Irritable bowel syndrome, also called IBS, is a very common disorder affecting the large intestine. Common symptoms of IBS include:
- Abdominal pain
This is a chronic condition that there is no cure for- you will need to manage your symptoms over the long term.
Even though the signs and symptoms of IBS are quite uncomfortable, it does not cause changes in your bowel tissue or increase your risk of colorectal cancer- unlike Crohn’s disease and ulcerative colitis.
There are only a small number of individuals with this condition that have severe signs and symptoms. In most cases, the condition can be controlled simply by managing stress, diet, and lifestyle. Others will need counseling and medications.
Symptoms of IBS
The signs and symptoms of this condition will vary widely from one person to the next and can sometimes seem as if it is another disease entirely. Some of the most common signs/symptoms are:
- Abdominal cramping/pain
- Feeling bloated
- Feeling gassy
- Mucus in stool
- Diarrhea/constipation- sometimes alternating bouts of each
For most individuals with this condition, it is chronic, but there may be times when the signs and symptoms are worse and then other times when they seem to improve or completely clear up.
When Should You See a Physician?
This is a common condition, affecting as many as 1 in 5 American adults. However, fewer than 1 in 5 of those experiencing symptoms seek help for it. However, it is critical that you see your physician if you have any persistent changes in your bowel habits or any other symptoms of IBS because it could be indicative of a much more serious condition- such as cancer of the colon.
Following are some symptoms that could be indicative of a more serious condition:
- Bleeding of the rectum
- Abdominal pain that occurs/worsens at night
- Unexplained weight loss
Your physician will help you find ways to relieve your symptoms as well as rule out any other conditions. He/she will also be able to help you avoid complications from problems such as chronic diarrhea.
Causes of IBS
At this time, the exact cause of IBS is not known. However, it is clear that there are a variety of factors at play. The walls of your intestines are lined with a muscle that contracts and relaxes as food moves from your stomach through your intestinal tract.
If you have IBS, these contractions may be much longer and stronger than normal- resulting in gas, diarrhea, and bloating. On the other hand, the opposite could occur- the contractions could be much weaker and slower, which results in hard and dry stools.
In addition, abnormalities in the gastrointestinal nervous system could play a role in this condition. This can result in you experiencing more discomfort than usual when your abdomen stretched from stool or gas.
Poorly coordinated signals between your intestines and brains can cause your body to panic over the normal changes that occur during the digestion process- which results in pain, constipation, or diarrhea.
Triggers for IBS
Just as the symptoms, the triggers vary from one person to the next. What triggers IBS symptoms in one person may or may not trigger the next person. Some of the most common triggers for an IBS flare-up are:
Foods: the relationship between food allergies/intolerance and irritable bowel syndrome is not fully understood yet- however, it does seem that many people have more severe symptoms when they eat specific foods.
There are a wide range of foods that seem to trigger these symptoms, including: spices, beans, broccoli, cauliflower, chocolate, fats, milk, cabbage, alcohol, and carbonated beverages.
Stress: in most cases, individuals with IBS do find that their signs and symptoms are worse or occur more frequently when they are stressed out for one reason or another. However, while stress does seem to aggravate the symptoms, it does not seem to trigger them.
Hormones: since women are much more likely than men to have this condition, it has been suggested that hormonal changes are related to this condition.
Other conditions: in some case, other conditions such as gastroenteritis or too much intestinal bacteria can trigger IBS.
Risk Factors for IBS
IBS is a common condition and many people do display occasional signs/symptoms of this condition. However, you are much more likely to have this condition if you meet the following criteria:
- Under the age of 45
- Female (twice as many women have IBS as men)
- Family history of IBS (could be genetics or shared family environment)
- Mental health problem
Complications Related to IBS
Both diarrhea and constipation can aggravate hemorrhoids. Additionally, if you avoid foods that trigger your IBS, you may not be able to get the nutrients your body needs, which can result in malnourishment.
However, the impact of the condition on your overall quality of life could be the most significant one. The effects of IBS are likely to leave you feeling as if you are not living your life to the fullest- which can lead to feeling depressed and discouraged.
