All you need to know about irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is a gastrointestinal disorder that may cause chronic pain over the long term. But most people aren’t going to experience serious complications.

IBS is also referred to by people as spastic colitis, mucous colitis and colon nerve. The condition is chronic. Yet over the years, the symptoms tend to change. Signs often get better as people learn to manage the disease.

We’re covering signs, causes, and treatment in this article, and how diet can influence IBS.

Symptoms

 Abdominal pain
A person with IBS may experience abdominal pain and cramping.

The most common symptoms of IBS include:

  • changes in bowel habits
  • abdominal pain and cramping, which often reduce after passing a stool
  • a feeling that the bowels are not empty after passing stools
  • passing excess gas
  • the passing of mucus from the rectum
  • a sudden, urgent need to use the bathroom
  • swelling or bloating of the abdomen

Between meals the symptoms often get worse. A flare-up can last for several days, and then symptoms either improve or fully resolve.

The signs and symptoms differ from one person to another. These often mimic signs of other diseases and conditions, and may affect different parts of the body as well.

These may include:

  • frequent urination
  • halitosis, or bad breath
  • headache
  • joint or muscle pain
  • persistent fatigue
  • in females, painful sex, or dyspareunia
  • irregular menses

There can also be anxiety and depression, often due to the pain and humiliation that may accompany the disorder.

Diet

Dietary factors may be instrumental in causing symptoms of IBS.

Symptoms also get worse after eating other things, like chocolate, milk or alcohol, for example. These may either cause constipation, or diarrhea.

Other fruits, vegetables, and sodas can cause bloating and discomfort. Whether a food allergy or sensitivity may play a role is uncertain.

Common dietary triggers of cramping or bloating include foods that cause flatulence, such as:

  • beans
  • celery
  • onions
  • carrots
  • raisins
  • bananas
  • apricots
  • prunes
  • Brussels sprouts
  • pretzels
  • bagels

Other foods that can trigger flares include:

  • dairy products
  • sugar free gum
  • some candies
  • products with caffeine in them, which may be due to sugar, sorbitol, or caffeine intolerance rather than IBS

Dietary steps that can help a person reduce the risk of a flare include:

  • Managing fiber intake: Some people with IBS need to increase their fiber intake, while others should consume less. A balanced level of fiber in the diet can help promote healthful digestion.
  • Probiotic supplements: Taking probiotics may help some people. These are beneficial bacteria that support gut health. A person may not feel their effects immediately, so they should take them over a few weeks to gauge their impact on gut health over a more extended period.
  • Food diary: Keeping a record of specific foods in the diet and their physical effects will help a person identify primary trigger foods.

Changes in eating habits have the potential to help reduce symptoms. No diet on IBS works for any person. Hence, a person may need to go through a trial and error process to find a reliable, comfortable diet.

Causes

It is unclear what causes IBS. However, it is not contagious and does not have links to cancer.

Factors that may play a role in IBS development include:

  • diet
  • environmental factors, such as stress
  • genetic factors
  • hormones
  • digestive organs with a high sensitivity to pain
  • an unusual response to infection
  • a malfunction in the muscles that move food through the body
  • an inability of the central nervous system (CNS) to control the digestive system
  • A person’s mental and emotional state can contribute to IBS development. People with post-traumatic stress disorder (PTSD) have a higher risk of developing IBS.

Hormonal changes can make symptoms worse. For example, symptoms are often more severe in women around the time of menstruation.

Infections, such as gastroenteritis, can trigger post-infectious IBS (PI-IBS).

Is it curable?

IBS is not a solution. Nevertheless, if an IBS patient avoids causes, makes dietary changes and takes advice from their doctor, they can significantly reduce the risk of flares and pain.

Considering that the causes of IBS are unclear, IBS treatment options seek to alleviate symptoms and improve quality of life.

Treatment

Treating IBS typically involves several changes in diet and lifestyle, and learning how to manage stress.

Dietary management

The following steps may help symptoms:

Avoid sugar alternatives in some chewing gums, natural foods and sugar-free candy, since they can cause diarrhea

  • consuming more oat-based foods to reduce gas or bloating
  • not skipping meals
  • eating at the same time every day
  • eating slowly
  • limiting alcohol intake
  • avoiding carbonated, sugary beverages, such as soda
  • limiting intake of certain fruits and vegetables
  • drinking at least 8 cups of fluid per day, for most people

Gluten avoidance can also reduce the risk of flares. Gluten-free food items are now widely available, and alternatives.

Anxiety and stress

The following may help reduce or relieve symptoms:

  • relaxation techniques, including exercises or meditation
  • activities such as Tai Chi or yoga
  • regular physical exercise
  • stress counseling or cognitive-behavioral therapy (CBT)

Medications

The following medications may help IBS symptoms:

  • Antispasmodic medications: These reduce abdominal cramping and pain by relaxing the muscles in the gut.
  • Bulk-forming laxatives: These can help a person relieve constipation. People should use them with caution.
  • Antimotility medications: These can reduce diarrhea symptoms. Options include loperamide, which slows down the contractions of the intestinal muscles.
  • Tricyclic antidepressants (TCAs): These often help to reduce abdominal pain and cramping.

Medications specific to IBS treatment include:

  • alosetron (Lotronex) for severe diarrhea-predominant IBS in females
  • lubiprostone (Amitiza) for constipation-predominant IBS in females.
  • rifaximin, an antibiotic that can help reduce diarrhea in people with IBS
  • eluxadoline

Typically these are the last line of treatment when other lifestyles or medical measures have failed, and symptoms remain severe.

Psychological therapy

Many people may find psychological therapy useful to reduce IBS flares and symptom impact: include techniques;

  • Hypnotherapy: This can help alter the way the unconscious mind responds to physical symptoms.
  • Cognitive-behavioral therapy (CBT): This helps people develop strategies for reacting differently to the condition through relaxation techniques and a positive attitude.

Exercise can also help reduce symptoms in some people.

Diagnosis

No specific imaging or laboratory examination may help a diagnosis of IBS.

Diagnosis requires ruling out conditions that cause IBS-like symptoms, and following a symptom categorization protocol.

There are three main types of IBS:

  • IBS with constipation (IBS-C): A person experiences stomach pain, discomfort, bloating, infrequent or delayed bowel movements, or hard or lumpy stools.
  • IBS with diarrhea (IBS-D): There is stomach pain, discomfort, an urgent need to go to the toilet, very frequent bowel movements, or watery or loose stools.
  • IBS with alternating stool pattern (IBS-A): A person experiences both constipation and diarrhea.

Over time many people encounter various types of IBS. The doctor can often diagnose IBS by, for example, talking about the symptoms:

  • Have there been any changes in bowel habits, such as diarrhea or constipation?
  • Is there any pain or discomfort in the abdomen?
  • How often does a person feel bloated?

A blood test may help rule out other possible conditions, including:

  • lactose intolerance
  • small intestinal bacterial overgrowth
  • celiac disease

Where clear signs or symptoms suggest a different condition may require further testing. Including:

  • anemia
  • localized swelling in the rectum and abdomen
  • unexplained weight loss
  • abdominal pain at night
  • progressively worsening symptoms
  • significant amounts of blood in the stool
  • family history of inflammatory bowel disease (IBD), colorectal cancer, or celiac disease

People with a history of ovarian cancer may need more study, as people over the age of 60 with changing bowel habits might need to. This could mean the possibility of intestinal cancer.

Risk factors

A 2019 review of 38 studies showed that the following characteristics and conditions could increase the IBS risk:

  • gastroenteritis
  • being a younger or older adult
  • a history of anxiety or depression
  • stress
  • overusing healthcare
  • a family history of IBS
  • pain
  • sleep disorders

IBS work is under way to develop improved preventive measures and new treatments.

For now the best steps to prevent flares of pain are to be conscious of food and stress.

Q:

Can I get IBS from eating gluten?

A:

Some people with IBS may have concomitant allergy or sensitivity to gluten. Therefore, ask your doctor to test you for the same. If you are allergic or sensitive to gluten, then it is a good idea to consider a gluten free diet.Saurabh (Seth) Sethi, MD MPH

Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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