Irritable Bowel Syndrome (IBS) – Types, Causes, Prevention and Treatment

December 27, 2017

Overview and Facts

Irritable Bowel Syndrome is a chronic gastrointestinal disorder. However, it is not the same as Inflammatory bowel disease (IBD). IBD is a more serious condition that causes inflammation of the digestive tract and may lead to many serious complications. IBS is a common long term or chronic condition of the digestive system. It can cause episodes of stomach cramps, bloating, constipation and diarrhea.

IBS affects around 25 to 45 million Americans, most of whom are women. This condition is more prevalent in people in their late teens to early 40s. IBS is basically discomfort in the belly with troubled bowel movements and frequent urge to go the loo. The stool may also be different in appearance sometimes hard or sometimes liquid. IBS is not a very serious disorder and it does not make you more prone to getting other conditions of colon like Crohn’s disease or ulcerative colitis or cancer of the colon. But this disease can have a strong impact on the way you live your life. People with IBS may feel handicapped as far as participation in daily life is concerned. IBS is known to affect 20% of people at some point of time in their lives. It usually strikes when a person is between 20 to 30 years of age. It is a lifelong condition and may improve over years.

It is estimated that worldwide 10-15% population has IBS. Most people suffering from IBS are under the age of 50. Many adults above the age of 50 also suffer from this condition. Stress is not the cause of IBS but because of connection between the brain and gut, stress can aggravate symptoms of IBS. Symptoms result from disturbance in the way of interaction of gut, nervous system and brain. People struggling with IBS have poor physical, emotional, and psychological well-being. According to research, it has been reported that diagnosis for IBS was made six and a half years after symptoms started. Around 20 to 40% of visits to gastroenterology are due to symptoms related to IBS.

Types and Symptoms of Irritable Bowel Syndrome

Types of Irritable Bowel Syndrome:

IBS with constipation: This is accompanied by pain and discomfort in stomach, bloating, abnormal bowel movements and hard stool. Gas, bloating, abdominal pain is reported as occurring on an average of 200 times a year.
IBS with diarrhea: It comes with pain in stomach, frequent need for moving the bowels and loose/watery stool.
IBS with alternating constipation and diarrhea: Around 33% to 50% of cases are reported to have IBS with alternating constipation and diarrhea.
Post Infectious IBS: The symptoms of these occur after infection in intestine. These are triggered by something else.
Post- diverticulitis IBS: Symptoms don’t occur very frequently and are short in duration. The symptoms include pain in the left side of the abdomen, fever, and inflammation in the lower left portion of the abdomen. Diverticulitis increases the risk of IBS.

Symptoms of Irritable Bowel Syndrome:

Pain and Cramps: Abdominal pain is the most prevalent symptoms and key in diagnosing the condition. In order to control digestion gut and brain coordinate with each other and work together. This process happens as hormones are released by good bacteria living in the gut. Modification in diet, therapies related to reducing stress, medicines can help in reduction of pain.
Diarrhea: It is one of the main types of the syndrome. Frequent loose stools are common in IBS and stools contain mucus. A study consisting of 200 adults found that those with diarrhea predominant IBS had 12 bowel movements daily.
Constipation: It seems very contradictory but IBS can cause constipation as well as diarrhea. Around 50% of the patients with IBS have constipation predominant IBS. It is marked by lesser than three bowel movements in a week. Constipation involves pain in abdomen which settles with bowel movements. There is a sensation of incomplete bowel movements after passing of stool.
Changes in Movements of Bowel: Stool in the intestine becomes dehydrated as water is absorbed by the intestine. This creates hard stools that further aggravates the symptoms of constipation. IBS changes the time stool stays in the intestine.
Bloating and Gas: Improper digestion may lead to production of more gas in the gut. This causes bloating. Following a food diet containing less of lactose may help prevent bloating.
Intolerance to Certain Foods: People with IBS report that some foods trigger symptoms of IBS. Lactose and gluten are some examples of trigger foods which must be avoided.