When to See a Physician
If you are experiencing symptoms of IBS, you should make an appointment with your physician. After an initial consultation, he/she may refer you to a gastroenterologist, who specializes in digestive disorders for more testing.
Following is some information to help you prepare for your appointment and what you should expect from your physician.
Before your appointment, you should take the time to write down any symptoms you may be experiencing and how long they have lasted. This will help your physician to identify your triggers.
Make sure to record all key personal information including any stressors or changes in your life. These could play a role in the severity and frequency of your symptoms.
List your important medical information including any medications, vitamins, or supplements you are taking and any conditions you are being treated for. If you have ever been evaluated for these same symptoms in the past, make sure to bring your medical records along with you.
Bring a friend/family member with you if possible. This way, they can help you to remember what he/she says.
Many times, appointments are rushed, so make sure that you take some time to write down any and all questions that you want to ask. This will help you to take advantage of the time you have with him/her. Some of the basic questions include:
- Do I have irritable bowel syndrome?
- What are some of the other possible conditions I may have?
- Is there any other possible explanation for my condition?
- What tests will I need to undergo?
- What is your first-line treatment approach?
- If that does not work, what would be the next step?
- What (if any) are the side effects associated with these treatments?
- Do you believe that my diet is playing a role in my symptoms?
- What changes should I make to my diet?
- Is there a specific diet I should follow?
- Are there lifestyle changes I can make to manage/reduce my symptoms?
- I have some other health concerns- what are the best ways to manage them together?
- Should I speak with a counselor?
- Is this condition chronic?
- How much improvement should I expect with treatment?
In addition to these, be sure to ask any other questions that come up during your appointment.
What You Can Expect from Your Physician
When you go in for your appointment, you won’t be the only one asking questions. Your physician will also ask some of their own. If you are prepared for them ahead of time, you will be able to spend more time on the things that are of importance to you. Following are some questions that you may be asked:
- What symptoms are you experiencing?
- How long have you had these?
- Do they come and go or are they consistent?
- Is there anything specific that seems to trigger these symptoms?
- Have you experienced unexplained weight loss?
- Has there been blood in your stools?
- Have you had any vomiting?
- Have you had a fever?
- Has there been any significant stress in your life lately?
- What is your typical diet?
- Have you been diagnosed with lactose intolerance or a food allergy?
- Are there any other medical conditions you have been diagnosed with?
- What medications are you currently taking- prescription, OTC, supplements, vitamins, or herbs?
- Do you have a family history of colon cancer or bowel disorders?
- How much are your symptoms affecting your life including functioning at school/work and personal relationships?
While you are getting ready for your appointment, make sure to ask around if any of your family members have been diagnosed with this condition or any other bowel conditions, including colon cancer. In addition, keep track of your symptoms and the triggers present.
A diagnosis of IBS is dependent upon a physical exam and collecting a complete medical history. Since there are no physical signs that can definitively diagnose this condition, it is most often a process of elimination of other conditions. In order to rule out these other conditions, there are two sets of diagnostic criteria that have been created.
Rome Criteria: this states that you must have specific signs/symptoms before your physician will diagnose you with IBS. The most important one is abdominal pain/discomfort lasting at least three days per month in the last three months. This is associated with two or more of the following: improvement with defecation, a change in the frequency or consistency of your stool.
Manning Criteria: this focuses more on the pain relieved by defecation, having mucus in the stool, changes in consistency of stool, and incomplete bowel movements. The more symptoms you have present, the more likely it is that you have IBS.
Your physician will measure how well you fit in these criteria as well as whether there are other signs/symptoms present that may suggest a more serious issue. Some of the red flags that suggest more testing is needed are as follows:
- Onset after the age of 50
- Unexplained weight loss
- Bleeding of the rectum
- Abdominal pain not relieved by bowel movements
- Persistent diarrhea
- Diarrhea that awakens you
- Anemia due to low iron levels
If you have the criteria for IBS and there are no red flag signs/symptoms present, your physician may suggest treatment without additional testing. However, if you do not respond to the treatment selected, more testing will be necessary.
