Do I Have Irritable Bowel Syndrome (IBS)?
Irritable Bowel Syndrome (IBS) describes an array of symptoms that affect the gastrointestinal tract (also known as the GI tract, intestinal tract, or digestive tract) that range from bloating and abdominal cramps to diarrhea and constipation. The GI tract is made up of hollow organs that stretch all the way from the mouth to the anus; it includes the mouth, esophagus, stomach, small intestine, large intestine (including the rectum), and anus. These hollow organs of the digestive tract are joined by the liver, pancreas, and gall bladder (solid organs) to make up the digestive system. This system is designed to help your body consume, digest, and absorb the nutrients that it uses for energy, growth, and cell repair.
IBS is not generally accepted as a diagnosis of a discreet disease, rather it is an umbrella classification used to describe the symptom grouping. It is difficult to put a clearly defined box around IBS because it is a functional disorder, meaning the function of a bodily process is impaired, but it appears normal under examination. There are many theories as to the cause of IBS, but there is little evidence to support any one over the other. Most physicians believe a variety of factors influenced by dysfunctions in brain-gut communication are at play, the degree to which they interact varying from person to person.
In this article, you will get an introduction to IBS and its symptoms, as well as learn about diagnosing and treating IBS, and conditions that present similarly to IBS.
What is Irritable Bowel Syndrome?
IBS is a common gastrointestinal disorder, affecting up to 20% of adults in the United States. IBS can affect any person at any age, but it more likely to affect women and typically appears before the age of 35. It is characterized as a functional disorder of the gastrointestinal tract. Functional disorders are classified by biological processes misfunctioning in a way that is not visible on medical tests or through inspection of the effected organs. For example, in contrast, Inflammatory Bowel Disease (IBD) is marked by visible, lasting inflammation to the intestine or digestive tract that can cause permanent physical damage. In functional disorders, no physical damage can be found, but the organ(s) are malfunctioning.
The intensity and frequency of symptoms can vary drastically from one patient to another, with some individuals suffering from debilitating symptoms on a daily basis and others experiencing episodes on a weekly or sometimes monthly basis. One study conducted in 2001 that surveyed ~1,450 patients found that 57% suffered daily, 25% weekly, and 14% monthly. In a 2002 survey of 350 patients conducted by the International Foundation for Functional Gastrointestinal Disorders (IFFGD), over one third of patients rated their pain as extreme or very severe.
The unclear nature of the pathophysiology, or physiological processes, associated with IBS is the main reason why no definitive IBS cure has been found. Researchers and physicians believe that the disorder is multifactorial, likely induced by a variety of factors that relate to the brain-gut communication axis. Some of these factors include:
- Excess fermentation and/ or gas production in the intestines
- Alterations in the gut microbiome due to gastritis
- Impaired transit of intestinal gas
- Increased visceral sensitivity
- Anxiety or depression
- Genetic variations, especially since your chances of having IBS are greatly increased if a family member has the same condition
The Rome Foundation, a not-for-profit organization that supports the creation of scientific data and educational information in order to assist in the diagnosis and treatment of functional gastrointestinal disorders (FGIDs) came out with its fourth diagnostic manual in June 2016 (Rome IV). The manual says the following about the classification of functional gastrointestinal disorders: “Functional GI disorders are disorders of gut–brain interaction. It is a group of disorders classified by GI symptoms related to any combination of the following: motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota, and altered central nervous system processing.”
IBS Definition of Symptoms
As outlined above, the symptoms of IBS can vary in duration and intensity from person to person. The symptoms can include:
- Changes to motility (diarrhea or constipation, in some cases alternating between both)
- Bloating or distention of the abdomen – especially after eating
- Abdominal pain and cramps
- Feelings of incomplete emptying
- Excess gas
- Mucus in the stool
IBS is typically classified as one of three categories:
- IBS-C. IBS-C is primarily characterized by constipation.
- IBS-D. IBS-D is primarily characterized by diarrhea.
- IBS-M. IBS-M is characterized by a mix of both constipation and diarrhea. Sometimes also referred to as IBS-A.
Conditions Similar to IBS
There are several conditions that have an initial presentation very similar to the symptoms of IBS. Some of these include:
- Inflammatory Bowel Disease– autoimmune disorders, including Chron’s disease and ulcerative colitis, that cause inflammation in the intestinal tract.
- Celiac disease – allergy to gluten, found in wheat.
- Lactose intolerance – allergy to lactose, most often found in dairy products.
