Which Specialist should I see for IBS Irritable Bowel Syndrome

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, Mr Andrew Millar explains in his excellent article for totalhealth - http://www.totalhealth.co.uk/clinical-experts/dr-andrew-millar/diagnosi…-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

Continuing IBS symptoms over the age of 50 could be a sign of bowel cancer

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."

The part of the body that contains the stomach, intestines, liver, gallbladder and other organs. Full medical glossary
A reduced level of haemoglobin, which carries oxygen in the blood. Anaemia causes tiredness, breathlessness and abnormally pale skin. Full medical glossary
The external opening of the back passage, the rectum. Full medical glossary
A fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. Full medical glossary
A common name for the large and/or small intestines. Full medical glossary
Abnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. Full medical glossary
The basic unit of all living organisms. Full medical glossary
The large intestine. Full medical glossary
The process of determining which condition a patient may have. Full medical glossary
A doctor who specialises in the digestive system and its disorders. Full medical glossary
An abbreviation for inflammatory bowel disease, a group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. Full medical glossary
irritable bowel syndrome, a combination of abdominal pain and constipation, diarrhoea, or bouts of each that occur in the absence of any other diagnosed disease Full medical glossary
Invasion by organisms that may be harmful, for example bacteria or parasites. Full medical glossary
The section of gut, or gastrointestinal tract, from the stomach to the anus. Full medical glossary
A craving to eat non-food substances such as earth or coal. Full medical glossary
The last part of the large intestine, where faeces are stored before being passed. Full medical glossary
the organ or the body where food is stored and broken down Full medical glossary
A physical injury or emotionally painful event. Full medical glossary