What is Irritable Bowel Syndrome (IBS)?
Irritable bowel syndrome (IBS) is a chronic disorder of the large intestine. It is characterized by recurrent abdominal pain and bowel movement issues that can be difficult to treat . Signs and symptoms of IBS are usually not severe or life-threatening, but finding relief may be frustrating.
In order to have a confirmed diagnosis, your IBS should include two of three key symptoms, including improvement of symptoms after defecating, pain that begins when the frequency of stool changes, or pain that begins when the stool changes consistency.
Other key symptoms include abdominal pain and discomfort, as well as bloating, cramping, gassiness, mucus in the stool, and fatigue. These may all be exacerbated by stress, specific foods, or hormonal changes, especially in women.
Treatment focuses on alleviating your symptoms through supplements and medication.
While many people with IBS try to cope with the condition on their own, it could make a big difference if you talk to your doctor. They may be able to recommend a variety of treatments such as medication, diet counseling, or alternative therapies.
How common is Irritable Bowel Syndrome (IBS)?
Irritable Bowel Syndrome (IBS) is also known as
Irritable Bowel Syndrome (IBS) Symptoms
According to the "Rome III IBS criteria" that define IBS, you must have abdominal pain or discomfort at least three days per month in the last three months and two or more of the following :
- Improvement of symptoms after defecating
- Pain begins when frequency of stools changes
- Pain begins when the stool changes consistency
Other symptoms experienced with IBS include the following.
- Bowel changes: This may include constipation, diarrhea or both, as they can alternate.
- Mucus in the stool
In addition, there are certain triggers that can cause IBS symptoms to flare up or reemerge:
- Stress: Most people with IBS experience worse or more frequent signs and symptoms during periods of increased stress. Though stress may aggravate symptoms, it does not cause them.
- Specific foods: True food allergies do not cause IBS but many people experience worse symptoms when they eat or drink certain foods or beverages such as wheat, dairy, beans, and carbonated drinks.
- Hormonal changes: The role of hormones (especially estrogen) can trigger IBS; many women report increased or worsening symptoms according to their menstrual cycles .
Irritable Bowel Syndrome (IBS) Causes
The exact cause of IBS has not been identified. The symptoms of the condition do not leave any visible signs of damage or disease on the digestive tract, making IBS hard to study microscopically. Nevertheless, factors that may play a role in the pathophysiology of the condition include :
- Overactive muscle contractions in the intestine: The walls of the intestines are lined with layers of muscle that contract as food moves through the digestive tract. Contractions that are stronger and last longer than normal can result in bloating, gas and diarrhea. On the other hand, weaker, shorter intestinal contractions can slow down the passage of food and lead to hard, dry stools and constipation.
- Nervous system abnormalities/overstimulation: The abdomen normally stretches when there is gas or stool present. However, abnormalities in the nerves of the digestive system may cause 1) greater than normal stretching that leads to discomfort or 2) overactive signals suggesting stretching when everything is actually normal. In either scenario, the dysfunctional nerves result in pain, diarrhea or constipation.
- Inflammation in the intestines: Some people with IBS have an increased number of immune-system cells in their intestines. This immune system response is associated with pain and diarrhea.
- Severe infection or bacterial overgrowth: IBS can develop after a severe infection of the gastrointestinal tract (gastroenteritis) caused by bacteria or a virus. IBS may also be associated with a surplus of bacteria in the intestines (bacterial overgrowth).
- Changes in bacteria in the gut (microflora or microbiome): Microflora is the "good" bacteria that live in the intestines and play a key role in health. The microflora in people with IBS may be dysfunctional or differ from the microflora found in healthy people.
Who is most likely to be affected
The signs and symptoms of IBS are common, and many people can experience these symptoms occasionally. However, the following populations are more likely to develop IBS and experience these symptoms chronically [1,4]:
- Young individuals: IBS occurs more frequently in people under age 50.
- Females: In the United States, IBS is more common among women. It is present in about 14 of every 100 women versus nine out of every 100 men. This may be due to estrogen therapy that can increase the risk of IBS.
- People with mental health conditions: Anxiety, depression and other mental health issues are associated with IBS. A history of sexual, physical or emotional abuse also might be a risk factor.
- People with a family history of IBS: A genetic link for IBS has not been found; however, sometimes this condition can run in families.
