bowel that comes and goes

Overview

This refers to digestive symptoms that come and go, such as abdominal pain, bloating, diarrhea, and constipation happening at different times. It is often linked to a common condition called irritable bowel syndrome (IBS), where the bowel works differently without any visible damage.

Yes, these symptoms are very common. Many people experience occasional digestive discomfort, but when it comes and goes regularly, it may be IBS.

It can affect anyone, but it is more common in women and often starts in young adulthood. People with stress, anxiety, or a family history of IBS are more likely to have it.

Symptoms

Common symptoms

• Abdominal pain or cramping that improves after a bowel movement
• Bloating and gas
• Diarrhea, constipation, or alternating between both
• Feeling like you haven't finished a bowel movement (incomplete evacuation)
• Mucus in the stool
• Urgency to use the toilet

Symptoms in children

• Recurring tummy aches, often around the belly button
• Changes in bowel habits (diarrhea or constipation)
• Bloating or feeling full quickly
• School absences due to stomach discomfort

Symptoms in older adults

• Similar symptoms but may be mistaken for other digestive problems
• Unintentional weight loss or new constipation should be checked by a doctor
• Older adults may be more likely to have side effects from medications affecting the bowel

Causes

Main causes

• Problems with how the brain and the bowel talk to each other (brain-gut axis)
• Food triggers such as fatty foods, spicy foods, or certain carbohydrates (called FODMAPs)
• Stress and emotional upset
• Changes in the normal gut bacteria (microbiome)
• Mild inflammation or increased sensitivity in the bowel

Risk factors

• Family history of IBS
• High levels of stress or anxiety
• Past gastrointestinal infection (post-infectious IBS)
• Being female
• Certain food intolerances (e.g., lactose, gluten)

When to see a doctor

See a doctor urgently if:

• If you see blood in your stool
• If you have unexplained weight loss
• If your pain is severe and constant

Book a routine appointment if:

• If your symptoms have lasted for more than a few weeks
• If they are affecting your daily life
• If you have a family history of colon cancer or other bowel diseases

Diagnosis

There is no single test for IBS. Doctors diagnose it based on your symptoms after ruling out other conditions. They will ask about your bowel habits, pain, and triggers.

Tests that may be done

• Blood tests to check for inflammation or anemia
• Stool tests to look for infections or bleeding
• Breath tests for food intolerances (like lactose or fructose)
• Colonoscopy (a camera test of the large bowel) if you have 'red flag' symptoms like bleeding or weight loss

What to expect at your appointment

The doctor will take a careful history and may suggest a symptom diary. Tests are used to rule out other diseases. Most people with intermittent bowel symptoms have IBS, which is not dangerous but can be disruptive.

Treatment

Treatment focuses on managing symptoms and improving quality of life. It often combines diet changes, stress management, and sometimes medications.

Self-care at home

• Keep a symptom diary to identify triggers (food, stress, etc.)
• Eat smaller, more frequent meals
• Increase fiber gradually if you have constipation, but reduce certain types (insoluble fiber) if you have diarrhea
• Stay well hydrated
• Practice relaxation techniques like deep breathing, yoga, or meditation

Medical treatments

If self-care isn't enough, doctors may recommend medications to help with pain, diarrhea, or constipation. They might also suggest low-dose antidepressants to calm the bowel nerves or antispasmodics for cramps. Always follow your doctor's advice on any medicine.

When is surgery considered?

Surgery is almost never needed for intermittent bowel symptoms like IBS. It is only considered if there is a complication like a blockage or if another condition (like diverticulitis) develops.

Living with this condition

Living with symptoms that come and go can be frustrating. Planning ahead—like knowing where toilets are—can reduce anxiety. A symptom diary helps you and your doctor see patterns.

Lifestyle tips

• Get regular physical activity (walking, swimming) to help bowel function
• Practice good sleep habits
• Reduce stress through hobbies, therapy, or support groups
• Avoid smoking and limit alcohol or caffeine

Diet and exercise

A balanced diet with adequate fiber is helpful. Some people benefit from a low-FODMAP diet, which is best done with a dietitian. Light exercise like walking after meals can ease bloating and cramps.

Mental health and emotional wellbeing

Anxiety and depression can make bowel symptoms worse. It's a two-way street: bowel symptoms can also increase stress. Cognitive behavioural therapy (CBT) or talking with a therapist can be very helpful.

Prevention

You cannot prevent having intermittent bowel symptoms, but you can reduce how often they happen by managing triggers like stress and certain foods. Building healthy habits early may help.

Screening programmes

There is no routine screening for IBS, but if you have a family history of bowel cancer, you may be offered colonoscopy screening. Talk to your doctor about what is right for you.

Complications

If left untreated

• Poor quality of life due to ongoing discomfort and worry
• Nutritional deficiencies if you avoid many foods
• Social isolation or missed work/school
• Worsening of anxiety or depression

Long-term outlook

Most people with intermittent bowel symptoms manage well with lifestyle changes and sometimes medical help. The condition does not lead to cancer or cause permanent damage. With the right approach, you can reduce symptoms and live a full life.

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