Irritable Bowel Syndrome (IBS) can be an extremely uncomfortable and painful condition whose precise cause is not yet fully understood. There are many potential triggers to IBS that vary from person to person and symptoms usually come and go. Multiple treatment options exist including medication and supplements, but most find they are able to control symptoms through diet and lifestyle changes.
What is Irritable Bowel Syndrome (IBS)?
Irritable Bowel Syndrome (IBS) is a common disorder that affects the large intestine in the body. The most common, and usually mild, symptoms include cramping, bloating, or constipation. IBS affects approximately 10 to 15 percent of the world’s population, the majority being under the age of 50 years old. The exact cause of IBS is not yet known but it appears that symptoms result from an irritation in the way the gut, brain, and nervous system interact.
- IBS with constipation (IBS-C): Most of your poop is hard and lumpy.
- IBS with diarrhea (IBS-D): Most of your poop is loose and watery.
- IBS with mixed bowel habits (IBS-M): You have both hard and lumpy bowel movements and loose and watery movements on the same day.
Symptoms of IBS
IBS is unpredictable as symptoms can vary and be contradictory depending on the type of IBS. Common mild symptoms of IBS include:
- Abdominal Pain and Cramping
- Alternating Constipation and Diarrhea
- Changes in Bowel Movements
- Gas and Bloating
- Fatigue and Difficulty Sleeping
More severe and often debilitating symptoms of IBS include:
- Weight loss
- Diarrhea at night
- Rectal bleeding
- Iron deficiency anemia
- Unexplained vomiting
- Difficulty swallowing
- Persistent pain that isn't relieved by passing gas or a bowel movement
*For severe symptoms, it is suggested to see a doctor as soon as possible. This Mira article outlines when one should go to urgent care to treat IBS symptoms.
Causes of IBS
As mentioned, the precise cause of IBS has not yet been determined. Researchers have yet to completely understand the exact cause of the syndrome, possibly due to many factors being involved such as genetics and prior adverse life experiences (eg. infection, trauma). Symptoms are thought to appear from disturbances caused by muscle contractions and increased sensitivity to food, gas, or stool in the bowel.
Disrupted muscle contractions and sensations may be due to disruptions in the brain-gut interaction. This interaction is crucial in maintaining normal bowel functioning. Research has shown that these main factors may play a role in the disruption of the brain-gut interaction:
- A genetic predisposition: relatives of an individual with IBS are two to three times as likely to have IBS
- An intestinal infection prior to symptom onset: the condition has also been shown to develop after a severe bout of diarrhea (gastroenteritis) caused by bacteria or a virus
- Chronic stressful life events, or other psychosocial factors: people exposed to stressful events, especially in childhood, tend to have more symptoms of IBS
These factors affect each individual differently, as one may be more relevant to an individual’s IBS symptoms than others. Multiple factors can also play a role in an individual’s IBS. Gastrointestinal symptoms, such as the ones experienced in IBS, have been recognized to occur in relation to fear, anxiety, and stress.
IBS is considered a functional disorder, which means symptoms are caused by a dysfunctional digestive system, rather than by chronic inflammation, growth, or permanent damage along the gastrointestinal (GI) tract that can be identified in a physical examination.
Potential Risk Factors of IBS
IBS can affect anyone, but research has shown that one is more likely to have the condition if they are:
- Have a family history of IBS
- Suffer from anxiety, depression or other mental health issues
Research has shown a higher correlation between IBS diagnosis and those under 50 years old, and also among women. Additionally, genes have been suspected to play a role, as are shared factors in a family's environment and/or a combination of both genes and environment. Stress, depression, and anxiety can sometimes trigger overactivity of the gut, which is thought to cause a flare-up of IBS-related symptoms
Diagnosis of IBS and Comorbidities
IBS can only be diagnosed by a medical professional. It is estimated that at least 50 percent of patients seen in primary care or by gastroenterologists have at least one overlapping condition (comorbidity) with IBS. Overlapping conditions that are common in IBS are often divided into 3 areas:
- Conditions that affect the gastrointestinal (GI) tract (the mouth to the anus,)
- Conditions that affect other areas of the body
- Psychological disorders
A study found that IBS patients were significantly more likely than controls to be diagnosed with chronic pain syndromes and psychiatric comorbidities. Researchers have found that the more conditions a person has, the more severe their IBS is likely to be. Common comorbidities that have been seen in IBS patients include:
- Celiac Disease
- Inflammatory Bowel Disease
- Chronic Fatigue Syndrome
- Chronic Pelvic Pain
How One Gets Diagnosed
While there is no test to definitively diagnose IBS, your doctor is likely to start with a complete medical history, physical exam, and tests to rule out other conditions, such as celiac disease. After other conditions have been evaluated, your physician is likely to use one of these sets of diagnostic criteria for IBS:
- Rome criteria - looks at abdominal pain and discomfort lasting on average at least one day a week in the last three months, associated with at least two of these factors: Pain and discomfort are related to defecation, the frequency of defecation is altered, or stool consistency is altered.
