Irritable bowel syndrome, also called IBS for short, is a common condition that affects 10-20% of American adults. It is a chronic intestinal disorder that causes abdominal pain, cramping, gas, and bloating, and bouts of diarrhea or constipation. IBS does not cause inflammation or permanent harm, nor does it progress to more serious conditions. Past names for this disorder include colitis, mucous colitis, spastic colon, spastic bowel, and functional bowel disease.

Causes of IBS

The exact cause of IBS is not known. There may be several causes, and IBS may itself be a collection of different conditions, each having a different cause. IBS is placed in a class of diseases known as "functional disorders," a term that means no structural, biochemical, or infectious cause has yet been discovered. Possible triggers for IBS include:

  • Ordinary events such as eating or bloating from gas-producing foods
  • Certain foods such as dairy products, chocolate, alcohol, caffeine, carbonated drinks, and fatty foods, or simply larger meals
  • Stress
  • Emotional conflict
  • Menstrual periods

Risk Factors for IBS

A risk factor is something that increases your likelihood of getting a disease or condition. It is possible to develop IBS with or without the risk factors listed below, but the more risk factors you have the greater your likelihood of developing it. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.

There are few known risk factors for IBS. They include:

  • Gender - Women are twice as likely as men to develop IBS.
  • Age - Symptoms of this condition typically begin in young adulthood.
  • Stress - While emotional stress is always part of the disease and may aggravate symptoms, there is no evidence that stress causes the disease.

Symptoms of IBS

IBS symptoms affect the intestines. The symptoms may come and go.

Symptoms of IBS range in intensity from mild to severe and include the following:

  • Abdominal cramps
  • Gas
  • Bloating
  • Pain that resolves with a bowel movement
  • Diarrhea
  • Constipation
  • Alternating bouts of diarrhea and constipation
  • Loose stools
  • Urge to move bowels, but no stool is passed
  • Feeling of incomplete bowel movement
  • Urge to move bowels after having a bowel movement
  • Mucus in the stool
    • If you see blood in your stool, consult your doctor immediately.

Diagnosing IBS

The diagnosis of IBS is one of exclusion. This means that a firm diagnosis cannot be made until all other causes of symptoms have been ruled out, which can require a rather extensive evaluation. Your doctor will begin with questions about your symptoms and medical history, and then perform a physical and rectal exam. Several tests will be done to look for signs of other conditions, such as colon or rectal cancers, or infectious disease.

Most experts currently make the diagnosis of IBS based on the “Rome Criteria”. These criteria are largely based on the symptoms that you report. According to the Rome III Criteria, IBS can be diagnosed when you have 2 or more of the following symptoms at least 3 days a month during the preceding 3 months:

  1. Pain relieved by a bowel movement
  2. Onset of symptoms with a change in stool frequency
  3. Onset of symptoms with a change in stool appearance

Other symptoms such as straining, mucous, or bloating can be used to further support the diagnosis.

Other tests may include:

  • Stool guaiac - A simple test for traces of blood in the stool. It can be done at the time of your physical exam.
  • Stool cultures - To look for causes of infection.
  • Blood and urine tests
  • Barium enema - Contrast material is inserted into the rectum. The contrast makes colorectal structures and any abnormalities easier to see.
  • Sigmoidoscopy - A lighted tube with a camera is inserted through the rectum to examine the rectum and the lower part of the colon. If needed, tissue samples (biopsy) can be taken for examination under a microscope.
  • Colonoscopy - A lighted tube with a camera is inserted through the rectum to examine the rectum and the entire length of the colon. If needed, tissue samples (biopsy) can be taken for examination under a microscope.
  • Absorption tests - To evaluate the food digestion process. This will determine if food is absorbed properly or if it is passing through the gastrointestinal tract without absorption.
  • X-rays of the stomach or gallbladder.
  • Hydrogen breath test - To look for bacterial overgrowth.

