Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a health problem that many people have but few people talk about. People who are diagnosed with IBS experience chronic symptoms related to the workings of their intestines.

What Is IBS?

IBS is a digestive disorder in which people experience recurrent bouts of abdominal pain, alongside significant changes to their experience of bowel movements. People who have IBS may experience chronic constipation, episodes of urgent diarrhea, or flip-flop back and forth between the two extremes.

IBS-A bowel movement patterns can change between weeks or months.

IBS is classified as a functional gastrointestinal disorder, in that it involves a malfunction in how the intestinal system works, but doesn’t present with any signs of visible disease process or tissue damage. It is estimated to affect up to 15 percent of the population at some point during their lifetime.

IBS symptoms may vary from person to person, or may vary over time for each individual who has the disorder.

People who have IBS may experience:

• Abdominal pain, cramping, spasms, or discomfort (often relieved by a bowel movement)
• Diarrhea: loose, watery stools, possibly with feelings of urgency, and/or three or more bowel movements a day
• Constipation: hard, dry stools, straining on the toilet, and/or three or fewer bowel movements a week
• Feelings of incomplete evacuation after a bowel movement
• Excessive intestinal gas
• Bloating, which often worsens as the day goes on
• Changes to the look of stools
• Mucus on stools

Top 4 Things to Know About IBS

1. Researchers are not yet quite clear why people develop IBS. Often the disorder manifests itself following a severe bout of gastroenteritis, otherwise known as the stomach flu. Sometimes symptoms appear after the experience of an extremely stressful event. A high incidence of IBS is seen in adults who were the victim of sexual or physical abuse in childhood.

1. IBS is diagnosed based on symptoms, as opposed to test results. This is because signs of IBS do not show up on diagnostic tests. Your doctor may choose to run some tests, based on your clinical picture and medical history, but these tests are used to rule out other digestive diseases that may be causing your symptoms.
2. The lack of positive test results does not mean that IBS is all in your head. Research indicates that IBS symptoms may be the effect of an interaction among many factors, including some or all of the following:
   • Changes in gut motility - the speed of intestinal movement
   • Visceral hypersensitivity - higher feelings of pain in internal organs than normal
   • Inflammation in the lining of the intestines
   • Dysfunction in the communication systems between the gut and the brain
   • An imbalance among gut bacteria
   • Food intolerance or sensitivity
   • Increased intestinal permeability (leaky gut syndrome)
3. IBS can be broken down into different sub-types: diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), and alternating type (IBS-A), in which the predominant bowel symptom changes over time.

What Else Could It Be?

IBS is diagnosed after other disorders have been ruled out through routine diagnostic testing. The following are some of the health conditions that your doctor will want to rule out:

Celiac Disease: Celiac disease is a condition in which eating foods that contain gluten results in a problematic autoimmune response in which the villi lining the small intestine are damaged. People who have IBS are at higher risk for undiagnosed celiac disease.

Inflammatory Bowel Disease (IBD): The inflammatory bowel diseases of Crohn’s disease and ulcerative colitis present with many of the same symptoms as IBS. However, IBD symptoms include bloody diarrhea, weight loss, and fevers, all symptoms that are not present in IBS. In addition, with IBD, visible signs of inflammation will be seen in the digestive tract during a colonoscopy.

Food Intolerance: A food intolerance differs from a food allergy in that the problem occurs at the level of the digestive system as opposed to an immune system response.

Food malabsorption or intolerance can cause IBS-like symptoms. Two of the more common kinds are lactose intolerance and fructose malabsorption.

Colon Cancer: People who have IBS frequently worry that they might have colon cancer that has been missed by their doctor. Symptoms of colon cancer that are not seen in IBS are signs of rectal bleeding or bloody stools, anemia, extreme fatigue, and significant unexplained weight loss. 

If You Have Recently Been Diagnosed With IBS

Although your doctor may tell you that there is no cure for IBS, you may find reassurance in the fact that there are plenty of things that can be done to help to quiet your symptoms. Here are some things for you to learn more about:

Medication options: Your doctor may choose to prescribe you a medication designed to ease your symptoms. Available options include:

• Antispasmodics: May be prescribed for relief of abdominal pain and cramping
• Antidepressants: May be prescribed for pain reduction and to address any co-existing depression or anxiety symptoms

• Antibiotics: Specific types may be prescribed that target a possible overgrowth of bacteria in the small intestine (SIBO)
• IBS-specific medications: These include Amitiza and Linzess for IBS-C and Viberzi for IBS-D.

Over-the-Counter Remedies (OTCS): Talk to your doctor about what OTCs are safe for you to use. OTCS that are more commonly used by people who have IBS include laxatives, probiotics, peppermint oil, antidiarrheal agents, and certain herbal supplements.

What to Eat! Figuring out what foods to eat when you have IBS can be challenging. It can be helpful to keep a food diary to look for any possible connection between the foods that you eat and the symptoms you are experiencing. The low-FODMAP diet has strong research support for its effectiveness in reducing IBS symptoms, but can be challenging to follow. Increasing dietary fiber, particularly soluble fiber, can be helpful if done slowly. In addition to learning what foods are best for you to eat, you should also pay attention to how you eat. You may find it to be helpful to eat smaller meals as large, heavy meals can strengthen intestinal contractions.

A Word From Verywell

Although we have all learned to keep "bathroom talk" private, there is no need to let embarrassment about your digestive symptoms keep you from getting the help and support that you need to get your IBS under better control. Talk openly with your doctor about your symptoms, so you can come up with an optimal treatment plan. Seek out IBS support groups online so that you will not feel like you are all alone in dealing with this frustrating health problem. Taking a matter-of-fact approach to your IBS will help to lower your stress level and serve to protect your self-esteem.

_Sources:

_{Minocha A. & Adamec, C. (2011) The Encyclopedia of the Digestive System and Digestive Disorders (2nd Ed.) New York:Facts on File.}

_{Tack J, Vanuytsel T, Corsetti M. Modern Management of Irritable Bowel Syndrome: More Than Motility. Digestive Diseases 2016;34:566-573.}

_{Torpy JM, Lynm C, Glass RM. Irritable Bowel Syndrome. JAMA. 2006;295(8):960.}