Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome, usually shortened to IBS, is a long term condition in which abdominal pain happens together with a change in bowel habit, and routine tests show no damage or disease in the bowel. The gut and the nervous system are not communicating normally, which makes the bowel more sensitive and its movements less predictable. Day to day that can mean cramping, bloating, and bowel movements that are hard to plan around.

What IBS is, and what it is not

IBS is not a diagnosis of last resort. Doctors in Canada make it positively, from a recognised pattern of symptoms, alongside a small set of tests to check for other conditions. It is grouped by the main bowel pattern: IBS with constipation, IBS with diarrhoea, or a mixed pattern that swings between the two. Which group you fall into can change over the years.

IBS is also not a form of cancer or inflammatory bowel disease, and it does not damage the bowel. Some symptoms do overlap with those conditions, which is why doctors look specifically for alarm features such as bleeding or weight loss. If those turn up, they are assessed on their own merits rather than put down to IBS.

Signs and symptoms

• Cramping or aching pain in the abdomen, often eased by having a bowel movement
• Bowel movements that are looser or harder than usual, or that swing between the two
• Bloating and visible swelling of the abdomen
• A sudden need to reach a washroom
• A feeling that the bowel has not fully emptied
• Mucus in the stool
• Ongoing tiredness, reported by about half of people with IBS

Symptoms vary a great deal between people and over time. Many people have settled stretches followed by weeks when the pain and urgency return, sometimes without an obvious reason.

What raises the risk

Some risk factors cannot be changed:

• Being female, as IBS is diagnosed about twice as often in women
• A previous episode of gastroenteritis or another gut infection
• A family history of IBS
• Age at onset, since symptoms often begin in the teenage years or early adulthood

Others can often be worked on, usually with support from a health care team:

• A high and sustained stress load, and untreated anxiety or low mood
• Eating patterns that include your own trigger foods, including some fermentable carbohydrates
• Poor sleep and low physical activity

How IBS is diagnosed in Canada

IBS is a positive diagnosis made with the Rome IV criteria, which describe recurrent abdominal pain that is linked to bowel movements or to changes in the frequency or form of stool over a sustained period. Doctors usually add a small set of tests to rule out other conditions: blood counts, blood tests for celiac disease, C reactive protein as a marker of inflammation, and a stool test for calprotectin or for hidden blood. Colonoscopy is not needed to confirm IBS. It is arranged for people with alarm features, or for those who fall into a colorectal cancer screening group.

Treatment and day-to-day management

Clinical research for Irritable Bowel Syndrome (IBS) is enrolling. See the current studies ↓

Care in Canada is built around reducing pain and urgency and making bowel habits more predictable, and it usually combines more than one approach. Depending on your pattern, what you have already tried and what matters to you, a health care team may discuss:

• Dietary approaches, including a structured low FODMAP elimination and reintroduction run with a registered dietitian, soluble fibre, and regular meal patterns
• Psychological and behavioural care, including cognitive behavioural therapy and gut directed hypnotherapy, increasingly delivered online in Canada
• Options available without a prescription, such as bulk forming or osmotic laxatives, antidiarrhoeal medicines, peppermint oil and specific probiotic strains
• Prescription medicines including antispasmodics, low dose neuromodulators for pain signalling, and agents licensed in Canada for IBS with constipation or IBS with diarrhoea
• Physical activity, sleep and stress management as ongoing self management supported by a primary care team

No two people with IBS end up with the same plan, and finding what helps often takes several attempts. These are decisions for you and your own clinician, and nothing on this page is a recommendation about any of them.

When to talk to a doctor

• Rectal bleeding, or blood mixed into the stool
• Unintended weight loss, fever, or symptoms at night that wake you from sleep
• Any change in bowel habit that persists, particularly one starting after age 50, and new symptoms in anyone with a family history of colorectal cancer or inflammatory bowel disease, all of which warrant prompt assessment

Why clinical research matters for IBS

There is still no test that confirms IBS, no way to predict which person will respond to which approach, and a large share of people continue to have symptoms after diet, medicine and psychological therapy. Studies now underway are testing gut microbiome and diet interventions, bile acid and gut barrier targets, new neuromodulators and secretagogues, digital cognitive behavioural therapy and hypnotherapy programs, and biomarkers that could separate the subtypes. Canadian researchers are also examining why reported prevalence differs so widely depending on which criteria are applied.

Clinical studies are how those questions get answered. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own doctor. Joining a study does not mean giving up the care you have now, and no one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• Canadian Digestive Health Foundation: IBS
• Gastrointestinal Society: IBS information
• Canadian Association of Gastroenterology
• HealthLink BC