Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) is diagnosed and treated by the GI Division of Premier Medical Group.

What is IBS (irritable bowel syndrome?)

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IBS or Irritable Bowel Syndrome is one of the most common disorders diagnosed, and often misdiagnosed, today. One in five Americans has IBS. It is also known as irritable colon, spastic colon, mucous colitis, and nervous stomach. More common in women than in men, it generally begins before the age of 35 in about 50 percent of people. IBS is a condition of the intestines, manifested as cramping, intestinal spasm, pain, bloating, diarrhea and/or constipation. Although IBS can cause a great deal of distress, it doesn’t generally harm the intestines or lead to a serious disease. With diet, medications, and stress management, most people can control their symptoms and live a normal life. For a few, it can be disabling. As patients find it difficult to work, travel or even attend social events.

Is irritable bowel syndrome (IBS) the same thing as inflammatory bowel disease (IBD)?

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No, these are two different conditions. Irritable bowel syndrome (IBS) is defined by abdominal pain, bloating, cramping, constipation, diarrhea, abnormal bowel movements, and intestinal gas—despite the fact that the bowel looks normal under diagnostic imaging. Inflammatory bowel disease (IBD) can be detected through chronic inflammation of the bowel as well as more severe symptoms that may include fever, fatigue, bloody stool, and unintended weight loss. IBD is typically caused either by ulcerative colitis or Crohn’s Disease.

What causes IBS?

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There is no specific cause for IBS. This is why irritable bowel is a syndrome, while inflammatory bowel is a disease. That said, some researchers have a theory that people with IBS have intestinal sensitivity to stress and certain foods. In general, IBS sufferers have more sensitive intestines or problems with the way the muscles of the intestines move. Yet, in others, irritable bowel is more of a wiring problem with the nervous system in which normal sensations are interpreted by the brain as abnormal, making us aware of them. The intestine can spasm or even stop working temporarily. Certain food sensitivities, stress, anxiety, hormonal changes and even some medications may trigger an IBS attack of pain and other related symptoms. The immune system may be involved.

The lining of the colon is called the mucosa which is covered by a thin cellular layer known as the epithelium. This regulates the absorption of fluids in and out of the colon. In people who have IBS, the contents of the colon can move too fast or too slow. This can result in either too much fluid uptake (constipation) or too little (diarrhea). With IBS, certain foods, stress, anxiety and medications can trigger this process causing spasms and other symptoms that would not be noticeable to most people.

More recent research has described that serotonin, a neurological signaling chemical known as a “neurotransmitter” is present in normal gastrointestinal (GI) functioning. What this means to the IBS patient is that the normal transport of the serotonin through the GI tract is affected. Ninety-five percent of the body’s serotonin is located in the GI tract and 5% in the brain. People with IBS have diminished receptor activity. This causes abnormal levels of serotonin to exist in the GI tract resulting in problems with bowel movements, motility and sensation, increased sensitivity of pain and other receptors in the GI tract.

Other research reports say that IBS is sometimes associated with a bacterial or viral infection and can sometimes occur, for a limited time, after such an infection, while others still claim to have found very mild celiac disease, sensitivity and allergies to certain foods, bacterial overgrowth and lactose intolerance as well as psychogenic malfunction of the gastrointestinal tract (cyclical vomiting syndrome) in some people with IBS symptoms.

How does stress affect IBS?

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Stress can trigger a variety of abdominal pains, including IBS symptoms. The colon has many nerves that connect to the brain via the spinal cord, and any feeling of mental or emotional tension, anger, feeling overwhelmed, can cause conscious (noticeable) spasms in the colon for people with IBS. Research on IBS tells us that stress relief is key. Relaxation therapies, meditation, counseling, acupuncture, regular exercise such as walking or yoga, and positive changes to stressful life situations can help to alleviate the symptoms of IBS. A good night’s sleep can be just as important and may itself be a critical turning point for alleviating IBS symptoms.