Treating IBS

There is no cure for IBS, but many people are able to control their symptoms with lifestyle modifications, stress management, medications, and alternative treatments like probiotic supplements. The goal of treatment is to minimize your symptoms and the effect they have on your life. Consider the following to help determine what triggers your IBS and to potentially help to alleviate some of them:

1. Diarrhea

  • Keep a food diary and avoid those foods that cause symptoms.
  • Eat foods that can help firm up stools, such as cheese and bananas.

2. Constipation

  • Consider foods that stimulate bowel movements, like high-fiber foods, fruits, and prune juice.
  • Consider a fiber supplement to help soften your stool and make bowel movements easier.
  • Consider stool softeners.

3. Gas

Keep a food diary and avoid those foods that cause gas. Foods that commonly cause gas are:

  • Legumes (beans)
  • Fructose and sorbitol in beverages
  • Dairy products
  • To help reduce gas caused by legumes, try Beano® or simethicone to reduce gas accumulation.
  • If dairy products cause gas, take the lactase enzyme when eating dairy foods, or try lactose-free milk or substituting yogurt for milk.

4. Cramps

  • Place hot or cold packs on your abdomen.
  • Limit caffeine.

5. Emotional Health

IBS can disrupt your life. It is very stressful to worry about having poor bowel control. Also, emotional stress is strongly linked to worsening of symptoms. Consider counseling or other methods of reducing your stress, including:

  • Relaxation techniques
  • Deep breathing exercises
  • Biofeedback
  • Counseling to help develop coping skills
  • Yoga
  • Hypnotherapy

6. Other Lifestyle Changes

Learn as much as you can about IBS and ways that you can reduce your symptoms. You also may find it helpful to join a support group to gain information and share your experiences.

7. Diet

What you eat plays a major role in treating your IBS. The first consideration is adequate nutrition. Because you may decide to avoid certain foods that cause symptoms, make sure you are not missing out on essential nutrients. For example, if you avoid dairy products, it may be difficult to meet your calcium needs. You may need to take a calcium supplement. A registered dietitian can help you determine if your diet is complete and how best to supplement it.

8. Food Restrictions

There are some foods more likely to cause symptoms in people with IBS. Reactions to foods are different for every individual, though, and you may find that foods other than those listed here also cause symptoms. Here are some tips:

  • Keep a food diary, listing what you eat and what the reaction is. Discuss the findings with your doctor or dietitian.
  • Make gradual changes to your diet and record the results.
  • Avoid foods that have provoked symptoms more than once. A dietitian can help you choose substitutes for offending foods.
  • The following foods and drinks are known to provoke symptoms in some people:
    • High-fat foods
    • Spicy foods
    • Dairy products (milk, yogurt, cheese, ice cream)
    • Legumes (dried beans, such as chickpeas, black beans, lentils, kidney beans, and others)
    • Onions
    • Cabbage
    • Other gas-producing foods
    • Large amounts of alcohol or caffeine
    • Sweetening agents, such as sorbitol and fructose (check the fine print on the food label)
  • Eat foods that may reduce the risk of spasm, such as:
    • Fruits and vegetables
    • Whole grains and other high-fiber foods (Note: Until your body adjusts, more fiber may increase gas and bloating; increase your fiber intake slowly and drink lots of fluids. Talk with your healthcare provider about the proper amount of fiber you should have in your diet.)
  • Eat smaller meals more often or smaller portions, rather than eating a few large meals.
  • Eat slowly and try not to swallow air.
  • Drink more water to help reduce constipation.

When to Contact Your Doctor

A working relationship with your doctor is critical to effective treatment. Find someone with whom you feel comfortable and stay in regular contact. Be sure to report any new symptoms or significant worsening of others.

Preventing IBS

Unfortunately, at this time, there are no guidelines for reducing your risk of IBS because the cause is unknown.

If you have symptoms of IBS, Commonwealth Specialists of KY is available for diagnosis and treatment. To schedule an appointment, call the office at (502) 875-7000, or click the button below to book an appointment online.

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American College of Gastroenterology (ACG)