Irritable Bowel Syndrome (IBS)
IBS is a mix of belly pain or discomfort and trouble with bowel habits: either going more or less often than normal (diarrhea or constipation) or having a different kind of stool (thin, hard, or soft and liquid). Doctors used to call IBS other names including:
- Spastic colon
- Spastic bowel
- Mucous colitis
- IBS colitis
- Nervous colon
IBS affects between 25 million and 45 million Americans. We don’t know what causes it but you are more likely to be affected if you are: a woman, have a family history of IBS, have stress, anxiety or other emotional issues, have food sensitivities, or have a history of physical or sexual abuse.
IBS isn’t life-threatening, and it doesn’t make you more likely to get other colon conditions, such as colon cancer, ulcerative colitis, or Crohn’s disease. But it can be a long-lasting problem that changes how you live your life.
People with IBS have symptoms that can include:
- Constipation alternating with diarrhea
- Belly pains or cramps, usually in the lower half of the belly, that get worse after meals and feel better after a bowel movement
- A lot of gas or bloating
- Harder or looser stools than normal (pellets or flat ribbon stools)
- Mucus in your poop
- A belly that sticks out
Other things may cause these symptoms but, if it’s IBS, you’ll likely have these symptoms weekly for 3 months, or less often for at least 6 months. Women with IBS may have more symptoms during their period. Stress can make symptoms worse.
When to talk to your Gorman Medical provider
If you have an IBS symptom that lasts a long time, you get a new symptom, or your pain is worse than usual or you have new pain, talk to your provider. If you usually take over-the-counter medications but now they don’t ease problems like diarrhea, gas, or cramping, you also need to talk to your provider.
Even if you don’t think a problem is physically part of IBS, but it bothers you, tell your provider. For example, if you’re stressed out or anxious about it, or if you’re losing sleep over the problem, let your provider know.
Your provider may recommend several tests, including stool studies to check for infection or problems with your intestine’s ability to take in the nutrients from food (malabsorption). You may also have a number of other tests to rule out other causes for your symptoms.
- Colonoscopy. Your doctor uses a small, flexible tube to examine the entire length of the colon.
- X-ray or CT scan. These tests produce images of your abdomen and pelvis that might allow your provider to rule out other causes of your symptoms, especially if you have abdominal pain. Your doctor might fill your large intestine with a liquid (barium) to make any problems more visible on an X-ray. This barium test is sometimes called a lower GI series.
- Upper endoscopy. A long, flexible tube is inserted down your throat and into the tube connecting your mouth and stomach (esophagus). A camera on the end of the tube allows the doctor to inspect your upper digestive tract and obtain a tissue sample (biopsy) from your small intestine and fluid to look for overgrowth of bacteria. Your doctor might recommend endoscopy if celiac disease is suspected.
- Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar found in dairy products. If you don’t produce lactase, you may have problems similar to those caused by IBS, including abdominal pain, gas and diarrhea. Your doctor may order a breath test or ask you to remove milk and milk products from your diet for several weeks.
- Breath test for bacterial overgrowth. A breath test also can determine if you have bacterial overgrowth in your small intestine. Bacterial overgrowth is more common among people who have had bowel surgery or who have diabetes or some other disease that slows down digestion.
- Stool tests. Your stool might be examined for bacteria or parasites, or a digestive liquid produced in your liver (bile acid), if you have chronic diarrhea.
Treatment of IBS and associated symptoms
- Dietary changes
- Alternative therapies
Bloating, abdominal pain and diarrhea may respond to dietary modification. For example, caffeine or fatty foods stimulate colonic contractions, so someone with IBS and diarrhea might have improvement by reducing their daily intake of caffeinated beverages and rich foods.
Those who suffer with bloating and abdominal discomfort might benefit from eating less food containing carbohydrates that are not digested well in the small intestine. Eating foods that contain large quantities of lactose, fructose and sorbitol, for example, may increase intestinal gas production, triggering more bloating, diarrhea and/or abdominal discomfort in those with IBS.
Many healthy foods, including some fruits and vegetables, contain these types of fermentable carbohydrates, in addition to fiber, another source of intestinal gas production. Finding the right balance of healthy foods can be a challenge if you have IBS. Ask your provider if you might benefit from a trial of the low FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet that has been shown in research studies to help reduce gassiness, abdominal pain and bloating in patients with IBS.
Working with a nutritionist is always recommended to make sure you are still getting all the nutrients you need, no matter which diet you are on.
There are several medications that can be used to treat IBS.
- Smooth muscle relaxants: These are best for relieving or preventing intestinal cramping.
- Antidiarrheal medications: Medications for those with diarrhea slow intestinal transit and reduce the frequency of bowel movements while improving the consistency of the stool.
- Laxatives: For patients who have constipation as the predominant symptom.
- Antibiotics: To attempt to alter the composition of the gut flora that might be responsible for the fermentation of poorly digested carbohydrates.
- Low-dose antidepressants: If pain and diarrhea are your predominant symptoms, you may find relief with these medications that work on the gut’s nervous system to make it less reactive to foods you eat or to emotional stress.
There is a strong connection between the nervous system and colonic function. Stress plays an important role in the frequency and severity of symptoms in IBS patients. A history of stressful life events or a current stressful situation can often precede IBS. Some patients who lost loved ones report the onset of symptoms shortly after the loss. Others with a history of depression notice that when the depression returns their symptoms worsen. Sometimes anxiety or depression occur with the onset of IBS symptoms.
If emotional stress is a trigger for your symptoms, there are several psychological interventions that might be used. The most studied is cognitive behavioral therapy, which has been shown to be effective for IBS. This type of therapy is provided by a trained mental health professional. Hypnotherapy has also been shown to help manage IBS symptoms.
- Certain probiotics have been shown to be helpful in managing some symptoms of IBS.
- Acupuncture may be helpful in managing anxiety, fibromyalgia, migraines and insomnia associated with IBS. Acupuncture also can have a direct gastrointestinal effect by altering GI motility and pain perception.
- Therapeutic massage can help reduce anxiety and relieve stress.
If you are experiencing symptoms such as those mentioned above, talk to your Gorman Medical provider. We can work with you to determine what is causing your symptoms and find a treatment that works for you.