A common gastrointestinal condition

What is irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a common chronic disorder involving the brain/mind-gut connection. In this syndrome, the gastrointestinal system is more sensitive to pain and gas distention. The muscles in the bowel contract irregularly thus leading to pain along with diarrhea, constipation, or both. With IBS, patients may have mild to severe symptoms but no visible signs of damage or disease in the stomach or intestines.

Studies suggest that 15% of the United States population has IBS. Irritable bowel colitis, spastic colon, spastic bowel, or nervous gut are other names for IBS.

What are the symptoms of irritable bowel syndrome?

· Abdominal pain, often relieved with a bowel movement

· Change in bowel habits

· Diarrhea

· Constipation

· Bloating

· Belching/burping

· Whitish mucus in the stool

· Worsened symptoms with stress

What causes IBS?

Despite extensive research, the cause of irritable bowel syndrome is not completely clear.

There are many theories including:

· Abnormal contractions of the intestines cause severe cramps and changes in bowel habits.

· IBS is triggered after a severe gastrointestinal infection (such as Salmonella or Campylobacter or viruses).

· Underlying stress and anxiety provoke and worsen symptoms through mind-gut connection.

· There is increased sensitivity of the intestines or “visceral hyperalgesia.” Patients with IBS will experience abdominal pain or bloating to normal amounts of gas or intestinal movement.

· IBS is associated with small intestinal overgrowth which is gut bacteria imbalance leading to altered nutrient breakdown and increased intestinal gas.

· Food intolerances or food sensitivities may be a cause. Many foods can mimic or worsen IBS such as dairy products (lactose), legumes (beans), and cruciferous vegetables (broccoli, cauliflower, and cabbage) by increasing gas in the gastrointestinal system.

How is IBS diagnosed?

Unfortunately, there is no specific test for IBS. Physicians use symptom patterns to assist in making the diagnosis. Anemia (low blood counts), blood in the stool, or weight loss are not associated with IBS. Additional tests may be used to rule out other medical conditions before diagnosing irritable bowel syndrome.

Your physician will review symptoms and family history and perform a physical exam. Blood or stool tests are helpful to screen for other conditions such as infections or celiac disease. Studies such as upper endoscopy (a camera is passed into the stomach) or colonoscopy (a camera is passed into the colon) and radiographic imaging are often performed.

How do doctors treat IBS?

There are many different therapies for irritable bowel syndrome. There are no surgeries or medications that cure this condition, so therapies focus on relieving symptoms. A combination of therapies may be necessary to get symptoms under control. Finding the right combination can take time. It is important to work with your physician about your symptoms, concerns, and stressors or triggers to find the treatment option that works best.

Diet and foods play a significant role in management. High fiber diets and fiber supplements may help regulate bowel habits. Dairy/lactose avoidance and the low FODMAP diet address gas production in the gastrointestinal tract. An elimination diet or specific avoidance diet (such as gluten free diet) may also be helpful. However, these diets may also worsen IBS symptoms.

Mental health therapies are an important aspect of treatment and focus on the mind-gut connection. This includes specific cognitive and behavioral therapies, counseling, meditation, support groups, and exercise. These therapies also assist in managing stress and anxiety.

Medications may be used to manage altered bowel habits, diarrhea or constipation associated with IBS. Your physician may suggest specific anti-diarrhea medications to address diarrhea or laxatives to manage constipation. Anti-spasm medications are used to decrease gut spasms; these include dicyclomine (Bentyl), hyoscyamine (Levsin) or peppermint oil.

Antidepressant medications such as the tricyclic agents (TCAs) or selective serotonin reuptake inhibitor (SSRIs) may help manage the pain and hypersensitivity aspect of IBS.

Some patients may benefit from antibiotic treatment (such as a rifaximin/Xifaxan) or probiotics to address small intestinal bacterial overgrowth and gut bacteria balance.

What is the prognosis of irritable bowel syndrome?

Irritable bowel syndrome is a chronic condition that can worsen and ease over time. Although there is no cure, the many therapy options can help manage the IBS symptoms. Irritable bowel syndrome does not progress to cancer or cause damage to the intestines.

Although IBS can cause significant physical discomfort and emotional distress, most people are able to control their symptoms and live a normal life. A thorough review with your physician will help direct the evaluation of IBS, rule out other medical conditions, and collaborate for the best therapy options.

Call to action:

  • The irritable bowel syndrome diagnosis and management can be difficult and frustrating. Contact your physician or gastroenterologist to discuss your concerns and find the right combination of therapy options.

About the author

Dr. Vanessa Lee

Dr. Vanessa Lee is a board-certified gastroenterologist with Peak Gastroenterology Associates. She received her doctor of medicine degree from Jefferson Medical College/Sidney Kimmel Medical College in Philadelphia, PA and completed training at the University of Virginia.