IBS or IBD?

Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) are both conditions affecting the gut.

Both can cause distress and a host of debilitating symptoms including chronic pain and discomfort, sudden changes in bowel habits and diarrhoea.

However, apart from a few common symptoms, these conditions are distinct, with IBD usually requiring a much greater degree of medical intervention

IBS is fairly common, affecting up to 1 in 5 of us, and is more prevalent in women than men. IBS is classed as a functional gastrointestinal disorder (FGID). This means there is no existing structural or biochemical abnormality upon examination although symptoms are apparent.

In general, the diagnosis of IBS comes about after serious health disorders have been ruled out – which, in a way, is a good thing.

Inflammatory Bowel Disease, or IBD, is less common with less than 1% of the population affected, but it is generally regarded to be much more serious.

IBD, unlike IBS, is characterised by structural damage or changes in the bowel with bleeding, chronic swelling, abscesses, fistulae and significant weight loss being common features. These outcomes are the result of chronic inflammation. Although the intestines are clearly inflamed, the reason why this occurs is not well understood.

IBD is the term used to describe a small group of disorders, most commonly: Crohn’s disease and ulcerative colitis.

Crohn’s disease is a chronic (long-term) inflammatory disease of the intestines, commonly affecting the lower part of the small intestine and into the large bowel. The development of ulcers, fissures and fistulae are often part of this condition. Crohn’s disease can result in inflammation of deeper layers of the bowel wall, including the muscle, rather than just the superficial layers of the gut as seen in ulcerative colitis.

Ulcerative colitis is defined as a chronic inflammatory condition distinctly affecting the large intestine. Often in the latter region of the large bowel, ulcerative colitis is characterised by ulceration of the inner layers of the gut.

The pattern of inflammation in ulcerative colitis is often uniform, displaying continuous inflammation of the large intestine. The affected areas in Crohn’s disease can differ somewhat and often present themselves in patches, broken up by sections of unaffected tissue.

Causes of both IBS and IBD are often hard to determine but plausible theories are as follows:

IBS is thought to be the result of a combination of factors including diet or food intolerance, altered gut function, psychological factors, gut bacteria imbalance, hormonal influences and genetic makeup.

As in IBS, causes of IBD are often uncertain but theories such as the impact of environmental factors (for example, diet or stress), exposure to infectious agents (bacteria or viruses), altered gut epithelial permeability, immune dysfunction and genetics are thought to have an influence.

Both IBS and IBD share common symptoms such as abdominal discomfort, pain and diarrhoea.

Generally, IBS symptoms are more centred on the digestive system and can include bloating, stomach pain, flatulence and altered bowel habits such as diarrhoea, constipation or both. Symptoms of IBS are more likely to be exacerbated by states of stress.

As well as abdominal issues, the inflammation in IBD can give rise to a whole host of other problems including complications in the joints, skin, eyes and can even result in fatigue. In some cases of IBS, low-grade immunoglobulin G (IgG) mediated inflammation is thought to occur and problems with the skin, for example, may arise.

In IBD, abdominal issues such as pain, swelling of the abdomen and diarrhoea are common but rectal bleeding or dark, bloody stools may also be a feature. Significant weight loss and malnutrition is also likely, especially in Crohn’s disease if the digestion and absorption of food is impaired due to damage and dysfunction of parts of the small intestine.

Please note if you experience bloody stools you should go to your doctor immediately.

The treatment for IBS is varied, especially if the causes are relatively unclear.

Often a range of dietary and lifestyle approaches can be useful. These can include: dietary management with particular attention to food intolerance, lifestyle changes such as addressing sleep issues or how much you exercise, considering psychological factors, mental wellbeing or your gut bacteria, which can all exacerbate symptoms, and finally considering all of these factors together with the addition of certain herbal remedies or conventional treatments, which can be useful in certain circumstances.

Although the cause of the inflammation in IBD may not be well understood, the main aim of treatment is to reduce this inflammation. Treatment usually involves medication or surgery in order to achieve long-term remission, although there is no cure.

Drugs used in the treatment of IBD include anti-inflammatory drugs, immune suppressants, antibiotics (if infection is apparent), anti-diarrhoeal medication, painkillers and any nutritional supplements that may be necessary to either address deficiencies or allow the bowel to repair (enteral nutrition). Surgery may also be required to remove areas of damaged intestine.

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