What is irritable bowel syndrome (IBS)?
Irritable bowel syndrome (IBS) or irritable bowel disease (IBD), is also known as spastic colitis, mucus colitis, and nervous colon. It is a chronic, or long-term, condition, but symptoms tend to change over the years.
IBS can cause persistent discomfort, but most people will not experience severe complications.
Symptoms often improve as individuals learn to manage the condition. Severe and persistent severe symptoms are rare.
Here are some key points about irritable bowel syndrome.
- IBS can cause discomfort, but it does not usually lead to serious complications.
- Currently, there is no cure for IBS.
- Dietary and emotional factors can play a key role in IBS.
- Reducing alcohol intake can ease symptoms.
- Excluding foods that cause gas can also improve symptoms.
IBS can lead to discomfort and abdominal pain.
The most common symptoms experienced by people with IBS are:
- changes in bowel habits
- abdominal pain and cramping, which often lessen after using the bathroom
- a feeling that the bowels are not fully emptied after using the bathroom
- excess gas
- passing of mucus from the back passage, or rectum
- a sudden urgent need to use the bathroom
- swelling or bloating of the abdomen
Symptoms often worsen after eating. A flare-up may last from 2 to 4 days, and then symptoms may either improve or go away completely.
Signs and symptoms vary considerably between individuals. They often resemble those of other diseases and conditions. They can also affect different parts of the body.
These can include:
- frequent urination
- halitosis, or bad breath
- joint or muscle pain
- persistent fatigue
- pain with sex (for females) or sexual dysfunction
- irregular menses
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 beans, celery, onions, carrots, raisins, bananas, apricots, prunes, brussel sprouts, pretzels, and bagels
- dairy products
- sugar-free gum
- some candies
- products with caffeine in them, maybe due to lactose (sugar), sorbitol, or caffeine intolerance, rather than IBS
Fiber: Some people with IBS need to increase their fiber intake, while others have to consume less. A proper balanced level of fiber in the diet can help promote healthy digestion.
Probiotics: These may help some people. The benefits take about 4 weeks to appear.
Food diary: Keeping a record of foods eaten and their effect will help identify the major trigger foods.
Changes in eating habits can help control symptoms. There is no IBS diet that works for everybody, so the person may need to go through a process of trial and error to achieve an optimum diet.
It is unclear what causes IBS, but it is not contagious or cancer-related.
IBS causes discomfort in the gastrointestinal system.
Factors that may be involved include:
- environmental factors, such as stress
- genetic factors
- digestive organs being excessively sensitive to pain
- an unusual response to infection
- a malfunction in the muscles used to move food through the body
- an inability of the central nervous system (CNS) to control the digestive system properly
A person's mental and emotional state may have an impact. People who have had a traumatic experience have a higher risk of developing IBS.
Hormonal changes can make symptoms worse. They are often more severe in women, for example, around the time of menstruation.
Infections, such as gastroenteritis, can trigger post-infectious IBS or PI-IBS.
As the causes are uncertain, treatment for IBS aims to relieve symptoms and improve quality of life.
This usually involves some dietary and lifestyle changes, as well as learning how to manage stress.
The following may help:
- avoiding sorbitol, found in some chewing gums, diet foods, and sugar-free sweets, as it can cause diarrhea
- consuming more oat-based foods to reduce gas or bloating
- not skipping meals and 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
- limiting tea and coffee intake to three cups per day
- drinking enough fluids, at least eight cups of fluid per day for most people
It may help to avoid or limit the intake of resistant starch, commonly found in processed or recooked foods and in some legumes. Resistant starch is not broken down in the digestive tract and counts as a component of dietary fiber.
Anxiety and stress
The following may help reduce or relieve symptoms:
- relaxation techniques, including exercises or meditation
- some specific physical activities, such as Tai Chi or yoga
- regular physical exercise
- stress counseling or cognitive behavioral therapy (CBT)
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 can help relieve constipation. These can be purchased over-the-counter or online, although they should be used with caution.
- Antimotility medications for diarrhea include loperamide, which slows down the contractions of the intestinal muscles. Loperamide may be purchased online.
- Tricyclic antidepressant (TCAs) often help to reduce abdominal pain and cramping.
Medications specific to IBS treatment include:
- alosetron (Lotronex) for severe diarrhea-predominant IBS in women
- lubiprostone (Amitiza) for constipation-predominant IBS in women
These are usually the last line of treatment, when other lifestyle or therapeutic interventions have failed, and symptoms remain severe.
Some psychological techniques can be useful:
- Psychodynamic interpersonal therapy (PIT), where the therapist helps the patient explore their past to find out whether anything may have affected them unconsciously.
- Hypnotherapy can help alter the unconscious mind's attitude to symptoms.
- Cognitive behavioral therapy (CBT) fosters strategies for reacting differently to the condition through relaxation techniques and a positive attitude.
Exercise can help reduce symptoms in some people.
IBS is uncomfortable, but it generally does not have serious medical implications.
No specific imaging or laboratory test can diagnose IBS.
Diagnosis involves ruling out conditions that produce IBS-like symptoms and then following a procedure to categorize the symptoms.
There are 3 main types of IBS:
- IBS with constipation (IBS-C): There is stomach pain, discomfort, bloating, infrequent or delayed bowel movements, or hard or lumpy stools.
- IIBS 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.
- IIBS with alternating stool pattern (IBS-A): There is both constipation and diarrhea.
Many people experience different types of IBS as time goes by.
The doctor can often diagnose IBS by asking about symptoms, for example:
- 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?
A blood test may help rule out other possible conditions, including:
If specific signs or symptoms suggest another condition, further testing may be required.
These could be:
- localized swelling in the rectum and abdomen
- weight loss (unexplained)
- abdominal pain at night
- progressively worsening symptoms
- significant blood in the stool
- family history of inflammatory bowel disease, colorectal cancer, or celiac disease
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.
The following groups of people are more likely to have IBS:
- Younger adults: IBS affects people of all ages, but diagnosis usually occurs before the age of 45 years, often at 20 to 30 years.
- Gender: It is more likely to affect women.
- Family history: If a close relative has or has had IBS, there may be a higher chance of developing it. However, there is no clear link.
- Environment: Ongoing research is investigating whether the family-history risk of IBS is linked to genes, a shared family environment, or both.
Research into IBS is ongoing. Improved preventive 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.