Is it IBS or something else?

Most diagnoses of Irritable Bowel Syndrome (IBS) are made after an examination of symptoms and having ruled out other disorders of the bowel.

A number of other conditions affecting the digestive system can share some of the same symptoms as IBS. This can be confusing or a cause for worry initially; however, there are often distinctions which can be made between the different digestive system conditions as we will discuss on this page.

IBS is a chronic condition affecting the digestive system. IBS is relatively common and is thought to affect up to 20% of the population. Although anyone can be affected by IBS and at any age, it most commonly develops in early adulthood and affects more women than men.

Unfortunately, there are no specific tests to determine whether or not you have IBS. On examination, no physical abnormalities can be found, the structural and biochemical environment of the gut all appear normal. The causes are unclear but psychological factors are an important factor in many cases of IBS.

The treatment of IBS is complicated as the cause is often unclear. However, it is important not to assume it is ‘something else’ just because managing your symptoms is proving difficult. Treating IBS can take time and very often, a number of factors need to be addressed together in order to effectively manage it.

IBS can give rise to a variety of embarrassing and debilitating symptoms.

These primarily affect the digestive system and common complaints include: bloating,  flatulence, stomach pain, constipation or diarrhoea.

However, other symptoms can manifest and our mood or weight may be affected, not to mention aches and pains in other less obvious areas of your body. The list of symptoms associated with IBS isn’t conclusive and is often individual.

Food intolerance is an adverse reaction to a component of the food and drink we consume. This can be in response to a wide range of common dietary elements, although some are more likely to act as triggers than others.

Common intolerances include those to wheat and gluten, dairy and lactose or FODMAPs. FODMAPs are a class of short chain carbohydrates which are found in a variety of fruit, vegetables, dairy products, and legumes.

A variety of symptoms can appear quickly in the affected individual, although they can develop slowly over a longer period of time which is something to consider. Common examples include:

• Bloating
• Flatulence
• Stomach pain
• Diarrhoea
• Constipation
• Nausea
• Vomiting
• Skin issues including rashes, hives or eczema
• Respiratory tract issues  – nasal congestion, sinusitis and cough
• Mouth ulcers
• Headaches, fatigue or brain fog

Food intolerances may occur alone or you may find that you are sensitive to more than one element of your diet. It can be a confusing concept as food intolerances may have a part to play in IBS or can occur alone.

It is possible to try and disentangle these conditions by keeping a food and symptoms diary. This helps you to detect patterns relating to specific aspects of your diet. By eliminating these from your diet you can begin to understand the impact they are having, either alone (intolerance) or if they are contributing to the bigger issue of IBS. Managing your diet is a huge part of tackling IBS as a whole.

Another important aspect of IBS, but not so specific to food intolerance, is psychological factors, so this area is also important to consider.

Inflammatory Bowel Disease, or IBD, is less common than IBS but it is generally regarded to be much more serious.
IBD, unlike IBS, is characterised by structural damage or changes to the bowel as a result of chronic inflammation.

Symptoms of IBD include many of those associated with IBS including swelling, diarrhoea and abdominal pain. However, additional warning signs to look out for include fresh blood, black stools, chronic swelling, abscesses, fistulae or a significant reduction in body weight.

IBD is an umbrella term for a number of conditions, including 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. The patterns of inflammation in ulcerative colitis are often uniform, displaying continuous inflammation of the large intestine, in contrast to Crohn’s disease where the inflammation often appears in patches, broken up by sections of unaffected tissue.

Coeliac disease is an autoimmune disease caused by an adverse reaction to a specific component of gluten called gliadin. The immune system mistakes gliadin for a pathogen and in doing so, attacks the lining of your small intestine, causing significant damage.

The structure of the inside of the small intestine wall is unique. Finger-like projections called villi project into the inside space, creating an increased surface area and allowing better absorption of the food we eat. Unfortunately, these delicate villi are attacked in coeliac disease and become shorter, flatter and less efficient at their job.

People with coeliac disease are susceptible to flatulence, constipation, diarrhoea, extreme stomach pain and cramping after eating sources of gluten, as well as nausea, vomiting, headaches, fatigue, malabsorption and deficiencies in certain vitamins and minerals. Common deficiencies in coeliac disease include iron, calcium, vitamin D, zinc, B vitamins, magnesium, folate and phosphate. Sufficient calorie intake and weight loss may also be a problem.

Unlike food intolerance, people with coeliac disease should not consume any gluten as the consequences can be so damaging. The condition is specific to this one ingredient.

Obtaining essential vitamins and minerals from fresh sources of gluten-free foods is essential. Many processed gluten-free products are lacking in nutrients so these should be consumed sparingly. Hidden sources of gluten can be found in many foods including soy sauce, processed meats and other packaged foods, so reading food labels is important.

Bowel cancer affects the large intestine and is one of the most commonly diagnosed types of cancer in the UK. It is more prevalent in people over 60 years of age.

Whilst symptoms of bowel cancer can sometimes share some symptoms that are similar to IBS; an additional symptom to look out for is the presence of blood.

IBS isn’t an inflammatory disorder, and therefore there should be no damage to structure to the intestine. The presence of fresh blood, or dried blood giving rise to black stools should always be investigated by your doctor.

Diverticular disease is when small pockets, called diverticula, develop on the lining of the large intestine. This is more likely to happen to people over the age of 70 and constipation increases the risk. If these pockets become inflamed the condition is known as diverticulitis.

Symptoms of diverticulitis can include bloating, nausea, quicker than normal bowel movements, diarrhoea and abdominal pain (often starting below the navel and moving towards the left had side of the body). An increase in body temperature is also a unique characteristic of this condition.

Indigestion, or dyspepsia, is a problem occurring further up in the digestive tract, affecting the stomach rather than further down in bowels. However, stomach problems over time can aggravate the bowels, so tackling this issue can actually improve issues further down in the digestive tract.

Common symptoms of indigestion include acid reflux or heartburn, feelings of fullness, bloating (again higher up in the digestive tract) and belching.

Indigestion may occur occasionally after a particularly heavy or fatty meal, however, if it happens more often it suggests there is an issue. Digestive remedies such as Digestisan may prove useful if indigestion is a repeat problem for you.

Endometriosis is a chronic condition affecting the womb, therefore specific to women. In endometriosis parts of the lining of the womb somehow make their way outside the womb which gives rise to a number of symptoms.

These symptoms generally include painful or particularly heavy periods and pain in the lower abdomen and back. This pain is often mistaken for bowel pain. Endometriosis can in rare cases also actually affect the bowels and blood may appear from the back passage, making the distinction even more unclear. As always, any signs of blood here should warrant a trip to the doctor.

To summarise, problematic periods are a common feature of endometriosis but not necessarily IBS, although the two can be mistaken for one another or the symptoms can become intertwined.

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