Irritable bowel syndrome: what is it and what are the symptoms, causes of IBS?

Irritable bowel syndrome: what is it and what are the symptoms, causes of IBS?
Photo source: Getty images

Irritable bowel syndrome is a functional, not an organic, disease of the digestive tract. It is caused by a combination of various risk factors, such as stress. It is characterised by abdominal pain, bloating and difficult defecation. Treatment may or may not be simple.


Irritable bowel syndrome is a chronic functional disorder of the digestive tract, or gut. It is multifactorial. The exact cause is unknown.

It is a functional, not an organic disease. This means that the intestine is not affected by a change in structure, structure, but its function is disturbed.

What is this disease and how does it manifest itself? How is it diagnosed? What is effective in the fight against irritable bowel syndrome? Will treatment help?

It is also referred to as IBS, which is an abbreviation of the English words irritable bowel syndrome. The designation of the syndrome carries because it is characterized by the presence of various symptoms.

On the internet and in the literature, we can come across other names such as irritable bowel syndrome, lower functional dyspepsia or dysfunctional bowel syndrome. However, all these names name the same problem.

Professionally, IBS is defined as recurrent abdominal pain or discomfort, for at least three days in one month, within the last three months, but with onset at least 6 months ago.

There are at least two symptoms between the complaints:

  1. the pain subsides or is less severe after bowel emptying, i.e. defecation
  2. initial changes in the frequency of defecation, e.g. diarrhoea or constipation
  3. initial changes in stool characteristics such as consistency, appearance and shape

IBS is not an organic disease. Therefore, normal physical findings on examination are a prerequisite for the diagnosis. This applies both to the digestive tract and to other organ systems. The history and subjective complaints of the person concerned play a major role in the diagnosis.

IBS - three dice with the inscription I - B - S on a brown background
Functional disease, not organic damage to the intestine. Source: Getty Images

Other methods of examination do not show a clear-cut disease. Therefore, the difficulties are often and erroneously classified under psychological disorders. However, the psyche is not the only factor behind the outbreak of unpleasant and life-harassing difficulties.

What is irritable bowel syndrome? Long-term digestive discomfort associated with abdominal pain, defecation disorders. With diarrhoea or cough, or alternation between them, with associated bloating and bowel overflow.

Irritable Bowel Syndrome affects women to a greater extent, allegedly due to hormonal interplay. The age range is wide, from 20 to 50 years. IBS occurs mainly in active, dominant, combative people in leadership positions and in individuals working under prolonged stress.

Irritable bowel syndrome affects 10-15% of people.

It is associated with a fast pace of life, inappropriate regimen and lifestyle. It occurs during adolescence and young adulthood and persists for several decades. Periods of calm alternate with bouts of intense discomfort or occur in mild form daily.

In both cases, IBS impairs quality of life, concentration and work performance, and daily existence. It is aggravated by stress, tension, pressure, but also by infectious diseases and long-term antibiotic treatment. It is often associated with food intolerance.

Other problems such as celiac disease, histamine intolerance or lactose intolerance also occur with IBS.

ENS = enteric nervous system

The mental state affects the gut, digestion and the entire gastrointestinal tract - and the reverse is also true. Discomfort and disease processes in the digestive tract will affect the overall health and mental state.

Long-term stress also negatively affects the gut, digestion, gut flora and the gastrointestinal tract. Irritable bowel syndrome can be the response of the gastrointestinal tract.

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ENS stands for enteric nervous system.

This independently active part of the nervous system is located in the digestive tract. It has an autonomous status, although it is influenced by the autonomic nervous system - sympathetic and parasympathetic. In addition, it is also in conjunction with the central nervous system - CNS.

It regulates the activity of digestion, the intestine and some organs associated with digestion. Its effects include:

  • motility - the motility of the stomach, intestines and speed of digestion
  • production of gastric and other digestive juices, acids, enzymes, mediators + hormones and pancreatic enzymes - insulin, gallbladder and bile secretion
  • GIT blood flow and absorption of nutrients into the blood
  • mucosal cell renewal
  • effective and important in the body's defence

The ENS is also referred to as the second brain. It contains approximately as many nerve cells as the spinal cord. It is responsible for the function of the digestive system. It is autonomous but is influenced by the CNS and the autonomic nervous system.

It contains several types of nerve fibres. For example, the plexus myentericus (Auerbach's myenteric plexus) affects the smooth muscles of the digestive system. The plexus submucosus (Meissner's plexus) innervates the mucosa and submucosa of the intestines.

