Irritable bowel syndrome (IBS) is a long-term gastrointestinal disorder that causes abdominal pain, bloating, mucous in stools, irregular bowel habits, and alternating diarrhea and constipation.
IBS is also known as spastic colitis, mucus colitis, and nervous colon. Although it is a chronic (long-term) condition, symptoms tend to wax and wane over the years.
In this article, we cover the causes, and types of IBS, and the risk factors, diagnosis, and treatment of IBS.
Contents of this article:
Fast facts on irritable bowel syndrome
Here are some key points about irritable bowel syndrome. More detail and supporting information is in the main article.
- Despite the discomfort caused by IBS, it generally does not lead to serious complications
- Currently, there is no cure for IBS
- Emotional state can play a significant role in IBS
- Reducing alcohol intake can ease symptoms
What is irritable bowel syndrome?
The causes of IBS are still relatively unknown.
Despite the chronic discomfort caused by IBS, it does not lead to any serious complications for the majority of patients. However, it can be a source of long-term pain and fatigue.
Fortunately, most patients find that symptoms improve as they become better at controlling their condition. Only a small percentage of individuals with IBS have severe symptoms.
There is no cure for irritable bowel syndrome. Treatment is aimed at relieving symptoms and includes dietary changes (avoiding caffeine, milk products, and sweeteners), relaxation techniques, medications, and exercise.
Most commonly, irritable bowel syndrome develops in individuals aged 20-30; however, it may affect people of any age. Twice as many females as males are affected by IBS.
Symptoms of irritable bowel syndrome
There are three types of irritable bowel syndrome (IBS):
- IBS with constipation - the patient experiences stomach pain, discomfort, bloating, infrequent or delayed bowel movements, or hard/lumpy stools
- IBS with diarrhea - the patient experiences stomach pain, discomfort, an urgent need to go to the toilet, very frequent bowel movements, or watery/loose stools
- IBS with alternating constipation and diarrhea
Many patients alternate between types of IBS as time goes by.
The most common symptoms experienced by people with IBS are:
- A change in bowel habits
- Abdominal pain and cramping - often relieved after going to the toilet
- After going to the toilet, the patient may feel that his/her bowels are not fully emptied
- Excess gas
- Passing of mucus from the back passage (rectum)
- Sudden urgent need to go to the toilet
- Swelling/bloating of the abdomen
Most symptoms tend to worsen after eating. Typically, a flare-up may last 2-4 days, and then symptoms either improve or go away completely.
IBS signs and symptoms vary considerably from patient to patient. They often resemble those of other diseases and conditions.
IBS may also cause symptoms to appear in parts of the body other than the bowel area; these may include:
- Frequent urination
- Halitosis (bad breath)
- Joint pain
- Muscle pain
- Pain in the lower back
- Persistent fatigue
Risk factors for irritable bowel syndrome
The following groups of people are more likely to have IBS:
- Younger adults - in around half of cases, the patient is 25 or younger
- Gender - women are twice as likely to suffer from IBS as men
- Family history - people with a close relative who has/had IBS are more likely to develop it themselves
- There is ongoing research studying whether family history IBS risk is linked to genes, a shared family environment, or both
Causes of irritable bowel syndrome
The causes of IBS are still relatively unknown.
Experts are not sure what causes IBS. It is thought that the following factors are probably involved:
- Dietary factors
- Environmental factors
- Genetic factors
- Central nervous system not controlling digestive system properly
- Digestive organs excessively sensitive to pain
- Unusual response to infection
- Problem with the immune system (possibly related to response to infection)
- Muscles used to move food through the body malfunctioning
Mental and emotional state - evidence suggests that psychological and emotional factors probably play a big role in irritable bowel syndrome. People who have had a traumatic experience have a higher risk of developing IBS.
Some people with IBS react strongly to stimuli that would not affect people without IBS. Examples may include:
Food - a significant number of individuals with IBS find that their symptoms get worse after they have eaten certain products, such as chocolate, milk, or alcohol, which give them either constipation or diarrhea. Bloating and/or discomfort may be caused by some fruits and vegetables, as well as fizzy drinks. Experts are not sure what role food allergy or intolerance play (if any) in IBS.
