What is IBS?
Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder that affects 10-15% of people worldwide. In fact, the rates may be higher because many people with IBS-like symptoms do not seek help from a healthcare practitioner and don’t get diagnosed, especially if the symptoms are mild and rare. People who had gut symptoms for a long time may get used to them and think that it is the normal state. IBS is more prevalent in women than men most likely because women tend to see a healthcare provider more often and get the diagnosis.
IBS is a chronic condition that affects the large intestine without damaging it or causing complications compared to Irritable Bowel Disease (IBD) which produces an inflammatory response and injury to the intestinal tissue. People with IBS will just get the adverse GI symptoms, such as diarrhea, constipation, excessive gas, and/or abdominal pain.
IBS can negatively impact someone’s quality of life when it is not managed properly. Social isolation, skipping work, missing social outings, traveling or going to the gym have been reported by people with IBS.
Symptoms of IBS
Symptoms of IBS differ from person to person. They can range from mild to severe and may last from several minutes to several days. Symptoms may come and go depending on diet and lifestyle factors.
Most common symptoms of IBS are:
- Belly distention
- Excessive flatulence
- Altered bowel habits (diarrhea, constipation, or both)
- Abdominal pain
Other symptoms that people may experience are:
- Lack of energy
- Mucus in stool
- Feeling of incomplete bowel movement
IBS symptoms can be seen in other conditions, such as in Celiac disease, endometriosis, Crohn’s, colitis, colon polyps, and even colon cancer. So, if you have symptoms similar to IBS, schedule an appointment with either primary care physician or gastroenterologist to get a diagnosis and rule out more serious disorders.
What is NOT a symptom of IBS
- Blood in the stool
- Involuntary weight loss
- Symptoms are getting worse and worse
If you experience any of these symptoms, mention this to your doctor to be evaluated for other conditions. Your doctor may run additional tests, such as blood test, stool test, x-Ray, CT scan, colonoscopy, or endoscopy to check for inflammation, infections, or structural impairments.
There is no specific test to diagnose IBS. People usually get diagnosed based on the symptoms after performing a medical examination and ruling out other serious conditions. Many of my clients report that they have done all possible tests that came back normal and were told by their doctor that “nothing was wrong with you”.
What causes IBS?
You may be wondering what causes the IBS. I get this question a lot in my practice. Actually, as of now there is no known cause of IBS. Hopefully, in future, we will know more about this condition and give clear answers to both practitioners and patients.
We know that there are some factors that play a role in the development of the symptoms. Here are some of them:
- Dysbiosis in the gut
- Hypersensitivity of the gut wall
- Gut motility problems (too slow or too fast)
- Gut-brain communication issues (stress, anxiety)
- Infection or gastroenteritis
- Some food or food components sensitivities
- Hormonal imbalance
How is IBS diagnosed?
There is no specific test to diagnose IBS, most likely because we don’t know the exact cause. In addition, IBS is a multifactorial condition, so there could be many factors contributing to the development of symptoms. At this moment doctors can diagnose IBS based on the presented symptoms and exclusion of other conditions with similar symptoms, such as celiac disease, colon polyps, endometriosis, IBD and others.
Diagnosis of Irritable Bowel Syndrome (IBS) is based on guidelines developed by the Rome Foundation. According to these guidelines, a patient is diagnosed with IBS if they experience abdominal pain at least once a week for the past 3 months, along with two or more of the following symptoms:
- Associated with bowel movement
- Alteration in defecation frequency
- Related to change in stool appearance
Furthermore, IBS is divided to subtypes based on Bristol Stool Chart (adopted from Rome Foundation):
1. IBS-C or constipation predominant type
Diagnosis of IBS-C subtype can be made if you have a recurrent abdominal pain at least once a week for the last 3 months and have 2 or more of the following:
- pain is associated with bowel movement
- change in stool frequency (reduced bowel movements) >75% of the time
- change in stool appearance (lumpy or hard stools) >75% of the time
2. IBS-D or diarrhea predominant type
In order to be diagnosed with IBS-D subtype, you should have recurrent abdominal pain at least once a week for the last 3 months and have 2 or more of the following:
- pain is associated with bowel movement
- change in stool frequency (frequent loose bowel movements) >75% of the time
- change in stool appearance (mushy and watery) >75% of the time
3. IBS-M or mixed bowel habits
IBS-M is characterized as alternating constipation and diarrhea. IBS-M subtype is diagnosed when more than 25% bowel movements are #1 and #2 and more than 25% bowel movements are #6 and #7 on Bristol Stool Chart.
Symptoms include both IBS-C and IBS-D types with recurrent abdominal pain.
4. IBS-U or unclassified
People who can’t be categorized into above 3 subtypes but have all of the characteristics of IBS fall under IBS-U. Examples of IBS-U are when someone takes a medication that can affect the GI tract, or the frequency of abnormal stools is rare.
Treatment of IBS
Many factors contribute to the development of IBS symptoms, thus finding an appropriate treatment is based on the cause and type of IBS. It is good to note that there is no cure for IBS as of now, and the best solution is to keep your symptoms under control and improve the quality of life. Some therapies include changes in diet and lifestyle, psychological and pharmacological therapies, as well as the use of some supplements. Here are the most common approaches to relieve symptoms of IBS:
- Low FODMAP Diet
- Finding trigger foods other than FODMAPs, such as fatty foods, spicy foods, alcohol or caffeine
- Stress management
- Use of antidiarrheals, antispasmodics and antidepressants
- Use of laxatives
- Use of supplements, such as dietary fiber, probiotics, or peppermint oil
- CBT or cognitive-behavioral therapy
- Exercise and physical activity.
Trying these strategies can help to identify your personal triggers because the cause may vary from person to person. The Low FODMAP diet has been shown to help 3 out of 4 people with IBS. You can start with diet and lifestyle changes to see if they can help improve your symptoms. Working with a registered dietitian who specializes in the low FODMAP diet is essential to help create a plan and identify your individual sensitivities.