What is IBS?
IBS stands for irritable bowel syndrome. It is a common disorder that affects the large intestine (colon). The symptoms include abdominal pain, bloating, gas, diarrhea and constipation. IBS is a chronic condition that requires long-term management. There is no cure for IBS, but symptoms can often be controlled through diet, stress management, and medications.
What causes IBS?
The exact cause of IBS is unknown. Current theories center around abnormalities in the gut-brain connection. Possible factors include:
- Muscle contractions in the intestine – Contractions may be stronger and last longer than normal, resulting in gas, bloating and diarrhea.
- Inflammation – Previous infection or intestinal injury may lead to chronic inflammation in the GI tract.
- Nervous system – Abnormalities in the nerves of the digestive system may cause the intestine to be extra sensitive and contract more easily in response to stimulation.
- Severe stress – Stress can affect gut function and worsen IBS symptoms.
- Changes in gut bacteria – Imbalances in gut microbiome may influence gut motility and sensation.
In most cases, the cause of IBS is believed to involve a combination of factors that work together to produce the symptoms. Genetics, diet, hormones, and mental health problems may also play a role.
What are the symptoms of IBS?
– Abdominal pain – This is the most common symptom. The pain may come and go in episodes lasting for hours to days. It is often described as cramping.
– Bloating – A feeling of gassiness and abdominal fullness, especially after meals. Bloating increases with constipation.
– Gas – Passing excessive amounts of gas. This may be embarrassing in social situations.
– Diarrhea – Having loose, watery stools. Diarrhea may alternate with constipation.
– Constipation – Passing hard, dry stools. Going fewer than three times per week. Straining during bowel movements.
– Mucus in the stool – This may indicate inflammation in the colon.
– Food intolerances – People with IBS often find that some foods trigger symptoms. Common culprits are dairy products, beans, cabbage, and carbonated beverages.
– Fatigue and difficulty sleeping – Abdominal discomfort and bowel changes may interfere with sleep quality.
What tests diagnose IBS?
There are no specific tests for IBS. It is diagnosed based on symptoms and ruling out other possible causes through testing:
– Medical history – The doctor will ask about your symptoms, bowel habits, diet, stress levels, and previous surgeries or illnesses.
– Physical exam – Checking for swollen abdomen, tender spots, abnormal sounds when pressing on the abdomen.
– Blood tests – To look for signs of inflammation, anemia, or thyroid problems. These can mimic IBS.
– Stool test – Checking for blood, parasites, or infection.
– Colonoscopy – Inserting a viewing tube into the colon to inspect the lining and rule out colon cancer or Crohn’s disease. Biopsies may be taken.
– Food intolerance tests – Breath tests or elimination diets may reveal trigger foods. Common intolerances are lactose, fructose, and gluten.
– Imaging studies – Abdominal CT scan or intestinal x-rays can detect blockages.
The diagnosis of IBS involves having the typical symptoms for at least 6 months, with no other obvious cause found on testing. It is considered a diagnosis of exclusion.
What are the complications of IBS?
For the most part, IBS does not lead to serious complications. However, it can significantly reduce one’s quality of life. Possible issues include:
– Nutritional deficiencies – Due to inadequate nutrient absorption from chronic diarrhea or avoiding trigger foods.
– Depression and anxiety – Chronic pain and bowel issues may lead to mood problems. Stress also exacerbates IBS symptoms.
– Difficulty working, traveling, or attending social events – Symptoms like pain, bloating, and diarrhea can interfere with daily activities and cause embarrassment.
– Ongoing abdominal pain – This is poorly controlled in some patients despite treatment.
– Bowel obstruction – Severe constipation may rarely progress to full intestinal blockage. This requires hospitalization.
– Gallbladder disease – Rapid colonic transit in diarrhea-predominant IBS increases the risk of gallstones.
The most concerning risk is a significant reduction in quality of life. Seeking appropriate treatment and support is important for managing symptoms and regaining normal function.
What dietary changes help with IBS?
Dietary adjustments are often helpful for managing IBS:
– Limit dairy – Lactose intolerance is common. Avoid milk, ice cream, soft cheeses. Take lactase enzymes if needed.
– Reduce FODMAPs – These poorly absorbed carbs ferment easily and produce gas. Examples are wheat, onions, beans, apples.
