Patient Education

Irritable Bowel Syndrome (IBS)

The healthy gastrointestinal tract produces anywhere between 3 bowel movements a day to 3 per week. While the majority of people experience constipation, diarrhea, bloating and gas at one point or another, about 20 % of the general population experiences these symptoms frequently and over a prolonged period of time. Irritable Bowel Syndrome (IBS) is a disorder characterized by changes in bowel movements such as constipation, diarrhea, and abdominal pain without detectable structural abnormalities.

There are different types of IBS:

  • IBS-D: IBS With Diarrhea is characterized by frequent loose stools and abdominal pain and the urgent need to move bowels.
  • IBS-C: IBS With Constipation is characterized by difficulty having bowel movements and the frequent urge to defecate but the inability to do so.
  • IBS-M: IBS Mixed have symptoms of both IBS-D and IBS-C.

IBS is a worldwide problem and can affect all genders, ethnic groups, and ages. Most new patients present with this disorder before the age of 45. IBS is considered to be the most common cause of referrals to GI physicians and can lead to frequent and excessive absences from school or work. Although IBS may impair quality of life, there are various effective ways to manage symptoms, whether it be through diet, stress management, probiotics, or medications prescribed by a doctor.

Causes

IBS results from a mix of hypersensitive nerve endings in the intestine, abnormal contraction patterns, and brain center feedback on how the gut works. There are factors related to past infections, such as very subtle ongoing inflammation, and other factors that are related to stress. The result is a variety of chronic symptoms, food sensitivities, and bowel function changes. The role of abnormal amounts of bacteria in the small intestine is sometimes major.

Signs & Symptoms

Symptoms of Irritable Bowel Syndrome include the following.

  • Changes in bowel movement patterns—diarrhea or constipation, sometimes both, often feelings of incomplete evacuation.
  • Bloating and excess gas, often the most annoying symptom!
  • Pain, usually in the lower abdomen
  • Mucus in stools, without bleeding – unless bleeding is due to hemorrhoids or other cause

Screenings & Diagnostic Tests

Since there are no detectable structural abnormalities in the bowel, the diagnosis of IBS is done through a careful review of medical history and physical examination. Depending on the situation, your gastroenterologist may order tests to help confirm that no other disorders or serious medical conditions are present. These tests may include blood and/or stool sample tests to check for hidden bleeding and infections. Imaging tests, such as ultrasound or CAT scans, may be ordered if your doctor believes there may be alternative causes of abdominal pain. A colonoscopy may be ordered to evaluate for other possible diseases, particularly when chronic diarrhea is the main problem.

The important thing to realize is that NEW symptoms related to IBS shouldn't be ignored or assumed to be IBS without discussing it with a doctor. Like anyone, patients with IBS can develop diseases such as inflammatory bowel disease and cancer. If bleeding, fever or new types of abdominal pain occurs, please consult your doctor about it. Unexplained steady or worsening changes in bowel habits may be cause for concern and require attention as well.

Treatment of IBS

Stress Management

Stress is one of the major triggers for IBS attacks. Adequate sleep, exercise, recreational and enjoyable activities are the main keys to remember – not just for the offset of IBS, but for an overall healthy lifestyle. Meditation, massage, tai chi etc. are just some suggested activities people can choose to participate in to manage emotional or chronic stress. If you do not respond to other natural treatments, a medicine used to treat anxiety and depression can also be helpful in managing IBS triggers.

Diet

Regular, well-balanced, low-fat meals with good fluid intake (over a quart of water a day) are frequently recommended for patients with IBS.

Studies on the effectiveness of high-fiber diets in IBS patients have produced mixed results. Some patients do better with smaller amounts of gluten (wheat protein) products or a lactose-free diet. What diet approach works for each patient varies. Your clinician will help you decide based on your individual experience with foods, symptom patterns and many times treatment trials of one or another dietary approach.

A more recent helpful diet has emerged from work in Australia, called the low FODMAP diet. The idea is to eliminate a variety of carbohydrate-type foods that produce gas fermentation in the gut. This can lead to bloating, gas and altered bowel function. Up to 70% of people with IBS get substantial relief with restriction of FODMAPs. It isn’t simple to implement and your physician should give you guidance, sometimes referrals to a dietitian or nutrition expert.

Check out these resources on the low FODMAP diet from:

Medications

There are a variety of medications and treatment strategies aimed at helping IBS patients with their predominant symptoms. Not all patients are alike and treatment is often very individualized with options including both over-the-counter and prescription medications. We encourage patients with Irritable Bowel Syndrome to discuss approaches they would like to try so we can review them for safety, medical evidence, and give precautions where appropriate.