Living with Irritable Bowel Syndrome: A Science-Based Guide

This article presents the most important, up-to-date, and evidence-based information about Irritable Bowel Syndrome (IBS), intended especially for patients and their loved ones. All advice, facts, and recommendations are based on the consensus Guidelines on the management of irritable bowel syndrome, published in the prestigious Gastroenterology Review in 2018. The team of authors includes leading researchers and gastroenterologists from top university and clinical centers in Poland: Dr. Anna Pietrzak, Dr. Barbara Skrzydło-Radomańska, Dr. Agata Mulak, Dr. Michał Lipiński, Dr. Ewa Małecka-Panas, Dr. Jarosław Reguła, and Dr. Grażyna Rydzewska. The aim of this material is to provide accessible and reliable knowledge on the causes, diagnosis, treatment, and daily management of IBS—according to the latest medical standards.

"Irritable Bowel Syndrome affects one in ten people worldwide, most often in younger individuals and in women—early diagnosis and awareness are the first steps toward a better life."

Expert Opinions

This article presents the most current expert and science-based recommendations for the diagnosis, treatment, and daily management of Irritable Bowel Syndrome (IBS), based on a consensus document developed by experts from the Polish Society of Gastroenterology and published in Gastroenterology Review in 2018. The authors are leading specialists from university and clinical centers across Poland, and their guidelines are based on a systematic review of global scientific literature and modern standards for evaluating medical evidence. Below are five key expert opinions/quotes that will help patients and their loved ones better understand the nature and treatment of IBS.

1. How common is IBS and who is at risk? 

"The prevalence of IBS in the global population is estimated at 11%. The prevalence of IBS in women is about twice as high as in men. Half of patients report their first symptoms before the age of 35."

Explanation: IBS is a widespread condition that most often affects young women but can occur at any age. If you're experiencing similar symptoms, you're not alone.

2. What are the main underlying mechanisms behind IBS? 

"In the multifactorial pathogenesis of IBS a key role is played by disorders of gut-brain interactions (DGBI). The intestinal microbiota is an essential element of these interactions, and its dysregulation directly affects the other pathogenic mechanisms of IBS."

Explanation: The causes of IBS are complex and involve not just physical factors but also neurological and psychosocial ones. That’s why treatment often needs to be comprehensive and personalized.

3. What are the main symptoms and how is IBS diagnosed? 

"We recommend diagnosis of irritable bowel syndrome based on the Rome IV diagnostic criteria. Recommendation: strong, quality of evidence: moderate."

Explanation: Diagnosis is primarily based on well-described symptoms and criteria, not on lab or imaging tests. Frequent abdominal pain linked with changes in the frequency or type of bowel movements is key.

4. What non-medication approaches are effective for relieving symptoms? 

"We suggest moderate physical exercise of various forms (including yoga) in order to maintain fitness and reduce the overall symptoms of IBS. Recommendation: weak, quality of evidence: very low."

Explanation: Even though scientific data is limited, exercise and mental well-being have been shown to help many people with IBS and can be an important part of managing the condition.

5. Which dietary and probiotic recommendations are supported by science? 

"In order to reduce the overall symptoms, we suggest a temporary (6-week) diet with a low content of poorly absorbed, easily fermentable oligo-, di-, monosaccharides and polyols (the low-FODMAP diet). [...] We suggest using certain strains or a combination of probiotic strains tested for their efficacy in IBS, rather than probiotics as a group, to reduce overall symptoms of IBS as well as bloating and diarrhoea in patients with IBS."

Explanation: Patients may benefit from trying a low-FODMAP diet and specific probiotic products. These choices should be discussed with a healthcare provider or dietitian to avoid mistakes and get the best results.

Questions & Answers

1. Can stress and emotional health affect IBS symptoms? 

Answer: Yes. Between 50% and 80% of IBS patients report a clear link between stressful situations and worsening symptoms. The central nervous system and emotional health (such as depression, anxiety, and somatization) play a significant role in the onset, perception, and severity of symptoms. That’s why stress management and psychotherapy are important parts of treatment.

2. What additional symptoms might I experience beyond digestive issues? 

Answer: In addition to typical symptoms like abdominal pain, bloating, and changes in bowel movements, many IBS patients also report non-digestive symptoms such as fatigue, headaches, back pain, frequent urination, and—for women—menstrual irregularities and pain during intercourse. These are not diagnostic but are common and can impact quality of life.

3. When is a colonoscopy necessary for IBS? 

Answer: Colonoscopy is recommended only for patients over 50 or those with “red flag” symptoms like unexplained weight loss, bleeding, anemia, fever, a palpable abdominal mass, family history of colorectal cancer, or suspected inflammatory bowel disease. In younger patients without these warning signs, a colonoscopy is usually not needed.

4. What role do dietary fibers play, and which ones are recommended for IBS? 

Answer: Long-term intake of soluble (not insoluble) fiber is recommended—for example, psyllium, oat bran, fruits, and vegetables. Insoluble fibers like wheat bran may worsen pain and bloating. The recommended dose is 10–25 grams of soluble fiber daily, as tolerated.

5. What medications are used for IBS, and are antidepressants helpful? 

Answer: Certain antispasmodics (such as hyoscine and drotaverine) are recommended to relieve symptoms and are generally safe. In more severe or persistent cases—especially with significant pain or emotional distress—tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) may be prescribed by a doctor, usually at low doses.

Conclusion

Irritable Bowel Syndrome (IBS) is a common condition with a wide range of symptoms that can significantly affect quality of life. Current international guidelines confirm the importance of a comprehensive, individualized, and informed approach—from careful diagnosis, through proper diet and physical activity, to conscious stress management and appropriate medication use. Patients play a central role in managing their condition, and awareness is the first and most important step toward effective coping and improving daily life.

Source:

Pietrzak A., Skrzydło-Radomańska B., Mulak A., Lipiński M., Małecka-Panas E., Reguła J., Rydzewska G. “Guidelines on the management of irritable bowel syndrome.” Gastroenterology Review 2018; 13(4): 259–288. DOI: 10.5114/pg.2018.78343