CONDITIONS

What Is Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common disorder that affects the functioning of the gastrointestinal (GI) tract. Irritable bowel syndrome has previously been referred to as spastic colon, colitis, mucous colitis, and spastic bowel. Experts have chosen the name irritable bowel syndrome to better encompass the many physical and mental aspects of the condition, and to accommodate a broad spectrum of symptoms that seem to be related. Unlike irritable bowel disorders such as ulcerative colitis and Crohn’s disease, IBS does not damage the GI tract. Patients with irritable bowel syndrome commonly experience cramping, abdominal pain, bloating, gas, diarrhea, and constipation, though their intestines typically remain free of erosion and scarring.

The National Institute of Health (NIH) categorizes IBS into four subtypes:

  • IBS with constipation. This type of IBS is characterized by hard or lumpy stools at least 25% of the time, and loose or watery stools less than 25% of the time.
  • IBS with diarrhea. This type of IBS is characterized by loose or watery stools at least 25% of the time, and hard or lumpy stools less than 25 percent of the time.
  • Mixed IBS. This type of IBS is characterized by hard or lumpy stools at least 25% of the time, and loose or watery stools at least 25% of the time.
  • Unsubtyped IBS. This type of IBS is characterized by hard or lumpy stools less than 25% of the time, and loose or watery stools less than 25% of the time.

Because little is known about what causes the functional changes of irritable bowel syndrome, IBS remains a syndrome – a grouping of symptoms that occur without a known cause – rather than a disease. It is, however, the focus of many major research projects, and many are hopeful that a definite cause is on the horizon.

According to the National Institute of Health, as much as 20% of the American adult population is affected by IBS, though only 5% to 7% receive a diagnosis. Women are twice as likely to suffer from IBS than men, and individuals under the age of 45 are at the highest risk of developing the disease.

What Causes Irritable Bowel Syndrome

Very little is known about the causes of IBS. Researchers suspect the following:

  • Improper functioning of gastrointestinal muscles. This might be the most concrete cause of IBS symptoms, as most patients experience improper functioning gastrointestinal muscles in one way or another. Frequent spasms of gastrointestinal muscles can cause cramping, diarrhea, and abdominal pain while a decrease in muscle activity could lead to constipation and bloating. However the causes of improperly functioning muscles remain unknown, with possibilities stretching from stress and emotional state to diet and lifestyle.
  • Nervous system miscommunication. In a normal individual, nerves in the gastrointestinal tract communicate with the brain to ensure proper digestion. Many scientists believe that there is a miscommunication between the brain and the gut in IBS, causing irregular bowel habits and sporadic pain/discomfort.
  • Mental health problems. IBS, among other GI disorders, is often found in individuals with mental health disorders such as depression and anxiety. Past trauma events also seem to make individuals more susceptible to the disease. Individuals with post-traumatic stress disorder (PTSD) and those who have suffered physical/sexual abuse are more likely to have GI disorders such as IBS.
  • Gut biome imbalance. The human gut is naturally home to billions of microorganisms that help the body digest more effectively. If the population of beneficial microorganisms is disturbed, individuals can experience a significant change in digestive patterns. Small intestine bacterial overgrowth (SIBO) has been thought to cause IBS symptoms. However patients who are suspected to have SIBO are often treated with antibiotics, which can further disrupt the balance of gut microorganisms elsewhere in the gastrointestinal tract.

In addition to the broad causes of IBS, there are a number of other conditions and diseases that can be underlying causes of IBS. These include:

  • Food allergies/sensitivity. Many individuals experiencing IBS symptoms find that cutting out a specific food group – such as gluten, eggs, nuts, or soy – greatly improves their condition. An intolerance to carbohydrates, specifically gluten, is among one of the most commonly reported sensitivities
  • Bacterial or parasitic infection. Travelers are especially vulnerable to bacterial and parasitic infection, which can cause symptoms that may be mistaken for IBS, and/or may lead to IBS in the future. Individuals who have had gastroenteritis (bacterial infection of the stomach) and various parasitic infections have been linked to the development of IBS. The cause of this link is still undiscovered, though some suspect that it may have to do with gut biome imbalances following antibiotic treatment.