The nervous systems are interconnected.

In addition, the GIT contains other fibers, such as viscerosensory and visceromotor fibers. These form connections between the nervous system and other organs that act synergistically in digestion. And it also contains the intestinal glia (supporting nervous tissue).


The exact cause of irritable bowel syndrome is not known. It is thought to be a combination of several factors. The syndrome is a functional disorder. The disease has no organic basis.

The gut is therefore not affected by a change in structure and structure, as in inflammation or cancer.

Up to 50% of patients seen by a gastroenterologist have functional problems. This includes IBS.

People living with an undetected cause of difficulty often fear the worst, but there is no reason to. Excessive stress from an unknown disease can make an already unpleasant difficulty worse.

What may be behind irritable bowel syndrome is listed in the table below

Possible causes Description
Motility of the digestive system
  • Motility is the name given to bowel movements
  • Helps move intestinal contents from the stomach towards the rectum
  • IBS is thought to be a functional motor disorder
  • Excessive irritation of the central nervous system of the CNS
  • Increased influence of the sympathetic nervous system
  • Decrease in parasympathetic nervous system activity
Passage of gases
  • The negative impact of abnormal passage of intestinal gases is considered
  • In addition to the brain, serotonin is predominantly produced in the GIT (gastrointestinal tract)
  • Its function is variously regulated in the GIT, and hence its effect on intestinal motility
  • Overproduction causes heaviness
  • Intestinal infections are the first thing to think about
  • Among other mechanisms, overproduction of serotonin may be the cause
  • As a late sequela of rotavirus infection
  • Systemic infections, i.e. infections outside the gastrointestinal tract, are also a cause
Antibiotic treatment
  • Long-term treatment with ATBs leads to disruption of the intestinal microflora
Disturbances of the microflora
  • As a consequence of ATB treatment, but also inappropriate diet and dietary errors
Irritation of the intestine
  • Substances such as lactose, gluten, bile, fatty acids, various allergens and chemicals
Genetic factors
  • Family history
  • But may be influenced by upbringing and family customs and habits
  • Possible association with temperament:
    • Neurotic, anxious
    • Aggressive
    • Panic, phobias
    • bad mood
    • depression
    • sleep disorders
  • Long-term stress
  • Workload, leadership positions
  • Energetic persons
  • In women, hormonal influence is related to fluctuations in estrogen and progesterone levels


IBS has its own characteristic symptoms. It is important to know that its manifestation is not organic changes in the wall of the digestive tube. It is a functional disease based on a disorder of motility and passage of intestinal contents and gases.

IBS is characterized by a change in the frequency of stool emptying. Diarrhea or constipation may be present. Both may alternate. Mucusy stools are also present with diarrhea.

Constipation may last for several days. Diarrhoea may follow stool emptying. Abdominal pain is associated, which may be crampy in nature. It is accompanied by bowel overflow, gurgling in the abdomen. The actual emptying of stool may also be accompanied by pain.

Read also the article on flatulence.

Pain from the abdomen sometimes radiates to the spine. Instead of pain, irritable bowel syndrome also manifests itself as a feeling of vague discomfort in the abdomen. After defecation, a person complains of imperfect, insufficient and unpleasant emptying.

However, this is usually followed by an alleviation or cessation of the discomfort. This is followed by a recurrent urge to defecate. The intake of milk or dairy products in some individuals causes a worsening of the course, abdominal pain, frequency of stools or bloating.

Similarly, stress, psychological strain, workload, feeling of responsibility, whether at work or in the family.

IBS - man has abdominal pain, cramps, holding his abdomen, blue checked shirt, sitting on the sofa
Abdominal pain, cramps, bloating, loud bowel movements in the abdomen. Source: Getty Images

Summary of difficulties accompanying irritable bowel syndrome:

  • Change in frequency of bowel movements.
    • diarrhoea, more than 3-5 loose to watery stools in 24 hours
    • constipation, defecating 1-2 times a week
  • change in stool consistency
    • thin
    • watery
    • hard
    • mucousy
    • with admixture of blood, watch out for other GIT diseases
  • abdominal pain
    • lower abdomen
    • to the entire abdomen
    • cramps
    • vague uncomfortable feeling in the abdomen
    • feeling of fullness
    • radiating pain into the back
    • prolonged and recurrent
  • painful defecation
  • urgent urge to pass stool
    • especially in the morning after waking up
  • urgent urge to pass stool
    • even shortly after eating
  • frequent urge to pass stools
  • feeling of imperfect, uncomfortable defecation
  • bloating, flatulence, flatulence
  • bowel movements
  • gurgling in the abdomen
  • prolonged fatigue
  • exhaustion
  • headache
  • mood changes
  • sleep disturbances
  • disturbed intestinal microflora and weakened immunity


The diagnosis of irritable bowel syndrome is based on the history and the subjective complaints described by the sufferer. These lead the doctor to a diagnostic conclusion and to the correct treatment.

