Charlotte, NC
Gauri Adhikari, MD
Bibhusan Basnet, MD
Key Highlights
Irritable bowel syndrome (IBS) is one of the common gastrointestinal disorders that is diagnosed in millions of people worldwide and affects approximately 10-15% of the United States population. It is more common in the Western world, with women being affected twice as often as men, and its symptoms start as early as childhood or adulthood. Although IBS does not result in structural damage to the digestive tract, its impact on individuals’ daily lives can be profound, often leading to missed workdays, reduced social activities, and overall diminished quality of life.
The muscles in your gut are responsible for the movement of food with the help of a series of contractions and relaxation. Alterations in the pattern of these movements can lead to changes in bowel habits, such as diarrhea or constipation. These alterations in gut motility are commonly seen in individuals with IBS.
Recent studies have shown the relation of IBS with the hypersensitivity of the nerves found on the gut wall. This heightened response to normal stimuli can result in the perception of pain or discomfort even with normal bowel function.
Alterations in the composition and function of the gut microbiota (microorganisms residing in the digestive tract) have been observed in individuals with IBS. An imbalance in the microbiota may contribute to symptom development.
A genetic predisposition to developing IBS may exist. Many individuals with IBS have also been found to have a family history of the condition.
Certain foods and dietary patterns can trigger or worsen IBS symptoms. Common triggers include high-fat foods, dairy products, certain carbohydrates, and artificial sweeteners.
Psychological factors such as stress, anxiety, and depression can influence the onset and exacerbation of IBS symptoms. The connection that exists between your gut and brain plays a significant role in the manifestation of symptoms.
Certain foods may trigger IBS symptoms. Common culprits include high-fat foods, spicy foods, caffeine, alcohol, dairy products, and foods high in fermentable carbohydrates (FODMAPs). You can keep a food diary to help identify specific triggers.
Emotional factors, particularly stress and anxiety, often contribute to IBS symptoms. High stress levels or anxiety can exacerbate abdominal pain and discomfort and alter bowel habits.
Fluctuations in hormones, especially in women during menstruation or menopause, can influence IBS symptoms. Some individuals may experience an increase in symptoms during these hormonal changes.
Carbonated beverages, artificial sweeteners, and drinks with high caffeine content can be triggers for some individuals with IBS. You should keep yourself hydrated with water to avoid having flare-ups when consuming these beverages.
Smoking has been associated with an increased risk of IBS and can exacerbate symptoms. Quitting smoking may contribute to symptom improvement.
IBS is classified into different types based on the predominant bowel habits and symptoms experienced by individuals. The three main types of IBS are:
Individuals with IBS-D experience frequent episodes of diarrhea as a predominant symptom. Other common symptoms may include urgency, a sense of incomplete bowel movements, abdominal pain, and discomfort.
IBS-C is characterized by infrequent and difficult-to-pass stools, with constipation being the predominant symptom. Individuals with IBS-C may experience abdominal pain, bloating, and a feeling of incomplete evacuation.
This type of IBS involves a combination of both diarrhea and constipation, with alternating periods of each. Individuals with IBS-M may experience a range of symptoms, including abdominal discomfort, bloating, and variations in bowel habits. The alternating nature of diarrhea and constipation can make management challenging, and treatment may focus on addressing specific symptoms.
It is an additional category for individuals whose symptoms do not clearly fit into the other categories.
The symptoms of IBS often wax and wane, and they may be triggered or worsened by factors such as stress, diet, and hormonal changes. The primary symptoms of IBS include:
It is the most common symptom and is important in establishing the diagnosis. The pain of IBS is typically located in the lower abdomen and may be described as crampy or sharp. These symptoms emerge after eating specific foods, food intake, or emotional stress and are often relieved by bowel movements.
In a diarrhea-predominant IBS, you might want to suddenly and immediately want to evacuate your bowels. The diarrhea in IBS occurs during the day. The stool appears loose and watery and may also contain mucus. If you have constipation-predominant IBS, you might have a sensation of incomplete bowel movement. As a result, one might strain unnecessarily. There’s a great relief once the gas or stool is passed.
People with IBS also experience symptoms unrelated to the intestine. Fatigue and disrupted sleep patterns are often reported by individuals with IBS, possibly due to the impact of symptoms on overall well-being and quality of life. There are various emotional factors, such as anxiety and depression, that are also associated with IBS.
Many individuals with IBS report bloating and a sensation of abdominal distension. Some people with IBS may experience a sudden and urgent need to have a bowel movement. This urgency is usually associated with IBS-D. A feeling of incomplete bowel movements is also commonly seen in individuals with IBS. Despite having a bowel movement, there may be a sense that the rectum is not completely empty.
Certain symptoms should not be overlooked as they can be a part of a grave diagnosis and should not be labeled as a part of IBS without further investigation. These include:
The diagnosis of IBS is typically based on a combination of clinical findings and the
exclusion of other potential gastrointestinal disorders. There isn’t a specific test for
IBS and the process involve a thorough evaluation by a healthcare professional.
The key steps in the diagnosis of IBS include:
Your doctor, often your primary care physician or a gastroenterologist will conduct a comprehensive clinical assessment. This involves taking a detailed medical history, including the nature and duration of symptoms, their impact on daily life, and any triggering or exacerbating factors.
The Rome criteria is widely used by clinicians to diagnose functional gastrointestinal disorders, including IBS. According to these criteria, IBS is diagnosed when symptoms last at least three days per month in the last three months.
To confirm the diagnosis of IBS, other conditions with similar symptoms are ruled out first. This process may involve laboratory tests, stool tests, imaging studies, and endoscopic procedures to identify or exclude conditions such as inflammatory bowel disease (IBD), celiac disease, and other organic gastrointestinal disorders.
The treatment of IBS typically involves a multifaceted approach to managing
symptoms and improving the individual’s overall quality of life. The treatment plan
often needs to be personalized based on the specific symptoms and needs of the
patient. Here are common strategies used in the management of IBS:
Some individuals with IBS find relief by following a low-FODMAP diet, which involves restricting certain types of fermentable carbohydrates known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). This kind of diet is more helpful in patients with complaints of abdominal bloating. A dietitian can guide patients in implementing and maintaining this diet. You should limit the intake of dairy products and gluten as lactose intolerance and gluten intolerance is a common entity among people with IBS.
Soluble fiber in food like oats and psyllium may help regulate bowel movements and alleviate symptoms in individuals with constipation-type IBS. However, the introduction of fiber should be gradual to avoid worsening symptoms.
Several activities are found to be helpful in the management
of IBS, including:
Behavioral therapies, such as cognitive-behavioral therapy (CBT) and gut-directed hypnotherapy, have shown effectiveness in managing symptoms, especially in individuals with IBS, where stress and psychological factors play a significant role.
