Alex Gazzola and Julie Thompson RD are guest-blogging for us during IBS Awareness Month! The co-authors of IBS: Dietary Advice to Calm Your Gut will be writing each week with tips and advice for management of IBS.
IBS Part One: Diagnosis
April is IBS Awareness Month – a four-week period aimed at focusing attention on this common, medically recognised condition.
IBS affects up to one in six of us, yet many remain undiagnosed, or manage their often painful and life-disrupting symptoms without the considerable help that may be available to them from medical and dietetic professionals. Helping these thousands of people is what drove us to write our latest Sheldon book, IBS: Dietary Advice to Calm Your Gut.
In this, the first of a special series of four weekly articles for the Sheldon Press blog during the Awareness Month, we’ll be looking at diagnosis of IBS. Could you be one of the many undiagnosed people in the UK with the condition?
Because there are no known physical abnormalities to detect in IBS, there are no tests available on the NHS which can confirm that you have it. Doctors will assess you for it on the basis of the types of symptoms you have been experiencing, and perhaps run a number of other tests to rule out alternative conditions.
There are many symptoms associated with IBS, and all patients will experience some, but not all of them, and with varying severity.
IBS symptoms associated with the bowel
diarrhoea and/or constipation – sometimes alternating;
changes in your normal bowel habits;
pain, discomfort or cramps in your lower abdomen;
urgency / incontinence;
bloating and swelling;
IBS symptoms not associated with the bowel
Seeing your doctor
There can be a natural reticence in wishing to ‘bother’ your doctor, but be reassured that no issue at all is too trivial for them.
It may help to make notes of what you wish to tell your doctor, ahead of the appointment, and taking them with you. It might be easier to keep a record of your symptoms before you go, or keep a symptom / food and symptom diary for a week.
Healthcare professionals are advised to consider assessing for IBS if the patient presents with one or more of these ‘ABC’ symptoms over the last six months:
change in bowel habit.
Furthermore, they will consider a diagnosis of IBS if any pain or discomfort is either relieved by pooing or associated with altered bowel frequency or stool form, and is accompanied by two or more of these symptoms:
altered passing of stool (straining, urgency, incomplete emptying of the bowel);
bloating, distension, tension;
symptoms made worse by eating;
passing mucus from the bottom.
Your doctor may arrange tests or investigations for you to aid a diagnosis. These include:
tests to look for inflammatory markers, which may indicate, for example, Crohn’s disease
tests for coeliac disease – an autoimmune condition causing extreme gluten intolerance (never alter your diet; continue to eat gluten beforehand)
ultrasound tests to look at the abdomen, liver and gall bladder.
gastroscopy – a tube with a camera at the tip to look at the oesophagus, stomach and duodenum.
colonoscopy – similar to a gastroscopy, but via the anus, to examine the large intestine.
hydrogen breath test – to test for lactose intolerance.
Confirming the diagnosis
Doctors may use a diagnostic algorithm to reach a conclusion to diagnose IBS. Some may instead use experience and instinct – with the support of exclusion tests – to confirm a suspicion of IBS.
You may not see a diagnosis of IBS as ‘positive’, but it does mean you can be reassured that your doctor is confident that there is no other disease involved.
IBS, whilst certainly having great impact on the quality of life for some people, is not going to limit the length of your life, nor mean you are at increased risk of future bowel disease or cancer.
The good news is that there are treatment options, and we’ll look at those in the next blog, next week.
Alex Gazzola is a journalist and author who has been specialising in gut health and food sensitivities for over a decade. He writes widely for the national and international press, and is author of several books, including Coeliac Disease: What you need to know, and Living with Food Intolerance, both for Sheldon Press. Julie Thompson is a registered dietitian with a specialism in inflammatory and functional gut disorders and ‘free from’ diets for food intolerances and allergies. She is an adviser to the IBS Network and runs the Calm Gut Clinic.