Irritable bowel syndrome

The typical symptoms of IBS include persistent upper or lower abdominal pain, cramps, and changes in the consistency of stool (poo). It tends to cause constipation in women and diarrhea in men, although some people have both. Other signs of IBS may include feeling very full, flatulence (gas) or mucous discharge.

Although the causes of IBS aren't fully understood, there are many theories. Factors that are believed to play a role include oversensitive nerves in the intestine, intestinal muscle disorders, inflammations of the intestinal wall and changes in gut flora ( bacteria and other microorganisms in the bowel). It has also been observed that IBS is more common in people who have taken antibiotics or had an intestinal infection with fever and severe diarrhea. IBS may be inherited as well. Psychological stress, eating habits and food intolerances are thought to be possible triggers too. But it's often not clear whether these things are causing the IBS or caused by the IBS.

It is estimated that about 10 to 20 out of 100 people have IBS. Most people first get it between the ages of 20 and 30. It is twice as common in women as it is in men.

IBS is usually a chronic condition. In other words, it often doesn't go away again. In many people, it comes and goes in phases: Then phases with mild symptoms or no symptoms are followed by phases with more severe symptoms.

You are considered to have IBS if

• symptoms such as abdominal pain or flatulence (gas) last for more than three months and your bowel movements have changed – for instance, if you have to go to the toilet more often or less often, or if you have diarrhea or constipation,
• the symptoms have a noticeable impact on your quality of life, causing you to seek help, and
• there is no reason to believe that the symptoms are being caused by another medical problem.

That's because these symptoms may be caused by something else, such as lactose intolerance or celiac disease. But some people have one of these conditions and irritable bowel syndrome at the same time.

Other symptoms – such as losing a lot of weight, blood in the stool, fever or pale skin – could be signs of something else, like an inflammatory bowel disease such as ulcerative colitis or Crohn’s disease. Another possible cause is diverticulitis, which is an inflammation caused by stool getting stuck in pockets in the bowel wall. Sudden and severe abdominal pain could also be a sign of gallstones.

If digestive problems are accompanied by signs such as blood in the stool, bowel cancer may be a possible cause. But it is very rare in people under the age of 50. If you discover blood in your stool it's important to see a doctor about it.

To diagnose IBS, the doctor will first ask about your symptoms and whether you have any known food intolerances or illnesses. Blood tests and other tests can be done to rule out other causes. The doctor will also ask you about factors related to your life circumstances – for example, whether the symptoms are worse when you’re stressed.

A balanced diet and enough exercise in everyday life are considered to be essential for healthy digestion. There are a lot of other tips when it comes to IBS. For instance, people who suspect that a particular type of food makes their symptoms worse can try to avoid eating it for a while. Some people have fewer problems if they eat their meals in smaller portions throughout the day. Keeping a food diary can help you find out how different foods affect the symptoms.

There are also a number of treatment options. It is best to talk to your doctor about what could help and then try a few things out. If you ask different people who have IBS, it becomes clear that something that helps one person may end up making someone else’s symptoms worse. There is also a lack of good research on most of the treatments. But a number of approaches have been shown to at least help some people for a short while. These include:

• Peppermint oil
• Probiotics
• Anti-cramping medications
• Medications for constipation
• Antibiotics
• Antidepressants
• Psychological treatments such as cognitive behavioral therapy and hypnosis

Medication in particular can have side effects too, so it's worth carefully considering the pros and cons of the various options.

Most people who have a milder form of IBS cope quite well with it. Yet for some the symptoms are so strong that it has a big impact on their quality of life. Some people may suddenly feel an urgent need to go to the toilet. This can make everyday life very difficult because meals and appointments have to be carefully coordinated to get the timing right. As a result, it's nearly impossible to be spontaneous.

People often feel ashamed too, because they have to go to the toilet so much or pass a lot of gas (fart). What's more, IBS isn't always taken seriously by other people – even by some doctors. This can be very hurtful for those affected.

But most people find ways to live with IBS without it affecting their lives too much. It is sometimes the little things that make day-to-day life easier and help you to stop worrying all the time. For instance, bringing along your own food to a party, finding out right away where the bathroom is, or taking an aisle seat at the movies.

When people are ill or need medical advice, they usually go to see their family doctor first. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.

There are many places people who have IBS can turn to for help, including support groups and information centers. Our list may help you to find and make use of suitable services in Germany.