Risk Factors of Irritable Bowel Syndrome

Gender: The condition is present in twice the number of women as compared to men. Although the exact cause for it is not known but changing hormones in menstrual cycle may be having something to do with it
Age: This condition is more common in people in their late teens to early 40s.
Genes: It runs in families. If someone in the family has IBS, there is greater likelihood of prevalence of the condition in other family members.
Stress: People who have more stress are more likely to have IBS. Stress Management and behavioral therapy have been known to relieve some symptoms of the condition.
Sensitivity to Food: There are some foods that can upset the stomach. It is best to prohibit fatty foods, carbonated drinks and alcohol.
Medicines: According to studies there is a link between IBS symptoms and antidepressants and antibiotics.
Digestive Problems: Food poisoning and diarrhea may activate some of the symptoms of IBS.

Do I have Irritable Bowel Syndrome?

Many of the symptoms of IBS are similar to symptoms of other conditions which makes the diagnosis of IBS difficult. You may wonder whether you have IBS or something else. Conditions with similar symptoms to IBS are:

Inflammatory bowel disease (IBD)
Celiac disease or lactose intolerance
colon cancer or ovarian cancer

It is advised that you must consult your health care provider to know whether it is IBS or something else.

IBS and IBD have stark differences. Both can cause cramps and diarrhea. The most common form of IBD are Crohn’s disease and ulcerative colitis. However, unlike IBS these are conditions in which inflammation inside digestive system causes damage to inner lining of intestines. Also unlike IBS, IBD does not cause mucus in stool and other symptoms like gas and bloating.

Celiac Disease and lactose intolerance can cause symptoms similar to IBS. Celiac disease is a condition in which eating gluten causes damage to the inner lining of the small intestine. IBS is not related to immune system and it does not cause any damage to the intestines as in celiac disease. Celiac disease causes symptoms outside the digestive tract like dental issues and osteoporosis. IBS however does not cause any symptoms outside the digestive tract. Further it must not be confused with lactose intolerance in which the symptoms are caused due to usage of dairy products. Thus, when dairy products are removed from the diet the symptoms go away.

Causes and Prevention of Irritable Bowel Syndrome

Causes of Irritable Bowel Syndrome:

The exact cause of IBS is not known. It is however believed that bad communication between the brain and intestinal tract is one of the causes. This leads to spasms and muscle contractions causing cramps and pain. These may cause diarrhea or constipation.
Sometimes sensitive intestines may also be a cause. Some people have intestines that react strongly to the elements that leads to IBS.
IBS may be triggered by factors like eating certain types of foods, hormonal changes like during menstrual cycles, usage of medications like antibiotics, psychological issues like depression and anxiety,
Genes may also be responsible for having irritable bowel syndrome. It occurs more predominantly in people having family history of the disorder.

Prevention of Irritable Bowel Syndrome:

Take care of your diet. Boost the daily fiber intake by including cereals, whole grains, vegetables and fruits in your diet. Drink enough water before and after meals. Avoid foods and drinks containing chocolate, alcohol and caffeine. Drink Juices and eat foods like dried plums.
Don’t consume meals with extreme temperatures for example ice cream and hot soup in the same meal.
Stay away from foods that cause gas. Eat smaller portions. Talk to your doctor if you suspect wheat allergy.
Get regular exercise and enough sleep. Refrain from drugs that can trigger IBS like antibiotics, antidepressants, sorbitol based medicines like cough syrups.

Diagnosis and Tests of Irritable Bowel Syndrome

For diagnosing irritable bowel syndrome, doctors look at symptoms and check for medical and family history and also perform a physical exam. Tests may be conducted to rule out other possibilities.

Your doctor will evaluate you for IBS if you have had any of the symptoms related to IBS. There are no definite diagnostic tests for IBS as it does not cause any detectable abnormalities in the digestive system.

Many cases of IBS can be diagnosed on the basis of symptoms. Sometimes test may be needed to check for other possibilities. You may be asked to undergo various blood test for ruling out other conditions that cause similar symptoms like infection or coeliac disease.