Risk Factors For Irritable Bowel Syndrome

Though the causes of IBS are largely unknown, there are several factors that can influence your risk of developing the disorder:

  • Sex. Women are approximately two times more likely to develop IBS than men. This could be connected to hormonal differences, as it has been observed that cases of IBS are more severe in menstruating women than they are in post-menopausal women.
  • Family History. IBS has been shown to aggregate in families. Studies have shown that individuals with a family member affected by IBS are 2-3 times as likely to develop the syndrome, and are more likely to experience severe symptoms.
  • Age. IBS typically develops in young adulthood, though it can develop at any age. The average age of onset for IBS is between 25 and 45 years of age.
  • Stress. Stress is among the many psychological factors linked to IBS. Stress can both trigger an IBS flare-up and worsen the severity of symptoms.
  • Anxiety/depressive disorders. Studies have shown significant correlation between patients with anxiety/depressive disorders and the development of IBS. Effective treatment of anxiety/depressive disorders can also help to lessen IBS symptoms in affected individuals.
  • Abuse. Survivors of physical, sexual, and emotional abuse are more likely to develop IBS. This could be due to the stress of dealing with past trauma. Post-traumatic stress disorder sufferers are also more likely to suffer from IBS.

Diagnosing Irritable Bowel Syndrome

An IBS diagnosis is exclusionary, meaning that a diagnosis is made when all other conditions with similar symptoms have been ruled out.

Before arriving at an IBS diagnosis, doctors may need to rule out the following conditions, which can present similar symptoms:

  • Ulcerative colitis
  • Crohn’s disease
  • Celiac’s disease
  • Diverticulitis
  • Endometriosis
  • Cancer of the colon or stomach
  • Lactose intolerance
  • Food allergy
  • Parasitic infection
  • Heartburn
  • Thyroid disease
  • Gallstones
  • Pancreatic disease
  • Laxative abuse
  • Substance abuse

Tests that may help a doctor arrive at an IBS diagnosis may include:

  • Flexible sigmoidoscopy, an examination of the lower colon via a flexible tube, helps to detect intestinal damage, inflammation, obstruction, and mucosal irregularities
  • Colonoscopy, an examination of the entire colon via a flexible tube, helps to detect damage, inflammation, obstruction, and mucosal irregularities throughout the entire intestine.
  • Computerized tomography (CT) scan, an X-ray that uses cross-sectional images to get a comprehensive view of the gastrointestinal tract, that can help detect bowel obstructions, scarring, and irregularity.
  • Lactose intolerance tests. Patients can be checked for lactose intolerance through either a hydrogen breath test or blood sample. In a hydrogen breath test, breath hydrogen levels are measured with a balloon-like device after the patient consumes a lactose solution. If the body is having trouble digesting lactose, breath hydrogen levels increase. If the body is able to digest lactose, it breaks it down into glucose, which is then absorbed into the blood stream. A blood test measures the amount of glucose in the blood following lactose consumption. Low levels of glucose may indicate lactose intolerance.
  • Blood tests. Blood tests can help rule out a multitude of other causes for IBS symptoms, including viral/bacterial infection and abnormal immune response (Celiac’s/Crohn’s).

In order to be diagnosed with IBS, a patient must experience symptoms for at least six months in total, and must have experienced symptoms at least three times a month for he three months leading up to the diagnosis.


According to the National Institute of Health, diagnostic criteria for the different types of IBS are as follows:

  • IBS with constipation. Hard or lumpy stools at least 25% of the time, loose or watery stools less than 25% of the time.
  • IBS with diarrhea. Loose or watery stools at least 25% of the time, hard or lumpy stools less than 25 percent of the time.
  • Mixed IBS. Hard or lumpy stools at least 25% of the time, loose or watery stools at least 25% of the time.
  • Unsubtyped IBS. Hard or lumpy stools less than 25% of the time, loose or watery stools less than 25% of the time.

