Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. The symptoms can be uncomfortable and painful, but IBS does not cause permanent damage to the digestive system.
What is IBS?
IBS is characterized by chronic abdominal pain and changes in bowel habits. The specific symptoms and their severity can vary greatly from person to person. Common signs and symptoms include:
- Abdominal cramping or pain that is often relieved after a bowel movement
- Bloating
- Gas
- Diarrhea
- Constipation
- Alternating diarrhea and constipation
- Mucus in the stool
While IBS symptoms can be painful and disrupt daily life, the disorder does not cause lasting damage to the digestive system or lead to serious diseases such as cancer. However, people with IBS are more likely to suffer from anxiety, depression, and other mental health issues.
What causes IBS?
The exact cause of IBS is unknown, but several factors are thought to play a role:
- Abnormal gut musculature: The walls of the intestines are lined with layers of muscle that contract as they move food through the digestive tract. Contractions that are stronger and last longer can cause gas, bloating and diarrhea. Weak intestinal contractions can slow food passage and lead to hard, dry stools.
- Nervous system abnormalities: Abnormalities in the nerves in the digestive system may cause the intestines to be overly sensitive to changes in consistency, gas or bloating. This can trigger pain and other symptoms.
- Inflammation in the intestines: Some people with IBS have an increased number of immune-system cells in their intestines. This immune-system response is associated with pain and diarrhea.
- Severe infection: IBS can sometimes follow a severe bout of diarrhea (gastroenteritis) caused by bacteria or a virus. IBS might also be associated with a surplus of bacteria in the intestines (bacterial overgrowth).
- Changes in gut bacteria: People with IBS tend to have fewer varieties and lower numbers of some types of beneficial bacteria in their intestines compared to healthy people. This can allow disease-causing bacteria to grow.
Factors that can increase the risk of developing IBS include:
- Being younger than age 50
- Female sex
- A family history of IBS
- A history of depression or anxiety
Is IBS Pain Constant?
IBS pain and discomfort does not occur all the time for most patients. Symptoms tend to come and go. Many people have long periods of remission where they are symptom-free.
When IBS flares do occur, the abdominal pain and cramps tend to be episodic, coming and going over a period of time. They may last for a few minutes to a few hours, rather than being constant. Pain levels can range from mild discomfort to severe pain.
IBS pain and cramps are often triggered or made worse after meals. The act of eating stimulates the intestines to contract to move food through. For people with IBS, these contractions and movements can be particularly painful.
Symptoms may be brought on by:
- Eating a meal
- Stress or anxiety
- Hormonal changes related to menstruation
- Food sensitivities
- Gas or bloating
IBS pain and discomfort is generally not present during sleep. Symptoms typically do not wake patients up at night. However, lack of sleep or insomnia can exacerbate IBS problems.
Typical IBS Pain Patterns
While IBS symptoms can certainly have a major impact on quality of life, the pain and discomfort is not normally constant. Some typical IBS pain patterns include:
- Morning pain: Many people with IBS experience abdominal cramps and pain after waking up and before breakfast. This is often related to the gastrocolic reflex – an increase in intestinal activity after eating that helps clear the bowels.
- Post-meal pain: Eating a meal triggers digestive processes and contractions to move food through the intestines. This can cause cramping, pain and diarrhea in IBS patients. Larger meals tend to provoke more symptoms.
- Nighttime pain: While less common, some people have symptoms at night, disrupting sleep. This may be associated with changes in hormone levels or disruption of the normal digestive processes.
- Menstrual pain: Women may notice more severe IBS symptoms during menstruation. This relates to changes in progesterone levels.
What Makes IBS Pain Worse?
Certain triggers can make IBS pain and discomfort more likely to flare up. Identifying and avoiding potential triggers may help reduce symptoms. Common factors that can aggravate IBS include:
- Stress – Stress hormones appear to upregulate nerve activity in the gut, causing more pain. Finding healthy ways to manage stress levels can help.
- Anxiety – The gut and brain interact closely. Anxiety states can increase intestinal inflammation and trigger spasms.
- Food intolerances – Some people have worse symptoms after eating or drinking milk products, beans, cabbage, broccoli or fatty foods.