– Limit caffeine – Caffeine stimulates the colon and may worsen diarrhea.
– Avoid large meals – Smaller meals are easier to digest. Don’t overstuff yourself.
– Increase soluble fiber – Foods like oatmeal, nuts, beans, lentils, berries. Insoluble fiber like wheat bran may worsen IBS.
– Drink adequate fluids – Dehydration makes constipation worse. Drink 8 cups of water daily.
– Identify trigger foods – Keep a food journal to determine your personal triggers. Common culprits are dairy, fat, beans, cabbage, carbonated drinks.
– Eat bland foods – Bland foods tend to be better tolerated. Examples are rice, applesauce, toast, eggs.
– Take probiotics – Probiotic supplements may help restore healthy gut flora. Yogurt with live cultures is a good source.
The low FODMAP diet and a food journal are useful tools for discovering your unique trigger foods. A dietician can provide personalized dietary advice.
What medications are used for IBS treatment?
Several types of medications may provide symptom relief:
– Antispasmodics – These drugs reduce muscle spasms in the intestine. Examples are dicyclomine, hyoscyamine. Side effects may include dry mouth, blurred vision, dizziness.
– Tricyclic antidepressants – In low doses, these have a direct effect of reducing abdominal pain perception. Amitriptyline or nortriptyline are commonly used.
– Linaclotide – This medication increases fluid secretion into the colon to improve bowel function. It is approved for both IBS-C and IBS-D. Brand name Linzess. Diarrhea is a common side effect.
– Lubiprostone – Helps relieve constipation by increasing secretions in the small intestine. Available as Amitiza. Nausea is common initially.
– Rifaximin – An antibiotic that alters gut flora. It provides short-term relief for bloating and diarrhea. Brand name Xifaxan.
– Loperamide – An over-the-counter anti-diarrheal medication. Useful for managing diarrhea-predominant IBS. Brand names include Imodium and Diasorb.
– Bile acid binders – Medications like cholestyramine and colestipol bind to bile acids and reduce diarrhea by slowing transit in the colon. Constipation is a common side effect.
Work with your doctor to determine which medications are appropriate for your predominant IBS symptoms. The benefits and potential side effects should be discussed.
What alternative therapies may be beneficial?
A number of complementary approaches may help improve IBS symptoms:
– Probiotics – Supplements containing healthy gut bacteria can help rebalance intestinal flora. Common strains are lactobacillus and bifidobacterium.
– Peppermint oil – May reduce abdominal pain and spasms. Available in enteric-coated capsules so it can work in the intestine. The brand name is Iberogast.
– Partially hydrolyzed guar gum – A soluble fiber supplement that helps improve constipation and diarrhea in IBS. Brand name is Benefiber.
– Ginger – Known for reducing nausea, inflammation, and intestinal spasms. Try ginger tea or supplements.
– Fiber supplements – Soluble fiber like psyllium may relieve both diarrhea and constipation by adding bulk to stools. Brand name Metamucil. Start low and increase slowly.
– Acupuncture – Insertion of thin needles along meridian lines may reduce pain perception. Requires repeated sessions for sustained benefit.
– Hypnosis – Clinically-guided hypnosis helps some patients control abdominal pain, bloating, and bowel function. Requires regular sessions.
– Stress management – Techniques like meditation, yoga, CBT therapy can reduce stress and improve IBS symptoms.
– Regular exercise – Can improve mood, stress levels, constipation, and abdominal discomfort. Aim for 30 minutes daily.
Discuss any alternative therapies with your doctor first, especially if adding supplements. Balance potential benefits with scientific evidence behind them.
What complications can occur with IBS treatments?
The main treatments for IBS are generally safe, but certain side effects may develop:
– Medication interactions – Antidepressants, antispasmodics, and antidiarrheals can interact with other drugs. It’s important to review all medications with your doctor.
– Worsening diarrhea – Linaclotide and lubiprostone, used for constipation-predominant IBS, may cause diarrhea. Loperamide overuse can also result in worsening diarrhea.
– Worsening constipation – Antispasmodics like hyoscyamine slow intestinal transit. Fiber supplements may exacerbate constipation if intake is too high.
– Dizziness, fatigue, dry mouth – Common side effects of antispasmodic drugs and tricyclic antidepressants used for IBS. Usually transient but may require dosage adjustments.