Stool sample may be collected to detect presence of a substance called calprotectin. The gut produces this substance when it is inflamed and the presence of this substance signifies inflammatory bowel disease (IBD).

You may also be required to undergo colonoscopy that detects polyps in your large intestine. Another test can be performed which is called flexible sigmoidoscopy. During these two procedures a narrow tube with a camera is inserted in the rectum. Then it is moved in the body to detect part or complete intestines.

During colonoscopy small sections of tissue from large intestine may be collected and examined under a microscope. This won’t tell whether you have IBS but may show if you have other conditions like colitis or IBD.

Treatment and Care of Irritable Bowel Syndrome

There is no single best approach for treatment of IBS. A mix of therapies can be used to bring about relief. These include changes in diet, exercise, management of stress, and consuming medicines. Symptoms can be managed by changing diet. Fiber rich diet reduces constipation.

Laxatives can be used but not regularly. Stimulant laxatives like Bisacodyl can be used. With these laxatives muscles in the bowels contract making stool pass through easily. It is important to talk it over with the doctor as long-term usage has many side effects.

There are prescription medicines available. Linaclotide works when other treatments have failed. This drug can be taken on an empty stomach. It relieves constipation by helping bowel movements. Lubiprostone ( Amitiza) is useful for treating women who do not respond to other treatments.

Doctors can also prescribe anti-depressants for IBS. Antidepressants block the perception of pain in the gut. Antispasmodic drugs like dicyclomine can relieve stomach cramps by relaxing the muscles of the gut.

There are medications approved for Irritable Bowel Syndrome:

Alosetron: This relaxes the colon and retards the movement of waste through the intestines. It should be considered only when other treatments are not helpful
Eluxadoline: It eases diarrhea reducing muscle contraction and secretion of fluids in the intestines
Rifaximin: It decreases bacterial overgrowth and diarrhea.

There are also other alternative treatments available:

Hypnosis: A professional will help you get into relaxed state where you will be taught to relax your abdominal muscles. It helps in reducing abdominal pain.
Training Related to Mindfulness: It is about being aware of sensations. Research suggests it is helpful in easing symptoms of pain.
Acupuncture: It helps in improving symptoms in people with IBS.
Peppermint: It is an antispasmodic that relaxes muscles in the intestines providing short term relief.
Probiotics: These are good bacteria living in the gut and found in foods like yogurt and other dietary supplements. These help in getting rid of symptoms like pain and bloating of stomach.

OTC Medications and Self-Management Methods for Irritable Bowel Syndrome

OTC Medications for Irritable Bowel Syndrome:

Osmotic laxatives like polyethylene glycol (Miralax) can be bought over the counter. This works by pulling water back in the stool thereby softening it. These make the stool easier to pass but these have been found to help only in cases of constipation. Other symptoms can worsen with its use. Side effects include diarrhea, dehydration and bloating.

Self-Management Methods for Irritable Bowel Syndrome:

Take FODMAP diet. FODMAP stands for fermentable, oligo- di- monosaccharides and polyols. These are found in grains, vegetables, fruits and dairy products.
Avoid problem foods that trigger your symptoms.
Eat regularly with not too much or too little gap between meals and exercise regularly.
Incorporating relaxation techniques like abdominal breathing, progressive muscle relaxation, Visualization of positive images have been related with reducing symptoms of IBS.

Thus, managing your stress and watching your diet are good ways to relieve IBS symptoms. It is also advised to talk to your health care provider to choose lifestyle techniques.

Natural Ways to Treat Irritable Bowel Syndrome

Go for citrus fruits: These foods help in digestion reducing inflammation of the digestive tract.
Let go of spicy foods and see if there is any difference.
Work out more often. Exercise helps by relieving stress which removes bowel discomfort by regulation of intestinal contractions.
Take as much rest as possible.
Eat more of fiber and less of dairy
Use laxatives with care.

Health Tip by Expert

“Eating vegetables like carrots could reduce symptoms of IBS as vegetables are rich in soluble fiber and can reduce diarrhea and constipation.”