Irritable Bowel Syndrome (IBS): What Is It and What Can You Do About It?

Imagine this: you wake up in the morning with a bloated stomach, you suffer from cramps, and you're never sure how your bowels will react that day. A dinner with friends or a meeting at work becomes a source of anxiety even before it happens. This is the daily life of millions of people with Irritable Bowel Syndrome. IBS is estimated to affect 10 to 15% of the adult population in the Netherlands — yet for many, the condition remains misunderstood or even undiagnosed. Fortunately, there is growing clinically-supported knowledge about IBS, and evidence-based treatment options are available that can significantly improve patients' lives. In this article, [KOL name], [Title and affiliation], clearly explains what IBS is, how to recognize it, and — more importantly — what you can do about it.

What is Irritable Bowel Syndrome?

Irritable Bowel Syndrome (IBS) is a functional bowel disorder in which the bowel appears structurally normal yet causes symptoms. The condition is diagnosed in medical practice using the so-called Rome IV criteria: recurrent abdominal pain, on average at least one day per week, over the past three months, in association with two or more of the following: the pain is related to defecation, the pain is associated with a change in the frequency of stool, or the pain is associated with a change in the consistency of stool. These criteria are internationally accepted and help doctors distinguish IBS from other conditions.

A common confusion is that between IBS and inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. The crucial difference: with IBD, there is demonstrable inflammation and tissue damage in the intestinal wall, visible during endoscopy and on biopsies. With IBS, no structural abnormalities are found during additional examinations — the symptoms are real, but the cause lies in the way the gut and brain communicate, not in a visible tissue defect.

In the Netherlands, an estimated 10 to 15% of the adult population suffers from irritable bowel syndrome, making it one of the most common reasons for referral to a gastroenterologist. Women are diagnosed slightly more often than men, and symptoms typically begin before the age of forty.

Symptoms of IBS

The most common complaints

IBS symptoms can vary greatly from person to person, but there is a recognizable pattern. The most frequently reported irritable bowel complaints are:

• Abdominal pain and cramps — often in the lower abdomen, which relieve after bowel movement
• Bloating (flatulence) — a full and distended feeling in the abdomen, often worsening during the day
• Wind — excessive gas production in the bowel
• Change in bowel pattern — alternating between diarrhea (IBS-D), constipation (IBS-C), or a combination of both (IBS-M, mixed type)
• Mucus in stool — without the presence of blood
• Urgency — sudden and urgent need to go to the toilet

Fatigue and a general feeling of unwellness are also part of the symptom spectrum, partly because sleep can be disturbed by nocturnal symptoms.

When to see a doctor?

Although IBS itself is not dangerous, there are so-called red flag symptoms that always warrant a visit to a GP or specialist. Consult a doctor immediately if you experience:

• Blood with or in the stool
• Unintended weight loss
• Persistent fever
• Nocturnal symptoms that wake you up
• First onset of symptoms above the age of fifty
• Family history of bowel cancer or IBD

These symptoms may indicate an underlying condition — such as IBD, celiac disease, or colorectal carcinoma — that requires further diagnosis.

What Causes IBS?

IBS has no single cause; it is a multifactorial condition where biological, psychological, and social factors play a role. Insights from clinical gastroenterology point to the following mechanisms:

Gut-brain axis dysregulation. The gut and brain communicate constantly via the enteric nervous system, the vagus nerve, and hormone-like signaling substances. In IBS, this bidirectional communication is disrupted: the gut sends amplified or incorrect signals to the brain and vice versa, leading to abnormal bowel motility and altered pain sensation.

Post-infectious IBS. In some patients, symptoms develop after an acute gastrointestinal infection (gastroenteritis). Estimates suggest that 10 to 25% of people who experience a severe infection subsequently develop IBS symptoms. This indicates long-term changes in the intestinal mucosal barrier and the immune system.

Disruption of the gut flora (dysbiosis). The composition of the gut microbiome plays an important role in regulating bowel motility, immune activity, and the production of neurotransmitters such as serotonin. Research shows that patients with IBS have an altered microbiome composition compared to healthy controls.

Visceral hypersensitivity. The threshold for experiencing pain in the intestines is lower than normal in IBS patients. Normal bowel contractions or gas passage, which cause no discomfort in others, are perceived as painful or unpleasant.

Stress and psychological factors. Anxiety, depression, and chronic stress are both risk factors and consequences of IBS. The gut-brain axis ensures that emotional stress can trigger noticeable bowel symptoms directly — a vicious cycle that perpetuates the symptoms.

IBS Treatment: What Works?

Effective IBS treatment is rarely monodisciplinary. The best available evidence points to a combined approach involving lifestyle, diet, psychological support, and — where necessary — pharmacological or microbiome-targeted interventions.

Dietary adjustments

For many IBS patients, food is a significant trigger. The low-FODMAP diet — which temporarily restricts fermentable carbohydrates — is currently the best-supported dietary intervention for IBS. Clinical studies show that 50 to 75% of patients experience a significant reduction in symptoms. The diet consists of three phases: elimination (2–6 weeks), reintroduction, and personalization. It is advisable to follow this diet under the guidance of a dietitian with IBS expertise, as too strict or prolonged elimination can be detrimental to the diversity of the gut microbiome.