– Bloating, gas, diarrhea – Common issues with probiotic supplements and psyllium fiber, especially when starting. Try lower doses and increase slowly.
– Allergic reactions – Probiotics rarely provoke allergy symptoms like rash, itching, and wheezing in sensitive persons. Non-dairy strains are an option.
– Dangerous bowel obstruction – Chronic severe constipation very rarely progresses to full obstruction requiring hospitalization.
– Ileus – Halted intestinal motility seen with opioid pain medications. Methylnaltrexone can reverse this.
For the most part, IBS treatment complications are minor frustrations rather than serious issues. Work closely with your doctor to maximize benefits and minimize adverse effects from prescribed therapies.
What lifestyle changes help manage IBS?
Simple lifestyle measures can significantly improve IBS:
– Regular exercise – physical activity improves GI motility. Aim for 30 minutes daily, even with short 10 minute walks. Yoga helps reduce stress.
– Adequate sleep – Get 7-8 hours nightly. Lack of sleep disrupts bowel function.
– Scheduled meals – Eat small meals at regular intervals. Don’t skip meals or eat late dinners.
– Limit alcohol and caffeine – These stimulate the colon and provoke symptoms in some people.
– Drink more fluids – Stay well hydrated to prevent constipation. Warm beverages can soothe the GI tract.
– Stress management – Practice relaxation techniques, meditation, mindfulness, counseling to reduce anxiety.
-OTC fiber/antidiarrheals – Metamucil, Imodium, and loperamide supplements are handy for episodic symptoms.
– Heating pads – Can provide relief for abdominal pain and muscle cramping after meals.
– Keep a symptom journal – Record foods, activities, stressors that worsen your IBS. Identify and avoid triggers.
– Join a support group – Communicating with others who have IBS provides reassurance and ideas for symptom management.
Simple lifestyle measures, stress reduction, and OTC medications go a long way in controlling intermittent IBS flares when combined with standard medical therapies.
What surgical options exist for severe IBS?
Surgery is only considered for severely uncontrolled IBS that is disabling:
– Colectomy – Removing the entire colon cures constipation-predominant IBS resistant to other treatments. It results in a permanent ileostomy bag for stool collection.
– Ileostomy – Diversion of the distal small intestine using an ileostomy bag provides relief from diarrhea-predominant IBS.
– Neuromodulation – Implanting electrodes to stimulate sacral nerves can reduce frequency of bowel movements. This is adjustable and reversible.
– Colostomy – Rarely done for IBS, a partial colostomy may divert stool and relieve symptoms from a severely affected section of colon.
– Small bowel resection – Removing a short segment of diseased small bowel can help reduce abdominal pain and diarrhea.
– Cecostomy tube – Inserting a decompression tube in the cecum relieves distention. This can temporarily manage bloating.
Overall, surgery is viewed as a last resort for IBS after other options have failed. The risks and permanent changes to bowel function require careful consideration. Most patients are able to avoid surgery through conservative treatments.
What is the long-term outlook for people with IBS?
IBS is a chronic condition, but the long-term outlook is generally good with proper management:
– Achieving normal life activities is possible for most patients. Symptoms fluctuate but are controllable.
– Trigger avoidance and conservative treatments prevent serious complications in the vast majority of patients.
– Symptoms tend to improve with age. Many experience fewer issues in their senior years.
– There is no known increase in mortality rates associated with IBS.
– Developing other chronic health conditions is not more likely, except mild anxiety/depression.
– Ending up with an ileostomy bag or other major surgery is very unlikely. Only a small percentage require surgery.
– Medications and lifestyle adjustments keep symptoms manageable over decades.
– Alternative therapies provide additional options for symptom control.
– New medications and treatments are continually being developed.
While IBS presents daily challenges, it is possible to establish an effective management plan and live a healthy, fulfilling life over the long term. The outlook for IBS continues to improve.
Conclusion
IBS is undoubtedly challenging to live with on a daily basis. Abdominal pain, bowel irregularities, and bloating disrupt normal activities. However, a wide range of dietary, medication, stress relief, and alternative treatment options exist to help control symptoms. Most people are able to manage IBS reasonably well through conservative measures without resorting to surgery. While IBS is lifelong, the prognosis is generally positive with today’s continually improving treatment options.
