Irritable Bowel Syndrome (IBS)
April is IBS awareness month, and as a disease that affects roughly 10-15% of people in the United States1, it is important to understand the disease, its symptoms, and the treatment options. IBS is a common disorder that affects the large intestine. It affects quality of life when symptoms flare up and everyday activities become difficult to complete. The precise cause of IBS is unknown; however, some factors appear to play a role:
- Muscle contractions in the intestine: the walls of the intestine are lined with layers of muscle that contract and relax as they move food through the digestive tract. Contractions that are stronger and last longer than normal can cause gas, bloating, and diarrhea. On the other hand, weak intestinal contractions can slow food passage and lead to hard, dry stools.
- Nervous system: abnormalities in the nerves in the digestive system may cause you to experience greater than normal discomfort when your abdomen stretches from gas or stool. Poor signals from the brain to the intestines can cause your body to overact, causing pain, diarrhea, or constipation.
- Severe infection: IBS can develop after a severe bout of diarrhea caused by bacteria or a virus.
- Changes in gut microbes: changes in bacteria, fungi, and viruses, which normally reside in the intestines and play a key role in health. Research indicates that the microbes in people with IBS might differ from those in healthy people.
IBS symptoms are variable depending on the person, so it can be hard to recognize them and confirm that it is IBS versus other diseases like ulcerative colitis, Crohn’s disease, lactose intolerance, diverticulitis, celiac disease, or gallstones. Symptoms of IBS include:
- Abdominal pain, cramping, or bloating that is related to passing a bowel movement
- Changes in appearance of bowel movement
- Changes in how often you are having a bowel movement
- Increased gas
- Mucus in the stool
Again, these symptoms vary, but are usually present for a long time. As always, see your doctor if you have a persistent change in bowel habits or other signs or symptoms of IBS. They may indicate a more serious condition, such as colon cancer. These more serious symptoms include weight loss, rectal bleeding, iron deficiency anemia, difficulty swallowing, and persistent pain that isn’t relieved by-passing gas or a bowel movement.
Treatment of IBS mainly focuses on relieving symptoms so that you can live as normally as possible. Mild signs and symptoms can often be controlled by managing stress and by making changes in your lifestyle, such as diet and exercise. Working with a dietitian can help with diet changes needed to improve IBS symptoms and improve quality of life. A dietitian will talk with you and might suggest that you eliminate the following from your diet:
- High gas foods: carbonated beverages, alcoholic beverages and other foods that you notice cause abnormal gas
- Gluten: research shows that some people with IBS report improvement in diarrhea symptoms if they stop eating gluten, even if they don’t have celiac disease
- FODMAP’s: certain carbohydrates can cause symptoms and issues with IBS, these are labeled as FODMAP’s, which stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are carbohydrates that the small intestine absorbs poorly, resulting in digestive distress. By limiting these in the diet, then symptoms of IBS can be lessened.
In addition, your doctor might suggest medications such as fiber supplements, laxatives, anti-diarrheal’s, and pain medications. There are also medications specifically created to treat IBS and include Alosetron, Eluxadoline, Rifaximin, lubiprostone, and linaclotide. Researchers are also investigating new treatments for IBS, such as fecal microbiota transplantation (FMT). FMT aims to restore healthy intestinal gut bacteria by placing another person’s processed stool into the colon of a person with IBS. Clinical trials on FMT are currently being done to determine its effectiveness.
- Irritable bowel syndrome. American College of Gastroenterology. https://gi.org/topics/irritable-bowel-syndrome/. Accessed April 11, 2022.
- Irritable bowel syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/all-content. Accessed April 11, 2022.
- Feldman M, et al. Irritable bowel syndrome. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed April 11, 2022.
- 6 tips: IBS and complementary health practices. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/tips/tips-ibs-and-complementary-health-practices. Accessed April 11, 2022.