Stress management and exercise

Given the central role of the gut-brain axis, relaxation techniques and cognitive behavioral therapy (CBT) are proven effective components of treatment. Regular physical activity — preferably aerobic, such as walking, cycling, or swimming — promotes bowel motility and reduces stress levels. Gut-directed hypnotherapy has also shown significant effects on quality of life in IBS in randomized trials.

The role of gut flora and probiotics for IBS

Not all probiotics are created equal. Scientific research makes a clear distinction between generic multi-strain products and specific clinically studied bacterial strains. The Bifidobacterium longum 35624™ strain — originally isolated from a healthy human gut and clinically proven to withstand passage through the gastrointestinal tract — has been studied in multiple randomized, placebo-controlled clinical trials, published in peer-reviewed journals.

The two most prominent clinical studies are:

• O'Mahony et al. (2005) — A placebo-controlled study in IBS patients showing that Bifidobacterium longum 35624™ normalizes the immune response and significantly improves symptoms compared to placebo.¹
• Whorwell PJ et al. (2006) — A randomized, double-blind, placebo-controlled trial in women with IBS, published in the American Journal of Gastroenterology (101(7):1581–1590). The study showed significant improvement in IBS symptoms — including bloating, abdominal pain, gas, and irregular bowel movements — compared to placebo.²

The authoritative judgment of the World Gastroenterology Organisation (WGO, 2016) endorses this clinical evidence: the WGO explicitly stated that the 35624™ strain «currently has the best evidence base for efficacy in IBS» — currently the best evidence base for efficacy in IBS among all probiotic strains studied.³ The strain is also included in international clinical guidelines for the management of IBS and lower gastrointestinal symptoms.

Alflorex, the probiotic from Walhalla Health that exclusively contains this clinically studied strain, delivers 10⁹ (1 billion) CFU per capsule — the dose used in the clinical trials. The strain was originally isolated from a healthy human gut and is clinically proven to withstand passage through the gastrointestinal tract. Alflorex is an evidence-based option for people seeking microbiome-targeted support for IBS symptoms.

When to consider medication?

For persistent or severe symptoms, medication may be considered, always in consultation with a doctor. Available options include antispasmodic agents (such as mebeverine or peppermint oil capsules), loperamide for diarrhea-dominant IBS, osmotic laxatives for constipation-dominant IBS, and in selected cases low doses of tricyclic antidepressants or SSRIs, which can modulate visceral pain sensation. Your GP or gastroenterologist can advise you on which option is most suitable for your specific IBS subtype.

Living with IBS: Practical Tips

IBS is a chronic condition, but it is excellently manageable. The following five practical tips help patients maintain control over their symptoms daily:

• Keep a symptom and food diary. Note what you eat, how much you exercise, your stress level, and your symptoms. This way, patterns become visible, and you can make targeted adjustments.
• Eat regularly and calmly. Don't skip meals. Chew thoroughly and eat without distractions. Large, fatty, or highly spiced meals can irritate the bowel.
• Schedule regular relaxation moments. Diaphragmatic breathing, yoga, or meditation — even five to ten minutes a day can noticeably reduce stress levels and, consequently, bowel symptoms.
• Exercise daily. Half an hour of moderate physical activity contributes to regulating bowel motility and reduces anxiety and stress. Start small and build up gradually.
• Talk to your doctor about it. IBS symptoms are still too often unreported or not taken seriously. A good treatment relationship with your GP or specialist is essential for a personalized treatment plan.

It's important to know: you are not alone. Millions of Dutch people live with Irritable Bowel Syndrome and find ways to lead an active and fulfilling life despite their symptoms.

Frequently Asked Questions about IBS

Conclusion

Irritable Bowel Syndrome is a common, complex, but manageable condition. Through the right combination of dietary adjustments, stress management, exercise, and — where applicable — targeted microbiome support, most patients can significantly reduce their symptoms and improve their quality of life. Science does not stand still: new insights into the gut-brain axis and the gut microbiome offer increasing avenues for effective treatment. Always discuss your symptoms with your GP as a starting point for a personalized treatment plan. Would you like to read more about evidence-based supplements for gut health, including clinically studied probiotics? Visit walhallahealth.com for further reading material and product information.

Clinical References

1. O'Mahony L, et al. (2005). Lactobacillus and Bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology, 128(3):541–551.
2. Whorwell PJ, et al. (2006). Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. American Journal of Gastroenterology, 101(7):1581–1590.
3. World Gastroenterology Organisation (2016). WGO Global Guidelines: Probiotics and Prebiotics. [35624™ described as: «currently has the best evidence base for efficacy in IBS».]
4. Quigley EMM, et al. (2012). The gut-brain axis and the microbiome: clues to pathophysiology and opportunities for novel management strategies in irritable bowel syndrome. Journal of Gastroenterology, 47(12):1247–1261.
5. Dutch Association of Gastroenterologists (NVMDL). Irritable Bowel Syndrome Guideline (most recent version). Available via: www.nvmdl.nl.