowel syndrome and improve your quality of life.