Symptoms of Irritable Bowel Syndrome

IBS symptoms can vary from patient to patient in severity and symptom type. The wide variety of possible IBS symptoms means that it is possible for the condition to present itself in entirely different ways in different patients.

Symptoms of IBS include:

  • Cramps or pain in the stomach area
  • Constipation or infrequent stools that may be hard and dry
  • Feeling like you haven’t finished a bowel movement
  • Diarrhea or frequent loose stools
  • Alternating between diarrhea and constipation
  • Mucus in the stool
  • Excessive Gas
  • Bloating and swelling of the abdomen
  • Feelings of urgency when needing to use the toilet

Prognosis

Because IBS encompasses such a large group of symptoms and patient experiences, prognosis varies from case to case. Some people find complete relief by changing their diet or making other small lifestyle changes, while others chronically suffer from symptoms. The overall prognosis for patients with IBS depends on the severity and frequency of symptoms, as well as the patient’s ability to control these symptoms, whether by diet, lifestyle changes, or medications. Since IBS does not cause physical damage to the intestine, individuals with IBS are not at a heightened risk of colon cancer.

Living With Irritable Bowel Syndrome

Many people report a significant improvement in symptoms by making lifestyle changes.

The following are tips to help you live more comfortably with IBS:

  • Eat five small meals rather than three large ones so your metabolism isn’t overloaded.
  • Keep your diet healthy with plenty of fresh fruits and vegetables. Avoid highly processed or fried foods.
  • Be aware of where toilets are located. If you find that you frequently make urgent trips to the bathroom, plan ahead for vacations and day trips to make sure that you have a bathroom available to you.
  • Keep a food journal. This can help you identify foods that may trigger IBS symptoms, and possibly help identify food allergies and intolerances.
  • Drink plenty of fluids; water is best. Dehydration can cause many of the symptoms of IBS such as constipation, bloating, and abdominal pain. Water is the best choice to keep hydrated. The sugar and caffeine in juices, carbonated beverages, coffee, and tea can irritate the gastrointestinal tract and worsen symptoms of IBS.
  • Limit stress. Stress can trigger IBS flare-ups. Deep breathing, meditation and yoga are all good choices.
  • Try to exercise regularly. You only need 30 minutes of exercise a day to help improve constipation and relieve stress. Find a mode of exercise that you enjoy and that does not put too much stress on your system, which can worsen symptoms.
  • Get support. Join an on-line group or forum and find family or friends with whom you can share your experience.

Screening

Because of the broad spectrum of cases within the scope of IBD, screening methods are not used to diagnose IBS in standard practices. If you are exhibiting any of the symptoms of IBS or feel that you may have IBS, your doctor will be able to perform diagnostic tests to help determine the cause of your symptoms.

Prevention

The exact causes of these conditions aren’t known so there is no absolute prevention. However, it does appear that IBS development is correlated to stress levels and diet. Dealing with stress through methods such as meditation, biofeedback, deep breathing and yoga, may help prevent flare-ups. Maintaining a life-long balanced diet and taking regular probiotics may also help promote a healthy gut biome and digestive process.

Medication And Treatment

Because little is known about the causes of IBS, most medications are directed at managing the symptoms of IBS. However, the FDA has recently approved a few medications to treat the causes behind specific cases of IBS.


The first line of treatment for IBS patients is most often symptom management through lifestyle and dietary changes. These include:

Restricted diet. Patients may be asked to cut out inflammatory food groups or change the balance of their diet.

  • High-gas foods such as cabbage, broccoli, and carbonated beverages should be avoided by those who suffer from gas and abdominal bloating.
  • FODMAPs (fermentable oligo-, di-, and monosaccharides and polyols) are a certain type of carbohydrate that causes gut irritation in many IBS sufferers. FODMAPs can be found in fruits such as apples, mangoes, vegetables such as cabbage and onion, and grain products such as breakfast cereals and wheat noodles.
  • Gluten is a point of controversy among those treating IBS patients. Some believe that it has inflammatory effects in the bowel while others do not. There has not been sufficient scientific research done to produce conclusive data.