However, the definitive diagnosis of IBS must be preceded by a differential diagnosis, which is concerned with the exclusion of other causative agents. Other causative agents may be, for example, inflammation of the GIT, infections anywhere in the body, colon cancer and others. The symptoms mentioned above may be the result of an organic and even more serious disease. If the difficulties persist, a specialist examination is necessary.

6 years = usual average from first symptom to diagnosis.

Normal physical findings in all other examinations are a prerequisite for the diagnosis of IBS. This is because it is a functional, not an organic disease. This means that the intestine does not have an altered structure, the intestinal wall or other parts of the digestive tract are not affected in this way. Other body systems such as the heart, lungs, kidneys or gynaecological system must also be normal.

In order to find a diagnosis, examinations are carried out, such as

  • laboratory tests
    • blood
    • stool
    • urine
    • CRP - an inflammatory marker
    • blood count
    • liver tests
    • minerals
    • glycaemia
  • parasitology
  • USG or sonography of the abdomen
  • endoscopic examination
    • colonoscopy
  • CT
  • MRI


In the disease, periods of rest usually alternate with bouts of difficulty. The initial change in the frequency of defecation is associated with a change in stool consistency. There is repeated diarrhea, defecation of thin stools. Constipation may be present, with defecation occurring 1-2 times a week.

These conditions may alternate with each other.

There is urge to pass stools, especially in the morning and also shortly after meals. Bloating, flatulence, pain and cramps in the abdomen are associated. At other times, the symptoms may be mild, such as a feeling of discomfort in the abdominal cavity or a feeling of fullness. There may be heaviness, a feeling of nausea or vomiting.

The pain may be in the lower abdomen, throughout the abdomen or radiate to other parts, such as the back.

After the bowels have been emptied, there is usually a phase of retreat or at least a lessening of discomfort. However, this may be replaced by an urge to pass stools.

The feeling of imperfect and unpleasant bowel movements is unpleasant.

Stress, strain and tension cause and exacerbate the problem. The urge to defecate severely limits the quality of life of the affected individual. IBS also affects people with significant responsibilities, in positions of authority, making important meetings and the performance of their duties uncomfortable.

Examples include increased stress in the home environment, with children, or restlessness between partners.

In women, a link with hormonal changes during the cycle is observed. The disruption of the microbial flora in the gut also has an impact. Disruption of the microbial flora in the gut occurs after treatment with antibiotics, but also as a result of inflammatory bowel disease or other systemic infections.

Therefore, the use of probiotics in ATB treatment is also important.

Appropriate diet and nutrition are essential

Difficulties in this disease are largely caused by stress. This can be influenced to some extent by the above treatments.

Diet is also of great importance in irritable bowel disease. What we eat can improve the passage of intestinal contents through the gut. Yes, we are talking about fibre and junk food.

We need to add fibre to the diet gradually. We start buying more leafy greens, peeling tomatoes, cooking carrots. Of fruits, apples, bananas or kiwis are best. We can also add oatmeal, any cooked or raw vegetable.

Limit foods high in saturated fatty acids. Food intolerances are often associated with IBS. So watch out for dairy, gluten and histamine intolerances.

Eating should be done in peace. One should not do other activities at the same time. When having breakfast, lunch or dinner, one should devote oneself exclusively to that at that moment. In addition, there are appropriate and inappropriate foods that can improve or worsen the course of this unpleasant disease.

The following table summarises which foods, substances or food groups are suitable and which are not

Food/substance/food group Is it or is it not suitable for this disease?
Fried foods, fats, oils No
Saturated fatty acids - fats No
Refined foods full of sugars and preservatives No
Sweetened beverages, energy drinks No
Gluten No
Hot foods, spices, cayenne pepper, hot peppers No
Milk and dairy products No
Alcohol, cigarettes No
Caffeine No
Garlic, lemons, grapefruit, limes, stevia Yes
Yogurts containing live cultures or probiotics Yes
Whole grain rice, oats, herbs Yes
Bananas Yes
Cooked but also raw vegetables Yes
Prebiotics and probiotics, e.g. psyllium Yes

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