Chronic IBS: Irritable Bowel Syndrome Explained
Irritable Bowel Syndrome, commonly referred to as IBS, is a chronic condition that affects the large intestine. It is characterized by a group of symptoms that occur together, including repeated pain in your abdomen and changes in your bowel movements, which may be diarrhea, constipation, or both. With IBS, you have these symptoms without any visible signs of damage or disease in your digestive tract.
IBS is a disorder that interferes with the normal functions of the colon. The symptoms are usually painful and uncomfortable, but they do not cause any damage to the intestines. The symptoms of IBS can be managed by controlling diet, lifestyle, and stress. More severe symptoms can be treated with medication and counseling.
Understanding IBS
IBS is a common condition that affects between 25 and 45 million people in the United States. About 2 in 3 IBS sufferers are female. About 1 in 3 IBS sufferers are male. IBS affects people of all ages, even children. The exact cause of IBS is not known. Symptoms usually begin around age 20 and are often present for life.
The severity of IBS varies from person to person. Some people can manage their symptoms by managing diet, lifestyle, and stress. Others will need medication and counseling. While IBS is a chronic condition, there will likely be times when the signs and symptoms are worse and times when they improve or even disappear completely.
IBS Symptoms
IBS symptoms vary widely from person to person, and often resemble those of other diseases. Among the most common are abdominal pain or cramping, a bloated feeling, gas, diarrhea or constipation, and mucus in the stool. For most people, IBS symptoms are more severe in the morning.
IBS is often classified into four types based on your usual bowel habit: IBS-D (diarrhea predominant), IBS-C (constipation predominant), IBS-M (mixed), and IBS-U (unclassified). Most people with IBS have times when the symptoms seem worse, such as during periods of increased stress or changes in their daily routines.
IBS Causes
The exact cause of IBS isn't known. However, certain factors appear to play a role. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food from your stomach through your intestinal tract to your rectum. If you have IBS, the contractions may be stronger and last longer than normal, causing gas, bloating, and diarrhea.
Some people with IBS also may have sensitive intestines that react strongly to certain foods or stress. Research has shown that serotonin, a chemical made by the body that has a wide variety of functions in the body, may play a role in IBS. Most of the body's serotonin is found in the gut, although it's also produced in the brain.
Diagnosing IBS
There's no test to definitively diagnose IBS. Your doctor is likely to start with a complete medical history, physical exam, and tests to rule out other conditions. If you have IBS, you'll likely have a history of symptoms. The Rome criteria, which are international guidelines for the diagnosis of functional gastrointestinal disorders like IBS, state that the pain and other symptoms are related to bowel movements, occur at least one day a week in the last three months, and started at least six months ago.
Your doctor may conduct a number of tests to rule out other conditions. These may include stool sample testing, blood tests, x-rays, and an endoscopy. In some cases, a colonoscopy may be performed. If the results of these tests are negative, the doctor may diagnose IBS based on your symptoms, including the frequency and duration of your abdominal pain and the relationship of the pain with your bowel movements.
IBS Criteria
The Rome IV criteria for IBS diagnosis state that the pain is related to defecation, it is associated with a change in stool frequency, and it is associated with a change in stool form or appearance. The criteria must be fulfilled for the last three months with symptom onset at least six months prior to diagnosis.
The Manning criteria focus on pain relieved by passing stool and having incomplete bowel movements, mucus in the stools, and changes in stool consistency. The more symptoms present, the greater the likelihood of IBS. A diagnosis of IBS can be made based on less strict criteria, so long as the symptoms are consistent with IBS and there is no evidence of another disease that could explain the symptoms.
IBS Tests
There are no specific laboratory tests to identify IBS. Your doctor may run tests to rule out other conditions. These tests may include stool sample tests, blood tests, and imaging tests, such as an x-ray or CT scan. Your doctor may also perform a colonoscopy or sigmoidoscopy to examine the colon.
During a colonoscopy, a small, flexible tube is inserted into the rectum. A tiny camera at the end of the tube allows the doctor to view the entire colon. If necessary, tissue samples can be collected (biopsy) during the colonoscopy and abnormalities can be treated. With a sigmoidoscopy, the rectum and sigmoid colon are examined. While these tests can be uncomfortable, they provide important information about your health.
