What is Irritable Bowel Syndrome?
Irritable bowel syndrome (IBS) is a common digestive disorder. It’s characterized by stomach pain or discomfort along with changes in how often you have bowel movements or what they look like. These symptoms occur without any clear reason. Over the years, doctors have improved how they diagnose IBS, and today they follow a guideline known as the Rome IV. Depending on the type of IBS a patient has, various medications and other treatments can help manage the symptoms. However, it’s important to remember that everyone’s IBS is unique and should be treated as such. A strong bond and understanding between a patient and their doctor are equally significant in managing IBS effectively.
What Causes Irritable Bowel Syndrome?
The exact cause of Irritable Bowel Syndrome (IBS) isn’t fully understood, but there are several factors that could contribute to its development. These include issues with intestine motion, the way the body feels pain from the organs, the connections between the brain and the gut, and mental health distress.
Risk Factors and Frequency for Irritable Bowel Syndrome
Almost 12% of patients go to their primary care doctors due to complaints connected to Irritable Bowel Syndrome (IBS). While studies show that between 10 and 15% of people suffer from IBS, most don’t actually seek medical help. This digestive disorder is most common in South America, with about 21% of the population affected, and least common in Southeast Asia, where only 7% of people have it. Women in the United States, Canada, and Israel are 1.5 to 2 times more likely to experience IBS symptoms than men. Women are also more likely to have abdominal pain and constipation, while men are more likely to have diarrhea. The chance of having IBS tends to decrease as people get older.
- IBS can be categorized into specific types: IBS with diarrhea (IBS-D), IBS with constipation (IBS-C), and IBS with mixed bowel patterns (IBS-M).
- The frequency of these three types of IBS varies between the United States and Europe.
- In the United States, the distribution of these diagnoses is equal.
- In Europe, IBS-C or IBS-M tend to be more common.
Signs and Symptoms of Irritable Bowel Syndrome
IBS, short for Irritable Bowel Syndrome, involves a variety of symptoms like belly pain or discomfort, changes in bowel movements resulting in constipation or diarrhea, bloating, and the feeling of these symptoms getting worse after eating. The pain can shift in location and the stool pattern can change over time. It’s important to watch out for concerning signs like symptoms starting after the age of 50, escalating symptoms, unexpected weight loss, bleeding from the rectum, anemia due to lack of iron, or having close relatives with serious digestive diseases like colon cancer, celiac disease, or inflammatory bowel disease. Information about your travels and social activities is also relevant.
Doctors use something called the Rome IV criteria to make an IBS diagnosis. This involves experiencing symptoms for at least three days per month during the past three months. The symptoms may include the feeling of relief after passing a stool, the beginning of symptoms coinciding with a change in stool frequency, and/or a change in the appearance or form of stool.
Testing for Irritable Bowel Syndrome
If you don’t have any serious warning signs like weight loss, bloody stools, or iron deficiency, you generally won’t need any routine tests. However, if your symptoms are not typical for irritable bowel syndrome (IBS) or if you have serious warning signs, your doctor may order some blood tests. These could include a complete blood cell count, comprehensive metabolic panel, tests for inflammation like the erythrocyte sedimentation rate or C-reactive protein, and thyroid stimulating hormone level.
When diarrhea is the main symptom, tests on stool samples may be ordered. These could check for specific infections like Clostridium difficile, Giardia, and Cryptosporidium. You might also need testing for celiac disease, a condition where the body reacts to gluten, for which a tissue transglutaminase or TTG-IgA test can be done.
A colonoscopy, which is an examination of your colon, could be beneficial if you have a family history of inflammatory bowel disease, colon cancer, or if you have serious warning signs. If you are experiencing diarrhea, random tissue samples can be taken during the colonoscopy for further examination.
Treatment Options for Irritable Bowel Syndrome
One of the key goals in managing Irritable Bowel Syndrome (IBS) is to establish a strong and trusting relationship between the patient and the doctor. This can be achieved by listening openly, showing understanding, and managing realistic expectations around treatment. Since IBS is defined by its symptoms, treatment largely focuses on relieving those symptoms, like pain, bloating, cramping, and irregular bowel movements.
If a patient is struggling with constipation, they may find relief from fiber supplements or laxatives. Those facing diarrhea, on the other hand, might benefit from specific medications like loperamide or probiotics. Engaging in physical activity regularly can also help manage the symptoms of IBS because it can improve the movement of food through the digestive tract.
Many IBS patients have found there’s a link between what they eat and the intensity of their symptoms. Certain foods, like wheat products, onions, fruits, vegetables, and products containing sorbitol or certain dairy products, may contain types of carbohydrates known as FODMAPs. These are not easily absorbed by the body and can aggravate IBS symptoms. It has been observed that IBS patients may have fewer gastrointestinal symptoms by limiting their intake of FODMAPs.
Patients with ongoing and chronic abdominal discomfort might respond well to low doses of tricyclic antidepressants (TCAs) or serotonin reuptake inhibitors (SSRIs). In addition, Alosetron is a drug that may be used to treat diarrhea-predominant IBS in women, although it can have serious side effects like ischemic colitis.
Rifaximin, a non-absorbed broad-spectrum antibiotic, is sometimes used to treat IBS patients. It has been observed to reduce abdominal pain and diarrhea in patients, supporting the theory that bacterial overgrowth may be a potential cause of IBS.
What else can Irritable Bowel Syndrome be?
When trying to figure out if a patient has Irritable Bowel Syndrome (IBS), doctors need to consider many other conditions that could have similar symptoms. What they consider often depends on whether the patient’s main issue is diarrhea or constipation.
If the patient mostly has diarrhea, the doctor might investigate whether they have:
- An intolerance to lactose (a type of sugar found in dairy products)
- A high intake of caffeine or alcohol
- Certain types of food poisoning or infections
- Inflammatory bowel disease
- Diarrhea that has been caused by the use of certain types of medication
- Celiac disease (an immune reaction to eating gluten)
- Various types of cancer
- Overactive thyroid gland
- VIPoma (a rare type of tumor)
- Ischemic colitis (an inflammation of the large intestine due to reduced blood flow)
If constipation is the main problem, some things doctors might consider are:
- Not enough fiber in the patient’s diet
- Immobility or lack of physical activity
- Conditions like Parkinson’s disease, multiple sclerosis, or a spinal injury
- Conditions like diabetes, underactive thyroid gland, or high calcium levels in the blood
- Constipation caused by certain types of medication
- Various types of cancer
- Blockage in the intestine (bowel obstruction)
- Endometriosis
- Diverticular disease (small bulges, or pockets, in the lining of the intestine).
If the patient’s personal health history makes the doctor think any of these conditions could be the culprit, they will order the appropriate tests to find out.
What to expect with Irritable Bowel Syndrome
IBS or Irritable Bowel Syndrome typically has a positive outlook, and once diagnosed correctly, it generally remains a consistent diagnosis over time. The usage of ongoing healthcare services by IBS patients can be lowered, particularly if a strong, positive relationship is established between the doctor and patient.
Preventing Irritable Bowel Syndrome
When someone experiences symptoms like stomach pain, bloating, cramping, or changes in how often they go to the bathroom, it’s a good idea to see a primary care doctor. If the doctor believes these symptoms point to a condition called Irritable Bowel Syndrome (IBS), they will recommend seeing a specialist known as a gastroenterologist. These experts can guide the next steps in managing and treating the condition.