Cramping or bloating after eating dairy products, sugar-free gum, some candies, or products with caffeine in them may be due to lactose (sugar), sorbitol, or caffeine intolerance, and not irritable bowel syndrome.
Hormones - a considerable number of women with IBS find that their symptoms are worse around the time of menstruation.
Infections - gastroenteritis can trigger IBS.
Tests and diagnosis of irritable bowel syndrome
Although IBS is uncomfortable, it generally does not have serious medical implications.
There is no specific imaging or laboratory test to diagnose IBS. Diagnosis involves ruling out conditions that produce IBS-like symptoms and then following a procedure to categorize the patient's symptoms.
A doctor will initially recommend a blood test and attempt to rule out other possible conditions, including:
- Have there been any changes in your bowel habits, such as diarrhea or constipation?
- Is there any pain or discomfort in your abdomen?
- How often do you feel bloated?
If there are specific signs or symptoms that may suggest another condition, further testing may be required. The signs or symptoms may include:
- Localized swelling in the rectum and/or abdomen
- Weight loss (unexplained)
Patients with a history of ovarian cancer may require further testing, as will patients over the age of 60 whose change in bowel habits have persisted for longer than 6 weeks.
Treatment for irritable bowel syndrome
As nobody is certain what the causes of IBS are, treatment is aimed at relieving symptoms and improving the patient's quality of life. This usually involves some diet and lifestyle changes, as well as learning how to manage stress.
Diet - some changes in eating habits can significantly help in controlling IBS symptoms. Unfortunately, there is no IBS diet which works for everybody. The patient may have to go through a process of trial and error until an optimum diet is achieved.
Doctors recommend keeping a food diary detailing foods eaten, and the effect they had. Eventually, the individual should be able to identify the major trigger foods and avoid them.
Fiber - some IBS sufferers may need to consume more fiber while others may have to do the opposite.
The following can help reduce symptoms:
- Avoid sorbitol which can cause diarrhea; it is found in some chewing gums, diet foods, and sugar-free sweets
- Consume more oat-based foods if gas or bloating is a problem
- Eat every meal; do not skip any
- Keep alcohol intake to a minimum
- Keep soda intake to a minimum
- Limit intake of fresh fruit (it is important to ask a health professional about this)
- Limit tea and coffee intake to no more than three cups per day
- Make sure fluid intake is adequate - this typically means drinking at least eight cups of fluid per day (may vary)
- Meals should be eaten at the same time each day
- Some people may have to avoid or limit their intake of resistant starch, which is commonly found in processed or recooked foods, as well as some legumes. Resistant starch is not broken down in the digestive tract and counts as a component of dietary fiber
- Eat slowly
Exercise - some patients find that exercise helps relieve symptoms, while others don't.
Probiotics - these may help some patients with IBS. The benefits of probiotics take about 4 weeks to appear.
Anxiety and stress - a significant number of people with irritable bowel syndrome will find their symptoms are relieved by:
- Relaxation techniques including exercises or meditation
- Some specific physical activities, such as Tai Chi or yoga
- Regular physical exercise
- Stress counseling or CBT (cognitive behavioral therapy)
Medications - the following medications are used for IBS symptoms:
- Antispasmodic medications - reduce abdominal cramping and pain by relaxing the muscles in the gut.
- Bulk-forming laxatives - for patients with constipation.
- Antimotility medications - for diarrhea. An example includes loperamide. This medication slows down the contractions of the intestinal muscles.
- TCAs (tricyclic antidepressant) - often help to reduce abdominal pain and cramping.
Psychological therapy - some psychological techniques can be useful:
- Psychodynamic interpersonal therapy (PIT) - the therapist helps the patient explore their past to find out whether anything may have affected them unconsciously
- Hypnotherapy - hypnosis is used to alter the unconscious mind's attitude to symptoms
- Cognitive behavioral therapy (CBT) - the patient is trained to react differently to their condition through relaxation techniques and adopting a positive attitude
Research into IBS is ongoing; improved preventative measures and new treatments will undoubtedly be discovered in the future. For now, being mindful of diet and stress are the best tips for avoiding episodes.