Understanding Irritable Bowel Syndrome (IBS) for Better Management

What is Irritable Bowel Syndrome (IBS)?

Irritable Bowel Syndrome (IBS), commonly known as IBS, is a functional gastrointestinal disorder that disrupts the brain-gut axis. It’s a condition where patients experience a variety of symptoms triggered by factors such as psychosocial elements, altered gut motility, abnormal sensations in the gut, infections, and allergies.

Irritable Bowel Syndrome (IBS)

The Mechanism Behind IBS

Patients with IBS exhibit a malfunctioning mechanism mediated by serotonin. Serotonin, a neurotransmitter, plays a crucial role in regulating intestinal functions. Dysfunction in serotonin signaling alters intestinal barrier functions, contributing to symptoms like excessive motility, secretion, and sensation.

Rome 4 Diagnostic Criteria

To diagnose IBS, medical professionals refer to the Rome 4 criteria, which include:

  1. Recurrent Abdominal Pain: The pain should occur at least once a week for three months, associated with criteria like:
    • Related to defecation.
    • Change in stool frequency.
    • Change in stool form/appearance.

Recognising Features of IBS

IBS manifests through various symptoms, including:

  • Colicky abdominal pain.
  • Altered bowel habits.
  • Abdominal distension.
  • Rectal mucus.
  • Incomplete evacuation.
  • Symptoms persisting for over six months.
  • Frequent consultations for non-gastrointestinal problems.
  • Worsening of symptoms under stress.

Understanding Subgroups

IBS presents itself in several subgroups:

  1. Alternating Bowel Habits (IBS-A)
  2. Constipation-Predominant IBS (IBS-C)
  3. Diarrhea-Predominant IBS (IBS-D)

Identifying Red Flag Features

Certain features should raise concern and prompt immediate medical attention:

  • Rectal bleeding.
  • Unexplained/unintentional weight loss.
  • Family history of bowel or ovarian cancer.
  • Onset after 60 years of age.
  • Anemia.
  • Nocturnal symptoms.

Primary Care Investigations

Primary investigations recommended for IBS patients include:

  • Full blood count.
  • ESR/CRP and fecal calprotectin tests to rule out inflammatory bowel disease.
  • Coeliac disease screen (tissue transglutaminase antibodies) due to its common occurrence alongside IBS.
  • Colonoscopy, especially for older patients, to exclude colorectal cancer.


Understanding the complexities of Irritable Bowel Syndrome (IBS) is crucial for effective management. By recognizing its various symptoms, subgroups, and red flag features, individuals can seek timely medical attention and adopt suitable lifestyle changes to alleviate discomfort.

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