- Gastroparesis – also known as stomach paralysis, gastroparesis is a disorder of
- Small intestine bacterial overgrowth (SIBO) – characterized by an excessive amount of bacteria accumulated in the small intestine. The bacteria ferment undigested food, causing symptoms that appear to be IBS.
- Diverticulitis – an infection or inflammation within the diverticula, small pouches or bulging pockets of tissue that can occur throughout the digestive tract.
How is IBS Diagnosed?
There are no tests to confirm a diagnosis of IBS. Instead, a thorough medical history is often the first step toward a diagnosis. Depending on the severity of symptoms, a variety of tests may be done to confirm that there are no other, potentially life threatening, illnesses masquerading as IBS. These tests include:
- Endoscopy: used to identify the presence of ulcers, stomach cancer, or other abnormalities of the stomach and duodenum (the beginning of the small intestine)
- Colonoscopy: can show any abnormalities of the large intestine, such as damage and inflammation related to Chron’s disease or ulcerative colitis, diverticulitis, or colon cancer
- Gallbladder ultrasound: can confirm or deny the presence of gallstones
- Celiac blood test: identifies whether a patient is allergic to gluten
- Stool test: used to identify any abnormalities, such as blood, H. pylori (bacteria that causes ulcers), or improperly digested fat
- Gastric emptying study: abnormal results can indicate gastroparesis, also known as delayed stomach motility or digestion
- Hydrogen breath test: used by some physicians to diagnose small intestine bacterial overgrowth (SIBO) but many medical facilities do not perform this test since there is debate regarding standard hydrogen levels
How is IBS Treated?
In the absence of a cure, the control and treatment of IBS focuses on the management of symptoms. Medicinal options range from over the counter solutions to strong prescription medications, including:
- Imodium (loperamine): used to control diarrhea on a short term basis
- Colace(stool softener), Ex-Lax (stimulant laxative), Milk of Magnesia (magnesium hydroxide, an osmotic laxative): used to relieve constipation on a short term basis
- IBgard (peppermint oil capsules), Gas-X chewable tablets, Mylicon drops, Beano: may provide modest relief of bloating, distention, gas, abdominal cramps
- Probiotics: may confer overall symptom improvement, especially in abdominal pain
- Antispasmodics and/or anticholinergics: prescription medications that are used to temper abdominal pain and cramps
- Antidepressants: prescription medications that are used to control abdominal pain and, in some cases, to reduce the occurrence of diarrhea
- Nonabsorbable antibiotics (rifaximin): used when small intestine bacterial overgrowth (SIBO) is suspected to be responsible for IBS symptoms; it lowers the bacteria count in the small intestine
- Selective serotonin 5-HT3 receptor antagonist (alosetron hydrochloride): alosetron is a very strong drug that is only prescribed to women with severe, refractory (unresponsive to treatment) diarrhea predominant IBS
In addition to medicinal interventions, most physicians and dietitians recommend that patients with IBS complete the FODMAP elimination diet. FODMAPs stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. These are short chain carbohydrates and sugar alcohols that are generally poorly digested and absorbed by the gastrointestinal tract. These molecules act as fast food to the bacteria that live within your intestines – the bacteria rapidly break down (ferment) the undigested material, which leads to the uncomfortable symptoms that accompany IBS. It is important to note that it is best to complete this elimination process under the guidance of a registered dietitian. For many IBS sufferers, the identification and subsequent avoidance of certain FODMAP “trigger” foods can provide significant symptom improvement. You can learn more about the FODMAP elimination diet and other foods that may affect IBS here.
There are also a variety of alternative methods that can be implemented on their own or, preferably, in combination with one or more of the treatments listed above. The goal is to calm the central nervous system in general, which confers overall health benefits and can help to calm the digestive tract. Alternative methods include:
- Meditation or mindfulness practice
- Yoga or gentle stretching
- Hypnotherapy (especially if the IBS protocol is used by your practitioner)
When to Contact a Doctor
While IBS is a serious condition that is often costly and greatly decreases quality of life, it is not a life threatening condition. Leaving IBS untreated is often intolerable to patients, but it does not put your life at risk. However, similar conditions such as Inflammatory Bowel Disease (IBD) can have grave consequences to your health that worsen the longer they are left untreated. If you are experiencing unintended weight loss, reduced appetite, fatigue, blood in your stool, or black, tarry stools in addition to the aforementioned IBS symptoms, you should contact your physician right away.
If you think you have symptoms of IBS, call or book online with PlushCare to set up an appointment with a top U.S. doctor today.
Read more from our IBS Series: