Irritable bowel syndrome (IBS) is a very common condition that consists of a group of symptoms: abdominal pain or discomfort and a change in bowel habits (either diarrhea or constipation or alternating between the two), bloating, and discomfort. Another common symptom is that patients often have some relief from pain or discomfort after a bowel movement.
IBS can come in many different types including IBS-D (diarrhea predominant irritable bowel syndrome), IBS-C (constipation predominant irritable bowel syndrome), and the mixed type, where patients alternate back and forth equally.
Post-infectious IBS is one of the most common and well-studied causes of IBS. It happens when a person develops IBS as a result of gastroenteritis (an inflammation of the digestive tract in the stomach and intestines.)
Anyone can develop IBS, but it typically affects women more than it does men and younger people more than older people.
There are a number of risk factors for IBS. Being female seems to be a very important risk factor. Having an underlying psychiatric condition such as depression or anxiety can also be a contributing factor. Finally, having gastroenteritis (inflammation of the stomach and intestinal lining) makes it more likely that one might develop IBS.
One of the mainstays of preventing IBS is preventing gastroenteritis (inflammation of the stomach and intestines and the tissue that lines them). Gastroenteritis can happen with a viral, bacterial, or parasite infection. It may also occur when someone is stressed or doesn’t sleep well. This means that to prevent IBS, good hand hygiene, healthy diet, physical activity, and management of underlying psychiatric conditions and stress is very important.
The common symptoms of IBS are abdominal pain or discomfort, diarrhea or constipation (sometimes both), bloating, gas, and distention of the abdomen. The abdominal pain with IBS is often a cramping type of pain. This pain could be in multiple different parts of the abdomen and move around. The diarrhea is typically unpredictable, as is the constipation. The unpredictability is one of the hallmarks of IBS that differentiates it from other conditions such as inflammatory bowel disease or Crohn’s disease, where diarrhea is very predictable. IBS symptoms are usually present during the day and not during sleep.
One of the underlying causes of IBS is an infection that damages the digestive tract. Another very important cause of IBS is an imbalance in the brain-gut connection. If the enteric nervous system (next to the digestive tract) is imbalanced or doesn’t connect properly with the nervous system of the brain, people can experience IBS symptoms. Another cause is underlying depression, anxiety, or stress.
SIBO stands for Small Intestine Bacterial Overgrowth and is a condition characterized by excessive bacteria in the small intestine. The symptoms are similar to those of IBS and patients tend to improve drastically in their IBS after treatment of SIBO.
IBS is a clinical diagnosis and is made when someone has the typical symptoms (abdominal pain, change in bowel habits, diarrhea and/or constipation). IBS does not usually have alarming symptoms or other clinical signs like weight loss, bleeding, or anemia. Diagnosis does not require blood tests or MRIs or an endoscopy.
Yes. Patients may go to the doctor complaining of bloating or gas without abdominal pain and with normal bowel habits and still be diagnosed with IBS. However, if you have abdominal pain but your bowel movements are okay, that is not IBS and could be simple constipation or diarrhea. IBS is a group of symptoms, and all of those symptoms must be present to make a diagnosis of IBS. It is very important to make sure that your doctor has thoroughly looked at your symptoms because you could have a more serious condition that is being overlooked.
Patients with IBS can often have a number of other functional disorders such as fibromyalgia, chronic fatigue, anxiety, and/or depression. Fibromyalgia is a disorder where patients develop pain throughout different parts of their body, so it’s really important to address the whole patient when managing IBS because a lot of those other associated conditions can have an impact on the symptomatology of IBS.
Because IBS is a group of symptoms, it is very important to make sure that a thorough history and physical examination is performed. This ensures that patients don’t have any alarming symptoms or any other signs of other conditions such as inflammatory bowel disease, celiac disease, microscopic colitis, or a thyroid disease. All of those conditions can mimic the symptoms of IBS, so it’s important for your physician to ask all the necessary questions to exclude these other conditions. Sometimes it’s not clear, and the doctor may require blood work or stool tests to rule out infections. They may even require an endoscopy or a colonoscopy if the symptoms are not clear-cut and you have risk factors for some of these other conditions.
Initially, IBS was a symptom-based treatment, meaning that if you would get medications to treat the symptoms of abdominal pain, diarrhea, or constipation. In recent years, developments have led to new treatment options. One in particular is Rifaximin, which is a very specific type of antibiotic that is not absorbed in the digestive tract and seems to help patients with irritable bowel syndrome or SIBO. Other treatments for IBS include SSRIs (Selective Serotonin Reuptake Inhibitors) which are also called antidepressants. These medications seem to work on the nerves of the digestive tract and help reduce the pain, cramping, and bloating.
There are symptom-based medications like antidiarrheals and over-the-counter constipation medications that can help. There are also specific medications for constipation predominant irritable bowel syndrome (IBS-C) that can help you have a bowel movement and target the underlying causes of why people get pain, bloating, and cramping. Antibiotics like Rifaximin have been shown to be very helpful in a large subset of patients with IBS who have SIBO (overgrowth of bacteria in the small intestine.) The last category of medications are antidepressants or anti-anxiety medications in the subset of patients who tend to have a stress and anxiety driven nature to their symptoms.
IBS can be cured (in a sense) as symptoms can be treated and never return. However, the majority of people tend to have some flares from time to time, though they can manage the condition with the proper medications, diet, and lifestyle changes.
An endoscopy is basically a procedure where a camera at the end of a tube is placed through the mouth down into the esophagus, stomach, and beginning portions of the small intestine to look for abnormalities. A colonoscopy is the same type of procedure but done through the large intestine.
Diet and food are paramount in living comfortably with IBS. Research that has shown that certain foods cause symptoms of IBS to be accentuated. For example, one of the main diets that helps in IBS is a Low-FODMAP diet. This diet includes avoiding foods that are highly fermentable. Specifically, these include dairy; gluten; certain raw fruits and vegetables such as avocados, peaches, and pears; vegetables such as broccoli and cauliflower; beans; artificial sweeteners; and a variety of other foods. Patients on the FODMAP diet are allowed to have alcohol but in moderation.
Yes. Exercise seems to play a very important role in the management of IBS. Patients who engage in regular physical activity tend to have improvement in their IBS symptoms. Other activities such as meditation, yoga, and tai-chi seem to help alleviate symptoms as well.
IBS is a group of symptoms, so typically patients don’t get the serious complications that one sees in other digestive disorders. However, IBS can be very frustrating and have significant effects on quality of life and relationships. IBS typically does not lead to hospitalization, surgery, or strong medications.
The prognosis for IBS is very good. Patients can have a short duration of symptoms and then be fine for many years. There are also patients who have mild symptoms, get better for a long time, and then have symptoms again. It’s really variable. Untreated IBS can affect the quality of life in many people. It can be one of the main causes of missed work. If you have IBS, it’s very important to find a doctor and get treated because you can lead a very normal life with IBS with all of the advancements in the field.
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