What are the symptoms of IBS?

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The most common symptoms of IBS are lower not upper abdominal pain, bloating, and discomfort. Other symptoms of IBS can include:

  • Frequent or infrequent bowel movements
  • Constipation
  • Diarrhea
  • Alternating periods of constipation and diarrhea or loose stools
  • Urgent and uncontrollable need to have a bowel movement
  • Straining and cramping when trying to have a bowel movement, often able to eliminate only a small amount
  • Bowel movements with mucus, difference in size or consistency
  • Intestinal gas

Where is IBS pain located?

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Unfortunately, there is no classic location for the abdominal pain associated with IBS. Irritable bowel can be felt as upper, middle and/or lower abdominal pain. The good news is that, while there may be bloating and upper abdominal pain especially after eating, IBS pain is rarely confused with a major heart attack. Middle abdominal pain is often experienced as bad cramping and is usually located at or around the navel. Lower abdominal pain is characterized by bowel movement disruptions, whether that means constipation, diarrhea, both, mucus in the stool, or an urgent need to have a bowel movement.

How is IBS diagnosed?

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IBS is diagnosed through a complete medical history, including a careful description of symptoms and physical examination. There is no specific diagnostic test for IBS, but some tests are used to rule out other possibilities and to ensure a more serious condition is not missed. The doctor may perform a colonoscopy or sigmoidoscopy. These allow the doctor to look inside the colon by inserting a tube with a camera. The camera then transfers images to a screen for the doctor to see. Other tests may include intestinal biopsies, X-Rays, blood tests and stool samples. Depending on the result of these tests as well as a thorough work-up, the doctor may diagnose IBS based on symptoms.

Bleeding, fever, weight loss, and persistent severe pain are not symptoms of IBS and may indicate other problems such as inflammation or, rarely, cancer.

IBS triggers can include large meals, bloating from gas in the colon, medicines, wheat, rye, barley, chocolate, milk products, or alcohol, drinks with caffeine, such as coffee, tea, or carbonated beverages (sodas), stress, conflict, or emotional upsets. Women with IBS sometimes have more symptoms during their menstrual cycle.

People with chronic IBS often suffer from depression and anxiety which makes their symptoms worse.

What are the treatment options for IBS?

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There is no cure or definitive treatment for IBS. However, there are effective treatment options to manage or even eliminate the symptoms. Regrettably, many people suffering from IBS are not receiving medical care for their symptoms. Your doctor will prescribe a course of treatment depending on your symptoms and their severity.

Medications, diet and stress management are three of the most important components of relieving IBS pain and related symptoms. Your doctor may also recommend among others, fiber supplements or laxatives for constipation and medicine to counteract the diarrhea. Some commonly prescribed medications are called “antispasmodics” which help to control intestinal muscle spasms and reduce abdominal pain. Antidepressants can also relieve symptoms when prescribed appropriately. Medications affect people differently and no one medication or combination will work the same for everyone. The key is to find the right combination of diet, medication, stress relief and support for your symptoms.

Controlling IBS symptoms with diet

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It’s important to take charge of your IBS. Begin by keeping a journal of the foods you eat noting which ones cause IBS pain and distress. For instance, some people may be able to tolerate yogurt, but not other dairy products. Fiber may be helpful to those people that are affected by constipation-predominant IBS. Whole grain breads, fruits and vegetables are excellent sources of fiber however in others, these very foods could be a source of sensitivity. In some, high fiber diets can cause bloating and gas. Eating more frequent and smaller meals may help. Large meals can cause cramping and diarrhea. Low-fat foods and foods that are high in carbohydrates such as rice and pasta may help symptoms, especially in people with diarrhea-predominant IBS.

Water intake is especially important if you suffer from IBS with constipation or diarrhea predominance. Carbonated beverages on the other hand, may cause more distress and gas. Working with a good nutritionist can often be beneficial.