Additional Testing for IBS
Your physician is likely to recommend several tests to rule out other causes for your signs/symptoms. Following are some of them:
- Flexible sigmoidoscopy: this test will examine the lower portion of your colon with the use of a flexible, lighted tube.
- Colonoscopy: if you are 50 or older and have signs of a potentially serious condition, your physician may recommend a colonoscopy, which is when a flexible tube is used to examine the entire length of your colon.
- X-ray: in some cases, your physician may use an x-ray to get an image of your colon.
- CT Scan: this test produces cross-sectional x-ray images of your internal organs, which will help the physician rule out other causes especially when you are experiencing abdominal pain.
- Lower GI: the physician will fill your large intestine with barium to make it easier to see any issues on the x-rays.
Lactose intolerance tests: your body needs the enzyme lactase to digest lactose. If your body is not producing this, you will experience symptoms similar to IBS including gas, diarrhea, and abdominal pain.
In order to discover whether or not this is the cause of your symptoms, your physician is likely to recommend a hydrogen breath test or even have you remove all milk-related products from your diet for a few weeks.
Breath tests: your physician will probably perform a breath test to find out if you have a condition known as bacterial overgrowth.
This is when bacteria from the colon have grown up into the small intestine which causes diarrhea bloating, and abdominal discomfort. This is most common in individuals who have had surgery on their bowels or have a condition that slows down their digestion
Blood tests: celiac disease is characterized by a sensitivity to barley, rye, and wheat proteins that can result in signs/symptoms similar to those of IBS. A blood test can rule out this possibility.
Children who have IBS have a much higher risk of developing celiac disease than those that do not. If your physician suspects that you have celiac disease, he/she will likely perform an upper endoscopy to biopsy your small intestine.
Stool tests: if you are experiencing chronic diarrhea, your physician may examine your stool for parasites or bacteria.
Treating Irritable Bowel Syndrome
Since the cause of IBS really isn’t clear, treatment typically focuses more on relieving the symptoms so that you can live a normal life.
Most of the time, you will be able to keep the mild signs/symptoms under control if you can learn to manage your stress and make some necessary changes in lifestyle and diet.
Try to make sure you avoid the foods that can trigger your symptoms. In addition, make sure you’re getting enough exercise, enough sleep, and drinking plenty of fluids.
- Eliminate foods that cause gas such as veggies, raw fruits, and carbonated beverages
- Eliminate foods containing gluten- however, this recommendation is controversial because the evidence is not clear
- Eliminate FODMAPs such as those found in specific veggies, dairy products, fruits, and grains. FODMAP stands for fermentable, oligo-, di-, and monosaccharides, and polyols. If you go on a strict low FODMAP diet, you may be able to slowly introduce these foods one at a time.
On the other hand, if your signs/symptoms are moderate to severe, you will probably need more than just a few changes in your lifestyle and diet. Chances are you will need medication such as the following:
Fiber supplements- these will help with constipation. You should know that natural fiber from food is much more likely to cause bloating than a fiber supplement. If this doesn’t help, your physician may recommend an osmotic laxative.
Anti-diarrheal medications- OTC medications can help get diarrhea under control– but some of them may also lead to bloating, so be careful with these.
Anticholinergic and antispasmodic medications- these can help with relieving painful spasms of the bowel and are sometimes used for individuals with diarrhea but can also cause constipation to be worse as well as lead to other symptoms. Individuals with glaucoma should be careful taking these.
Antidepressant medications- if you are also experiencing pain and/or depression, your physician will likely prescribe an antidepressant medication such as an SSRI or a tricyclic medication to help relieve your depression. Even if you have these symptoms without depression, your physician may still suggest a lower than normal dose. Be aware that side effects can include drowsiness and constipation.
Antibiotics- in some cases, the symptoms are due to bacterial overgrowth in an individual’s intestines and they may benefit from antibiotics.
Counseling- if stress and/or depression are worsening your symptoms, you may benefit from counseling.
If you are experiencing signs/symptoms of IBS, see your physician to make sure that it is not a more serious condition or to get your symptoms under control.