- Caffeine – Coffee, tea and soda with caffeine can stimulate the intestines and worsen diarrhea.
- Alcohol – Alcohol consumption can irritate the digestive tract.
- Medications – Some prescription and over-the-counter drugs like antibiotics and NSAIDs can exacerbate IBS.
- Hormone changes – IBS tends to worsen during or around menstruation due to hormone fluctuations.
- Lack of sleep – Not getting adequate rest can increase inflammation and disrupt digestive functions.
- Dehydration – Not drinking enough fluids can worsen constipation symptoms.
When to See a Doctor
It’s a good idea to make an appointment with your doctor if you have signs and symptoms of IBS that persist for more than a few weeks. Seek immediate medical care if you have severe pain, vomiting, bloody stools, anemia or are losing weight unintentionally.
Your doctor will perform a physical exam and take a complete medical history to help rule out other potential causes of your symptoms, such as celiac disease, inflammatory bowel disease or chronic infections.
You may need to keep a food and symptom diary for a few weeks to help identify any dietary triggers. Your doctor may order blood tests or a stool test to check for infection or inflammation. Sigmoidoscopy, colonoscopy or endoscopy procedures allow your doctor to examine your rectum and bowel for any abnormalities.
IBS Treatment Options
While there is no cure for IBS, treatment can help alleviate symptoms. A multifaceted approach is often most successful. Treatment options may include:
- Dietary changes – Eliminating foods that trigger symptoms (FODMAPs, gluten, etc.), eating smaller meals and drinking adequate fluids.
- Medications – Antispasmodics, antidiarrheals, laxatives, anti-depressants, antibiotics (for bacterial overgrowth) and probiotics.
- Stress management – Counselling, cognitive behavioral therapy, relaxation techniques.
- Exercise – Regular moderate physical activity can help reduce stress.
Keep a record of foods, medications, activities and stress levels to identify triggers. Your doctor can help adjust treatment over time to control your most bothersome symptoms.
Outlook for People with IBS
IBS is a chronic condition, meaning it lasts for years, often requiring ongoing management. However, the prognosis for people with IBS is generally quite good.
With the right dietary adjustments, lifestyle changes, stress management, and possibly medications, many people are able to control their symptoms and improve comfort. Flare ups when they occur can often be managed at home.
While IBS does not itself cause serious illness or damage to the intestines, it is linked to a slight increase in risk for gastrointestinal infections, chronic fatigue syndrome and other functional disorders. People with IBS also have higher rates of anxiety, depression and fibromyalgia.
Tips for Living and Coping with IBS
Making specific lifestyle changes and using self-care strategies can help people better cope with irritable bowel syndrome. Tips include:
- Avoid known triggers – Keep a food journal to identity problem foods and drinks. Limit coffee, alcohol, carbonated beverages.
- Stay active – Moderate exercise helps relieve stress and digestive symptoms. Yoga may be particularly beneficial.
- Prioritize sleep – Aim for 7-9 hours per night. Consistent sleep times are best.
- Manage stress – Try journaling, meditation, breathing exercises, cognitive behavioral therapy, music or art therapy.
- Take warm baths – Heat applied to the abdomen can relieve IBS pain and cramps.
- Try peppermint – Peppermint oil capsules may reduce symptoms of pain, bloating and gas.
- Ask for support – Friends and family can help with dietary changes, emotional support or daily responsibilities during flare ups.
- Keep a symptom diary – Note dietary triggers, lifestyle factors and effective medications or natural remedies.
Conclusion
Irritable bowel syndrome is a common disorder affecting the large intestine and causing symptoms like abdominal cramping, bloating, and changes in bowel habits. However, IBS pain is not normally constant. People often experience flare ups brought on by triggers like stress, hormones, diet, or disruption of the gut microbiome. Identifying and avoiding triggers can help reduce or prevent symptoms.
Treatment options such as dietary changes, stress management techniques, exercise, and medications can help control IBS. While uncomfortable and disruptive, IBS does not cause permanent damage or lead to serious disease. With proper management, most people with IBS can find relief from their symptoms and enjoy a good quality of life.