Complications that can result due to IBS may include the following.
- Poorer quality of life: Many people with moderate to severe IBS report poorer quality of life due to factors such as missed work and strained relationships.
- Mood disorders: Experiencing the signs and symptoms of IBS can lead to depression or anxiety. Depression and anxiety also can make IBS worse.
Treatment Options and Prevention
Treatment of IBS is multifactorial and includes management of lifestyle factors such as diet and stress as well as medications. IBS is the most commonly diagnosed gastrointestinal condition, although, your physician may want to rule out other diagnoses through testing. For example, celiac disease is more common among people who also have IBS and may be causing your symptoms to be more severe or varied . Your physician will likely ask about the symptoms you are experiencing, the duration, and possible triggers.
In order to better manage and even prevent IBS symptoms, the following lifestyle changes may be helpful.
- Avoid food triggers: This is a key aspect of IBS management and treatment. Your physician may suggest working with a dietician in order to plan meals that do not contain gluten, high-gas foods such as caffeine, cabbage, and broccoli, or carbohydrates known as FODMAPs (fermentable oligo-, di- and monosaccharides or polyols). FODMAP carbohydrates are found in some grains, vegetables and dairy products . However, true food allergies are rare (between three to four percent of the population), so the suggested limitations will likely be in moderation in order to ensure you are receiving proper nutrients [2,6].
- Reduce stress: Eating regularly and getting enough sleep are great ways to help reduce stress, which can ease symptoms of IBS. Other strategies include mindfulness training, counseling, and relaxation exercises to help control symptoms, especially if you are experiencing serious anxiety or depression.
Supplements and other medications
Your physician may first suggest medications that focus on specific symptoms such as pain or constipation/diarrhea.
- Fiber supplements: These may be a good option if a diet rich in fruits and vegetables is not providing relief. This may include psyllium fiber (Metamucil) or methylcellulose (Citrucel), which are safe to take every day . Laxatives, probiotics, and antidiarrheal medications can also help alleviate some of the discomfort caused by IBS.
- Pain medications: These can also help relieve the abdominal pain and cramping associated with the disease. Narcotics should be avoided.
- Antidepressants: Your physician may also suggest antidepressants which can not only help any mood symptoms you are experiencing but may also treat symptoms such as diarrhea .
There are also a number of medications specifically approved for IBS that are designed to combat some of the proposed causes of IBS, such as overactive muscle contraction or bacterial overgrowth. These may include linaclotide (Linzess), rifaximin (Xifaxan), or eluxadoline (Viberzi) . Talk to your physician about these options and if they are the right treatment plan for you.
When to Seek Further Consultation
If you have a persistent change in your bowel habits or other symptoms of IBS that do not get better, make sure to make an appointment with your physician. Such persistent symptoms may indicate a more serious condition such as colon cancer. Symptoms of concern include:
Questions Your Doctor May Ask to Diagnose
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Any fever today or during the last week?
- Have you lost your appetite recently?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Are your symptoms causing difficulty at work, socializing, or spending time with friends & family?
- Have you experienced any nausea?
The above questions are also covered by our A.I. Health Assistant.
- Irritable bowel syndrome. Mayo Clinic. Published March 17, 2018. Mayo Clinic Link
- Occhipinti K, Smith JW. Irritable bowel syndrome: A review and update. Clinics in Colon and Rectal Surgery. 2012;25(1):46-52. NCBI Link
- Heitkemper MM, Chang L. Do Fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome? Gender Medicine. 2009;6(Suppl 2):152-167. NCBI Link
- Irritable bowel syndrome: Overview. National Center for Biotechnology Information. Updated October 20, 2016. NCBI Link
- FODMAP food list. IBS Diets. Updated October 3, 2018. IBS Diets Link
- True food allergies are serious but rare. American College of Gastroenterology. American College of Gastroenterology Link
- Picco MF. I find it difficult to eat enough fruits and vegetables. Is there any harm in taking a fiber supplement every day? Mayo Clinic. Published September 26, 2015. Mayo Clinic Link
- Clouse RE. Antidepressants for irritable bowel syndrome. Gut. 2003;52(4):598-9. NCBI Link
- Irritable bowel syndrome. Mayo Clinic. Published March 17, 2018. Mayo Clinic Link