Irritable bowel syndrome

Living with Irritable Bowel Syndrome (IBS) can be frustrating and unpredictable. One day you may feel relatively well and the next find yourself struggling with abdominal pain, bloating or an urgent need to find a bathroom. For some people, these symptoms become persistent enough to affect work, travel, eating, sleep and social life. When abdominal pain becomes a major part of IBS, specialist pain management can sometimes provide an additional perspective alongside gastroenterology care.

IBS is a common disorder affecting the way the bowel functions. Importantly, it does not mean that the bowel is damaged. Instead, there appears to be a complex interaction between the bowel, its nerves and the brain, sometimes called the gut–brain axis. In some patients these nerves become unusually sensitive, meaning normal stretching and movement within the bowel can be experienced as uncomfortable or painful.

Symptoms vary considerably. You may experience cramping or aching abdominal pain, bloating, excessive wind and changes in bowel habit, including diarrhoea, constipation or a mixture of both. Symptoms may improve after opening the bowels and can sometimes be influenced by particular foods, stress, hormonal changes or illness. However, triggers are highly individual and are not always obvious.

The most important first step is making sure that IBS is the correct diagnosis. New or changing bowel symptoms, unexplained weight loss, bleeding, anaemia or other concerning features require appropriate medical investigation. Pain management should complement—not replace—assessment by your GP or gastroenterology team where this is required.

Treatment is therefore personalised. Depending on your symptoms, this may involve dietary advice, carefully selected medication, exercise, improving sleep, stress management and treatments directed at the communication between the bowel and nervous system. Psychological approaches can also be surprisingly effective—not because the pain is imagined, but because the brain and bowel are closely interconnected.

For patients whose abdominal pain remains troublesome despite appropriate treatment of their IBS, my role as a Pain Specialist is to look more closely at the pain itself. Sometimes there is an additional problem such as abdominal wall pain, myofascial pain, nerve entrapment or heightened sensitivity within the nervous system. Where a specific pain generator can be identified, treatments such as trigger-point injections, abdominal wall nerve blocks or ultrasound-guided peripheral nerve injections may occasionally be appropriate. More invasive procedures are not routine treatments for IBS itself and are considered only when there is a separate, clearly identifiable pain indication.

The objective is not simply to suppress symptoms. It is to understand why you hurt, reduce the sensitivity of the pain system and help you become less restricted by your condition. By combining gastroenterological treatment with specialist pain management when necessary, we can develop a more comprehensive plan aimed at improving comfort, confidence and quality of life.

IBS can be a long-term condition, but that does not mean you should simply accept persistent pain. Every patient experiences IBS differently. By listening carefully to your symptoms and considering the bowel, nervous system and wider factors contributing to your pain, we can work together towards a treatment strategy that is practical, individual and focused on helping you get back to living your life.