Exercise regimen. Exercise can help minimize stress and promote regular digestion. If you do not already exercise regularly, your doctor may suggest implementing a routine that is manageable for you.


Nutritional Supplements. If the bowels are moving too quickly, proper nutrient absorption may be disrupted, leading to critical nutrient deficiencies such as iron deficiency and vitamin B deficiency. Ask your doctor or a registered dietitian about what supplements are best for you.


Medications. Medications are also available to help manage IBS symptoms. These include:

  • Laxatives can help treat symptoms of constipation. Though laxatives are available over the counter, patients with IBS should consult with a doctor before using them as they might worsen IBS symptoms.
  • Bulking agents can help to coagulate stool and ease stool passage. Examples include bran or psyllium husk.
  • Anticholinergics/Antispasmodics have limited benefit for treating IBS. In some persons they relieve abdominal pain or discomfort, usually if the symptoms occur soon after eating. Examples include:
    • Dicyclomine (Bentyl)
    • Hyoscyamine (Levsin).
  • Anti-anxiety and anti-depressant medications – Since the mind and gut are so closely related, medications that treat chemical imbalances in the brain that affect mood may help relieve symptoms of IBS when given in smaller doses. Many anti-anxiety and anti-depressant medications have serious side effects. Consult with your doctor about the possible risks and benefits of each medication. Anti-anxiety and anti-depressant medications used to treat IBS include:
    • Amitriptyline
    • Bupropion (Wellbutrin)
    • Citalopram (Celexa)
    • Desipramine (Norpramin)
    • Fluoxetine (Prozac)
    • Imipramine (Tofranil)
    • Paroxetine (Paxil)
    • Sertraline (Zoloft)
    • Trazodone
    • Venlafaxine (Effexor)

If symptoms worsen while taking any of these medications, or thoughts of suicide develop, stop taking the medication immediately. If you are experiencing thoughts of suicide, call the suicide hotline at 1-800-273-TALK (8255)


The following are the FDA approved medications for the treatment of IBS:

Alosetron (Lotronex). Alosetron has been linked to serious side effects, and prescription of the medication is therefore limited to female patients suffering from IBS with diarrhea who have not responded to other treatments. Alosetron works by relaxing the colon and lengthening the time it takes stool to pass through the colon.

       Common side effects of Alosteron include:

  •  Stomach pain
  • Nausea
  • Constipation

     More serious side effects include:

  • Severe constipation
  • Ischemic colitis (blocked blood flow to the colon)
  • Fever
  • Rapid heart rate

Do NOT take Alosteron if you:

  • Suffer from constipation or IBS with constipation
  • Have a history of blood clots
  • Have suffered from bowel blockage
  • Have evidence of blocked blood flow to the colon (ischemic colon)
  • Have suffered or currently suffer from Crohn’s disease, ulcerative colitis, diverticulitis, or liver disease.
  • Are taking fluvoxamine (Luvox)

Lubiprostone (Amitiza). Lubiprostone is also connected to serious side effects, and is therefore limited to female patients 18 years and older suffering from IBS with constipation who have not responded to other treatments. Lubiprostone works by increasing the secretion of fluids in the small intestine to help ease the passing of stool.

 Common side effects of Lubiprostone include:

    • Nausea
    • Diarrhea
    • Abdominal pain and distension

           More serious side effects include:

    • Severe diarrhea
    • Severe nausea
    • Chest tightness

Do NOT take Lubiprostone if you:

  • Have severe diarrhea
  • Have liver disease

Lubiprostone may cause fetal harm, though studies are inconclusive. If you are pregnant or are thinking about getting pregnant, consult with your doctors about before taking Lubiprostone.

