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Irritable bowel syndrome (IBS) is a long term gastrointestinal disorder that can cause persistent discomfort. However, most people will not experience severe complications.
People also refer to IBS as spastic colitis, mucous colitis, and nervous colon. It is a chronic condition. However, its symptoms tend to change over the years. Symptoms often improve as individuals learn to manage the condition.
Until recently, scientists were not sure what caused IBS, but there is growing evidence that microbes present during infectious gastroenteritis may trigger a long-term reaction.
In this article, we discuss symptoms, causes, and treatment, and how diet can affect IBS.
The most common symptoms of IBS include:
- changes in bowel habits
- abdominal pain and cramping, which often reduce after passing a stool
- a feeling that the bowels are not empty after passing stools
- passing excess gas
- the passing of mucus from the rectum
- a sudden, urgent need to use the bathroom
- swelling or bloating of the abdomen
Symptoms often get worse after meals. A flare-up may last for several days, and then symptoms either improve or resolve completely.
Signs and symptoms vary between individuals. They often resemble symptoms of other diseases and conditions and can also affect different parts of the body.
These may include:
- frequent urination
- halitosis, or bad breath
- joint or muscle pain
- persistent fatigue
- in females, painful sex, or dyspareunia
- irregular menses
Dietary factors can play a role in triggering IBS symptoms.
Some fruits, vegetables, and sodas can trigger bloating and discomfort. It is unclear whether a food allergy or intolerance plays a role.
Common dietary triggers of cramping or bloating include foods that cause flatulence, such as:
Other foods that can trigger flares include:
- dairy products
- sugar free gum
- some candies
- products with caffeine in them, which may be due to sugar, sorbitol, or caffeine intolerance rather than IBS
Dietary steps that can help a person reduce the risk of a flare include:
- Managing fiber intake: Some people with IBS need to increase their fiber intake, while others should consume less. A balanced level of fiber in the diet can help promote healthful digestion.
- Probiotic supplements: Taking probiotics may help some people. These are beneficial bacteria that support gut health. A person may not feel their effects immediately, so they should take them over a few weeks to gauge their impact on gut health over a more extended period.
- Food diary: Keeping a record of specific foods in the diet and their physical effects will help a person identify primary trigger foods.
Changes in eating habits can help control symptoms. No IBS diet works for every person. Therefore, an individual may need to go through a process of trial and error to find a consistent, comfortable diet.
It is unclear what causes IBS, but experts believe that microbial factors may play a key role.
Scientists have linked it to food poisoning. In fact, 1 in 9 people who experience food poisoning develop IBS at a later date. It seems that the microbes involved in infectious gastroenteritis may have an impact on the immune system that leads to long-term changes in the gut.
Other factors that may play a role include:
- environmental factors, such as stress
- genetic factors
- digestive organs with a high sensitivity to pain
- an unusual response to infection
- a malfunction in the muscles that move food through the body
- an inability of the central nervous system (CNS) to control the digestive system
- A person’s mental and emotional state can contribute to IBS development. People with post-traumatic stress disorder (PTSD) have a higher risk of developing IBS.
It is not contagious and does not have links to cancer.
Hormonal changes can make symptoms worse. For example, symptoms are often more severe in women around the time of menstruation.
Infections such as gastroenteritis may trigger post-infectious IBS (PI-IBS).
There is no cure for IBS. However, if a person with IBS avoids triggers, makes dietary adjustments, and follows their doctor’s advice, they can significantly reduce the risk of flares and discomfort.
Treatment options for IBS aim to relieve symptoms and improve quality of life.
Treating IBS usually involves some dietary and lifestyle changes, as well as learning how to manage stress.