- Determine the type of IBS (IBS-C, IBS-D, or IBS-M)
Diagnostic procedures can include:
Laboratory tests can include:
- Lactose intolerance tests
- Breath test for bacterial overgrowth
- Stool tests
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Treatment of IBS
The treatment of IBS typically focuses on relieving symptoms so that one can live as normally as possible. The majority of those diagnosed with IBS find great success with diet and lifestyle changes.Different treatments are associated with each kind of IBS, so it’s essential to understand which symptoms best describe what you are experiencing. Whether you are experiencing mild, moderate, or severe IBS, it is important to educate yourself on the condition and consult with a physician.
Consider the following key points to remember about IBS:
- IBS is a long-term condition
- Symptoms flare over and over again
- Symptoms can change over time
- The symptoms themselves are non-life-threatening
- IBS is not a risk for another more serious disease
If one thinks they have IBS or has been diagnosed with IBS, they may have begun to realize that certain things trigger flare-ups of symptoms. Common triggers often include certain food and medication, as well as emotional stress. Some researchers have even suggested that IBS is the gut’s response to life’s stressors.
Changing Your Diet
Changing or modifying your diet can prove beneficial in reducing your IBS symptoms. Your doctor may recommend trying one or more of the following:
- Eating more fiber
- Avoiding gluten
- Following a low FODMAP diet as displayed in the picture below
Source: Nutrition Link Services
Common foods that have been shown to trigger IBS symptoms include:
- Fried Foods
- Caffeinated Drinks
Changing Your Lifestyle
Another trigger to IBS could be certain routines within your lifestyle that may require modification to improve symptoms. Research has suggested that these lifestyle changes may help reduce IBS symptoms:
- Increasing physical activity
- Reducing stressful life situations
- Getting enough sleep
- Drinking lots of fluids
In some cases, a physician may recommend and prescribe medicine to relieve IBS symptoms. The medicine prescribed usually works to treat the major symptoms being experienced by the patient - diarrhea, constipation, mixed-bowel, and abdomen pain.
Consider the following table that shows what medications are often prescribed for the type of IBS:
|IBS with diarrhea (IBS-D)|
|IBS with constipation (IBS-C)|
|IBS with mixed-bowel habits (IBS-M)|
Probiotics may also be a good option for treating IBS symptoms and can be found at most health food stores. Probiotics are the good live bacteria and/or yeasts that naturally live in your body. Adding probiotic supplements to one’s daily life may be a great option to relieve IBS symptoms and add good bacteria to one’s body. Research has suggested that “probiotics may improve overall IBS symptoms, as well as bloating and flatulence.”
To improve gut health, a healthy balance of bacteria is needed. Harvard Health states that “many digestive processes rely on a balance of various bacteria, which are found naturally in the gastrointestinal tract. If these bacteria fall out of balance, gastrointestinal disorders may occur, possibly including IBS.” Again, the precise cause of IBS still remains unknown, but researchers have pointed to probiotics as a way to restore a healthy gut microbiome as a way to relieve IBS symptoms.
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Mental Health Therapies
In some cases, one experiencing IBS symptoms may be recommended for mental health therapy to improve symptoms. Some therapies commonly used for treating IBS symptoms include:
IBS Frequently Asked Questions (FAQs)
Consider the following information when considering prevention, screening, and treatment of IBS.
How do I know which IBS treatment is right for me?
No specific therapy works for everyone, but most people with IBS can find a treatment that works for them. One’s healthcare provider will personalize an IBS treatment plan for one’s specific needs - usually including dietary and lifestyle changes.
Does insurance cover IBS treatment?
The majority of health insurance plans will cover the cost of visiting a gastroenterologist. However, there may be copays or coinsurance associated with the visits. We recommend speaking with one’s doctor before their visit to get an idea of what the fees will look like and if insurance will cover most of them. Additional costs may be added if one has any procedures done or is prescribed any medications.
Can I Prevent IBS?
No. Since there is no known cause for IBS, one can not prevent or avoid it. However, thoroughly understanding one’s condition can aid in the avoidance of triggers that cause IBS symptoms to flare up. There is also no cure for IBS, the goal of treatment is to control and manage symptoms, ensuring a high quality of life for the person diagnosed.
IBS is a disorder characterized by recurring issues with abdominal pain associated with a range of symptoms. It is important to get diagnosed to rule out other conditions and to learn more about one’s condition. Working to identify and avoid triggers, including certain foods, medications, and stressful situations can help one improve their quality of life. Talk to your healthcare provider about the specific symptoms one is experiencing as IBS will likely be with that person for life. Treatments vary by person and by type of IBS and are implemented to manage symptoms, not to cure IBS.
IBS must be diagnosed by a health care provider involving a complete medical history, physical exam, and tests to rule out other conditions. Lab tests can become a costly event, but Mira is here to help as we offer low-cost lab testing for a wide range of preventative care needs. Additionally, if your doctor has prescribed medication for your IBS symptoms, Mira offers up to 80 percent off over 1,000 different prescription medications. For only $45 a month, Mira members receive low-cost urgent care and primary care visits, and same-day lab testing. Don’t let the cost bring you any more pain; sign up for Mira today.
Kendra Bean is from Maui, Hawaiʻi. She is currently enrolled at the University of Hawaiʻi at Mānoa, specializing in Epidemiology. She is passionate about improving health literacy and access to care, specifically in rural areas.