Linaclotide (Linzess). Linaclotide was approved for the treatment of IBS with constipation for both men and women in 2012. Linaclotide works by increasing the movement of food and waste through the gastrointestinal tract and by blocking problematic nerve signals in the colon.

      Common side effects include:

  • Diarrhea
  • Gas
  • Abdominal bloating
  • Abdominal pain

   More serious side effects include:

  • Severe diarrhea
  • Bloody stools

Complementary and Alternative Treatment

Most naturopathic approaches to healing IBS are focused on rebuilding the gut biome. According to Dr. Michael Hyman, medical doctor and best-selling author of the books The UltraSimple Diet and The Daniel Plan: 40 Days to a Healthier Life, there are almost 3 pounds of bacteria (more than 500 species) in your gut that help along your digestive process. When this massive population of microorganisms is disrupted, it can cause severe digestive upset.

Dr. Hyman recommends the following 5 steps to cure your IBS:

  • Get tested. Try to get a test for IgG food allergies and eliminate the foods that test positive for 12 weeks. Or simply try an allergy elimination diet for a few weeks.
  • Test yourself. If you can’t afford the test mentioned above, then just eliminate the most common food allergens for 12 weeks – that’s dairy, gluten, yeast, eggs, corn, soy, and peanuts. And then reintroduce them to see if they cause symptoms. This is an effective way to isolate the foods that may be causing you problems. I have created a simple program to follow based on a comprehensive elimination diet called The UltraSimple Diet.
  • Get rid of the unwanted visitors in your small bowel. Ask your doctor to prescribe rifaximin (Xifaxin) and take two 200 mg tablets three times a day for seven to 10 days. This is often the best way to deal with the chronic bacterial overgrowth that causes bloating and irritable bowel syndrome. You may also need an anti-fungal such as nystatin or fluconazole for two to four weeks.
  • Repopulate your digestive tract with good bacteria by using high potency probiotics. The best evidence relates to a particular organism, Bifidobacterium infantis 35624. Studies have shown this strain to be superior to placebo in relieving the main symptoms of the irritable bowel syndrome (abdominal pain/discomfort, distension/bloating and difficult defecation).
  • Try digestive enzymes with meals to help break down food while your gut heals. You also may benefit from nutrients that help heal the lining of the gut including fish oil, GLA (from evening primrose oil, zinc, vitamin A, glutamine and others.

Many alternative health practitioners recommend certain mind-body practices that have been shown to reduce stress. These include:

  • Meditation
  • Hypnosis
  • Tai Chi
  • Biofeedback
  • Yoga

Additionally, acupuncture may be able to effectively treat IBS symptoms and IBS-linked stress. Acupuncture to specific points is thought to release the energy and redirect its flow. In some cases electrical stimuli are given to the acupuncture needles to increase the effect (electro-acupuncture).Two very small trials examining acupuncture for the treatment of IBS have been performed with contradictory results. Despite this lack of data, many patients pursue acupuncture for abdominal pain, bloating, and nausea.

When To Contact A Doctor

If you suffer from IBS, call your doctor if you experience:

  • Severe pain or bloating in your abdomen after meals
  • Sores in your mouth
  • Sores in your anal area (around your rectum)
  • Fever above 101.0F (38.3C) or chills
  • Poor appetite or weight loss
  • Bloody diarrhea
  • Nausea or vomiting
  • Skin rashes or skin that weeps
  • Bloody stools
  • Fatigue
  • Symptoms that wake you in the night

Questions For A Doctor

If your doctor has diagnosed you with IBS, you may want to ask him or her the following questions:

  • How severe is my IBS?
  • Is my IBS hereditary or related to my environment/lifestyle?
  • What lifestyle changes will help my condition?
  • What complications may I experience?
  • Does my IBS increase my risk for developing any other medical problems?
  • Will a board-certified gastroenterologist be performing my diagnostic test?
  • How should I prepare for this diagnostic test?
  • Are there any side effects or complications associated with this diagnostic test?
  • Are there any side effects to the OTC or prescription medications?
  • Is there a cure for IBS?