If I have been diagnosed with IBS should I see a Gastroenterologist, the GP, the Pharmacist or a Dietician?
The symptoms of Irritable Bowel Syndrome (IBS) are often mild but for many the condition is a long term burden. In some cases a more serious underlying problem might be the cause. This concern can often be reduced by a simple professional assessment without the need for invasive tests. Tests to exclude serious disease are important when appropriate and, in older patients, may help to reduce the risk of future colonic malignancy. Management of IBS should start with carefully listening to the patient’s clinical history, performing appropriate examination and investigation and then starting treatment, preferably based on diet and non-pharmaceutical therapy. Many patients can be managed by their family doctor and pharmacist. For those with more significant symptoms a gastroenterologist and dietician are often the best team to help the patient manage the condition.
As Consultant Gastroenterologist, Dr Andrew Millar explains in his article for Total Health - Diagnosing and Treating Irritable Bowel Syndrome - Latest Expert Advice; "Irritable Bowel Syndrome (IBS) is very common, affecting one out of 6 adults. Although the symptoms of IBS vary there are typical features which can help doctors make an accurate diagnosis without using invasive investigations. A diagnosis of IBS also relies on checking for worrying symptoms, which doctors call ‘warning’ or ‘red flag’ signs."
When these symptoms appear more thorough investigation is needed.
- IBS Step One - is to exclude serious disease; often with as little intervention as possible.
- IBS Step Two - is to treat the condition as effectively as possible.
- IBS Step Three - it is important to provide explanation and support to minimise the impact of remaining symptoms and to allow the patient to manage the condition in the long term, themselves.
When should you be worried that bowel symptoms are not due to IBS?
Many serious bowel disorders can mimic IBS but almost always have other features that should raise concern and lead to investigation.
Duration of the symptoms – IBS is a long-term condition. It can start with a bowel infection, an operation or trauma to the intestine but the starting point in most patients is not obvious. Anyone with recent symptoms that are not getting better may well have a different problem.
Rectal bleeding - The passage of blood is NOT a feature of IBS and should always be fully assessed.
A lump in the abdomen or rectum – Anyone feeling a lump in the abdomen that does not pass on opening their bowels or any in the anus or rectum should see a doctor for a full examination
Age – The main concern here is bowel cancer. Although this can occur at almost any age, it is incredibly rare under 20, very rare under 30 and rare under 50.
The ‘Red Flag’ or ‘Warning’ features – Those features listed below should always be investigated, as should lesser symptoms, or those in younger people, that are started fairly recently and are worsening over days, weeks or months. The ages are not given as a single figure as there is no absolute cut off above which we should become concerned. The red flag features are:
- The passage of dark blood, or blood mixed in with the stool, particularly if the stool has become looser or more frequent
- New onset of any blood in the stool in a patient over 40–45
- Recent onset of stools looser than normal for more than 3 weeks, in those over 40–50 and 6 weeks if less than 40-50
- Unexplained significant weight loss with altered bowel habit at any age
- Iron deficiency anaemia in any male and any female who does not have significant menstrual blood loss
- Anyone with a mass in the abdomen, anus or rectum
- Any person with very severe bowel symptoms, at any age
Latest Probiotic Treatment for IBS
See - New Multi-Strain Probiotic Effective for IBS and IBD by Professor Ingvar Bjarnason
As Prof Bjarnason says, "Currently licensed drugs for IBS have such limited efficacy that many of us have stopped using them."
He goes on to say, "Additionally, any marginal benefit is often outweighed by side effects. For most patients, there is no effective treatment, and all we can do is offer management strategies and as much support as possible". And then referring to the new four-strain probiotic, Symprove, "An effective therapy would have an enormous impact on this frustrating situation."