The following steps may help symptoms:
avoiding sugar alternatives in some chewing gums, diet foods, and sugar free sweets, as they can cause diarrhea
- consuming more oat-based foods to reduce gas or bloating
- not skipping meals
- eating at the same time every day
- eating slowly
- limiting alcohol intake
- avoiding carbonated, sugary beverages, such as soda
- limiting intake of certain fruits and vegetables
- drinking at least 8 cups of fluid per day, for most people
Avoiding gluten can also reduce the risk of flares. Gluten free food products and alternatives are now widely available.
Anxiety and stress
The following may help reduce or relieve symptoms:
- relaxation techniques, including exercises or meditation
- activities such as Tai Chi or yoga
- regular physical exercise
- stress counseling or cognitive-behavioral therapy (CBT)
The following medications may help IBS symptoms:
- Antispasmodic medications: These reduce abdominal cramping and pain by relaxing the muscles in the gut.
- Bulk-forming laxatives: These can help a person relieve constipation. People should use them with caution.
- Antimotility medications: These can reduce diarrhea symptoms. Options include loperamide, which slows down the contractions of the intestinal muscles.
- Tricyclic antidepressants (TCAs): These often help to reduce abdominal pain and cramping.
Medications specific to IBS treatment include:
- alosetron (Lotronex) for severe diarrhea-predominant IBS in females
- lubiprostone (Amitiza) for constipation-predominant IBS in females
- rifaximin, an antibiotic that can help reduce diarrhea in people with IBS
These are usually the last line of treatment when other lifestyle or therapeutic interventions have failed, and symptoms remain severe.
Some people may find psychological therapy useful in reducing IBS flares and the impact of symptoms: Techniques include;
- Hypnotherapy: This can help alter the way the unconscious mind responds to physical symptoms.
- Cognitive-behavioral therapy (CBT): This helps people develop strategies for reacting differently to the condition through relaxation techniques and a positive attitude.
Exercise can also help reduce symptoms in some people.
As experts learn more about possible links between IBS and microbial activity there is hope that, one day, new treatments will be available that target this factor effectively.
Until recently, there was no specific imaging or laboratory test to support an IBS diagnosis. However, experts have now developed a blood test that can accurately reveal whether a person has IBS with diarrhea (IBS-D) or irritable bowel disease (IBD).
During diagnosis, a doctor will aim to rule out conditions that produce symptoms similar to IBS. They will also follow a procedure to categorize the symptoms.
There are three main types of IBS:
- IBS with constipation (IBS-C): A person experiences stomach pain, discomfort, bloating, infrequent or delayed bowel movements, or hard or lumpy stools.
- IBS with diarrhea (IBS-D): There is stomach pain, discomfort, an urgent need to go to the toilet, very frequent bowel movements, or watery or loose stools.
- IBS with alternating stool pattern (IBS-A): A person experiences both constipation and diarrhea.
Many people experience different types of IBS over time. The doctor can often diagnose IBS by asking about symptoms, for example:
- Have there been any changes in bowel habits, such as diarrhea or constipation?
- Is there any pain or discomfort in the abdomen?
- How often does a person feel bloated?
A blood test may help rule out other possible conditions, including:
If specific signs or symptoms suggest a different condition, further testing may be necessary. These include:
- localized swelling in the rectum and abdomen
- unexplained weight loss
- abdominal pain at night
- progressively worsening symptoms
- significant amounts of blood in the stool
- family history of inflammatory bowel disease (IBD), colorectal cancer, or celiac disease
A 2019 review of 38 studies found that the following characteristics and conditions may increase the risk of IBS:
- being a younger or older adult
- a history of anxiety or depression
- overusing healthcare
- a family history of IBS
- sleep disorders
Research into IBS is on-going to develop improved preventive measures and new treatments.
For now, being mindful of diet and stress are the best steps for avoiding flares of discomfort.
Can I get IBS from eating gluten?
Some people with IBS may have concomitant allergy or sensitivity to gluten. Therefore, ask your doctor to test you for the same.
If you are allergic or sensitive to gluten, then it is a good idea to consider a gluten free diet.
Saurabh (Seth) Sethi, MD MPH Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.