General practitioner Dr. Preeya Alexander wants to set things straight about Irritable Bowel Syndrome– it’s a lot more complex than you might think.

Irritable bowel syndrome (IBS) – either you have it, know someone who does or have had a dinner table conversation about the condition (or is this just me?). Some people thrive better with a label for their ‘upset belly’ and self diagnose IBS when in reality we know there is a lot more to the condition and a lot more needs to be done by a doctor before we can diagnose it.

So what is this syndrome? What causes it? And do every man and his dog really have it?

IBS affects 10 to 15% of the Australian population and occurs much more commonly in women.

We now know a lot more about the condition and it’s seriously complex but to simplify it – we believe it has a great deal to do with the way the brain and the gut talk to each other. We believe patients with IBS have a more sensitive “on edge” gut which interacts with a more sensitive brain and so the signals from the gut are perceived differently in someone with IBS than someone without it. Where a bit of wind and spasm might not affect a healthy gut, in IBS it can cause great distress and pain for the patient.

So hello symptoms of an “anxious bowel” – diarrhea or constipation (or both for some poor patients), flatulence, bloating and belly pain. For some the symptoms are every day, for others it’s in times of stress like during an exam period and for some it’s completely erratic so they have no idea when the symptoms will hit them.

You might be reading this thinking – “wow this is me, I think I have IBS.” The key is to see your GP first so that a checklist of things can be done before we label you with the syndrome. We will usually take a history of your bowel habits, examine you and run some tests (usually blood and faecal tests). We do these to check there is nothing else going on – nothing more serious like coeliac disease, Chron’s disease or bowel cancer. If these things look OK and we think you don’t need a colonoscopy (a camera test of the bowel) or a specialist review then it’s probably time to talk IBS.

Given its complexity there are loads of things that can help from diet changes and medications to psychological strategies. The low FODMAP diet is often the first thing we use in IBS – I won’t go into this acronym now because you would be reading forever – but it’s essentially a diet that tries to limit foods which irritate an already sensitive bowel and a dietician is normally key in implementing this properly.

Truth is – it is a chronic condition you will likely have for the long haul. I can’t snap my fingers and cure it and neither can a magic drug nor surgery BUT we can certainly control your symptoms and improve quality of life. Between diet changes, medications (like peppermint oil which soothes the abdominal pains) and psychological inputs that can help to work on the brain gut interactions – there are loads of options. And then we know that lifestyle interventions like exercise and relaxation strategies can help the IBS symptoms too, which allows for many other non-drug treatment options! And whilst we might suggest breath testing in some patients (to look for fructose or lactose malabsorption), others do not need it – the path to diagnosis and a happier gut is different for every person.

But for everyone there’s the same start point – if you’re bothered by diarrhea/constipation/abdominal pains or think something just isn’t right in your gut – it all has to start with a chat to the GP.


Dr Preeya Alexander is a General Practitioner working in Melbourne. She is passionate about preventative health and believes strongly in educating patients so they have the tools needed to drive their own positive health changes. Preeya health blog, the Wholesome Doctor, covers a range of issues from nutrition and weight management to pregnancy and child health. Preeya can be followed on Instagram (@thewholesomedoctor).