Treating IBS
Because it's not clear what causes IBS, treatment focuses on symptom relief so that you can live as normally as possible. Mild signs and symptoms can often be controlled by managing stress and by making changes in your diet and lifestyle. Try to:
- Avoid foods that trigger your symptoms
- Eat high-fiber foods
- Drink plenty of fluids
- Exercise regularly
- Get enough sleep
Your doctor might suggest that you eliminate from your diet high gas foods, gluten, or certain carbohydrates, such as fructose, fructans, lactose, and others, known as FODMAPs. If your symptoms are severe, your doctor might suggest a medication such as fiber supplements, laxatives, anti-diarrheal medications, antispasmodic medications, pain medication, and antidepressants.
Dietary Changes
For many people with IBS, careful eating reduces or eliminates symptoms. You might try avoiding caffeine, alcohol, fatty foods, gas-producing foods (such as beans, cabbage, and broccoli), and the artificial sweeteners sorbitol and xylitol (often used in sugarless gum and sugarless candy).
To reduce constipation, eat a diet rich in fiber, including whole grains, fruits, and vegetables. Drink plenty of fluids and exercise regularly. Some people with IBS find it helpful to increase fiber in their diets gradually, to allow their bodies to get used to this change in the diet.
Medications
Several types of medications are available to treat IBS symptoms. The choice of medication depends largely on whether the main symptom is constipation, diarrhea, or pain. Over-the-counter medications, such as fiber supplements or laxatives, can help with constipation. Anti-diarrheal medications can help with diarrhea. Antispasmodic medications can help with abdominal pain.
Your doctor might also suggest a prescription medication for IBS. These medications include lubiprostone (Amitiza), linaclotide (Linzess), eluxadoline (Viberzi), and rifaximin (Xifaxan). These medications all have specific uses and cannot be used interchangeably. They also have potential side effects. Discuss the pros and cons of each treatment with your doctor.
Living with IBS
Living with IBS can be challenging, but it doesn't have to take over your life. Many people with IBS lead fulfilling and active lives. It's important to take care of your physical health, but it's also important to take care of your mental health. Stress, anxiety, and depression are common in people with IBS. It's important to seek help if you're feeling emotionally overwhelmed.
There are many resources available for people with IBS. Support groups, counseling, and therapy can all be beneficial. It's also important to stay informed about your condition. The more you know about IBS, the better equipped you'll be to manage your symptoms and lead a healthy, active life.
Support and Resources
There are many resources available for people with IBS. These include patient support groups, online communities, and educational websites. These resources can provide valuable information and support for people with IBS and their families. They can also help you connect with other people who are facing similar challenges.
Many people find that joining a support group is very helpful. Support groups offer a safe place to share experiences, get advice, and give and receive emotional support. They can also provide practical tips for dealing with IBS, such as diet and lifestyle changes, stress management techniques, and more.
Mental Health and IBS
IBS can have a significant impact on your mental health. Stress, anxiety, and depression are common in people with IBS. These can be a result of dealing with chronic pain, as well as the social and practical challenges of living with IBS. It's important to seek help if you're feeling emotionally overwhelmed.
Therapy and counseling can be very beneficial for people with IBS. Cognitive behavioral therapy, in particular, can be very helpful. This type of therapy helps you identify and change negative thought patterns that can lead to feelings of anxiety and depression. It can also help you develop coping strategies for dealing with IBS symptoms and stress.
Conclusion
IBS is a common, chronic disorder that affects the large intestine. While the exact cause of IBS is unknown, it's thought to result from a variety of factors, including changes in gut bacteria, inflammation in the intestines, and abnormalities in the nervous system. IBS is typically diagnosed based on symptoms, and treatment focuses on managing symptoms.
Living with IBS can be challenging, but with the right treatment and support, most people with IBS can manage their symptoms and lead active, fulfilling lives. If you have symptoms of IBS, it's important to seek medical advice. With the right diagnosis and treatment, you can manage your IBS and improve your quality of life.
