IBS: Understanding Symptoms, Causes, and Treatment Options
Are you tired of constantly battling digestive issues and feeling like you can never fully enjoy your favorite foods? If so, you're not alone. Irritable bowel syndrome, or IBS, is a chronic gastrointestinal disorder that affects between 10% and 15% of the global population, making it one of the most common gastrointestinal disorders worldwide (1). From uncomfortable bloating and cramping to unpredictable bowel movements, IBS can significantly impact a person's quality of life.
Despite being a common condition, IBS is often poorly understood, both by people who have the condition and by healthcare professionals. This can lead to delays in diagnosis and inadequate management of symptoms. In this blog post, we will provide an overview of IBS, including its causes, symptoms, and treatment options. We will also explore some of the ways IBS can impact a person's physical and emotional well-being, and provide tips for managing the condition effectively.
Let’s dive in!
Overview of IBS
Irritable bowel syndrome (IBS) is a very common functional gastrointestinal disorder characterized by chronic abdominal pain, bloating, and altered bowel habits. It is an umbrella term that can be applied to different conditions like spastic bowel, spastic colon, mucous colitis, colitis and functional bowel disease.
The exact cause of IBS is not fully understood, but it is thought to involve abnormalities in the interaction between the brain, gut, and nervous system, as well as changes in gut microbiota and inflammation (2). IBS is often classified into three subtypes based on bowel habits: IBS with diarrhea (IBS-D), IBS with constipation (IBS-C), and mixed IBS (IBS-M) (3).
Symptoms of IBS
IBS symptoms can vary from person to person, but they typically include (4):
Abdominal pain: This is one of the most common symptoms of IBS. The pain is usually located in the lower abdomen and can be mild or severe.
Bloating: This is a feeling of fullness or swelling in the abdomen that can be accompanied by gas.
Diarrhea: This is characterized by loose, watery stools and a frequent urge to go to the bathroom.
Constipation: This is characterized by infrequent bowel movements and difficulty passing stool.
Alternating diarrhea and constipation: Many people with IBS experience both diarrhea and constipation at different times.
Nausea: This is a feeling of sickness in the stomach that can be accompanied by the urge to vomit.
Fatigue: Many people with IBS experience fatigue or tiredness, which can be related to disrupted sleep patterns or stress.
Anxiety and Depression: It is estimated that up to 60% of people with IBS experience anxiety or depression, and these mental health conditions can have a significant impact on the severity and frequency of IBS symptoms (5).
Symptoms of irritable bowel syndrome (IBS) can be irregular and may vary in severity and frequency. Everyone experiences IBS differently, which can make it difficult to diagnose and treat.
Causes of IBS
The exact cause of IBS is unknown. It is believed to be a multifactorial condition, meaning that it is likely caused by a combination of things, rather than a single cause. Factors that may play a causative role include (6):
Abnormalities in gut bacteria: The bacteria in the gut may be altered in people with IBS, leading to changes in digestive function and inflammation.
Abnormalities in gut motility: The muscles in the gut that move food through the digestive tract may not work properly in people with IBS, leading to symptoms such as bloating and constipation.
Abnormalities in the nervous system: The nerves in the digestive system may be more sensitive in people with IBS, leading to changes in bowel function and increased sensitivity to pain. This phenomenon is known as “visceral hypersensitivity”.
Intestinal inflammation: Chronic low-grade inflammation in the gut may contribute to the development of IBS, as well as activation of the immune system.
Carbohydrate malabsorption: Carbohydrate malabsorption occurs when the body is unable to properly digest and absorb certain types of carbs, such as lactose, fructose, and sorbitol. A low FODMAP diet is often recommended to help address this.
Psychological factors: Stress, anxiety and depression can exacerbate IBS symptoms in some people. This may be due to the complex relationship between the brain and the gut, known as the gut-brain axis.
Hormonal changes: Women with IBS may experience changes in symptoms during their menstrual cycle, suggesting that hormonal changes may play a role in the condition.
Risk Factors
There are several risk factors associated with developing IBS. Some of these risk factors include (7):
Gender: Women are more likely to develop IBS than men.
Age: IBS is most commonly diagnosed in people under the age of 50.
Family History: There may be a genetic component to IBS, as people with a family history of the condition are at higher risk of developing it.
Psychological Factors: People with anxiety, depression, or a history of trauma may be more likely to develop IBS. These factors can also exacerbate symptoms.
Antibiotics: Antibiotics can disrupt the balance of the gut microbiome, resulting in changes in gut motility and increased intestinal permeability.
Inflammation and Infections: Inflammation and infections in the digestive tract can increase the risk of developing IBS. This can include conditions like gastroenteritis or small intestinal bacterial overgrowth (SIBO).
Diet: Certain types of food can trigger IBS symptoms, such as spicy or fatty foods, caffeine, alcohol, lactose, gluten, and artificial sweeteners.
Sedentary Lifestyle: Lack of physical activity can increase the risk of developing IBS.
It's important to note that having one or more of these risk factors does not necessarily mean that a person will develop IBS. However, being aware of these risk factors can help you take steps to reduce your risk of developing IBS and manage your symptoms if you do develop the condition.
Diagnosis of IBS
Diagnosing IBS can be challenging because there are no specific tests or biomarkers for the condition. Instead, doctors use a combination of symptom assessment, physical exam, and medical history to make a diagnosis. The Rome criteria, established by the American College of Gastroenterology, is a set of diagnostic criteria that is commonly used to diagnose IBS. According to these criteria, a person must have recurrent abdominal pain or discomfort for at least three days per month in the past three months, associated with two or more of the following (8):
Improvement with a bowel movement
Onset related to a change in the frequency of the stool
Onset related to a change in the appearance of the stool
Other tests may be ordered to rule out other conditions that may cause similar symptoms, such as inflammatory bowel disease, celiac disease, or colon cancer. These tests may include blood tests, stool tests, colonoscopy, or imaging tests such as an MRI or CT scan.
Comorbidities
Those who have IBS also have other chronic conditions:
Fibromyalgia: It is estimated that up to 70% of people with fibromyalgia also have IBS (9).
Chronic Fatigue Syndrome (CFS): CFS is a complex disorder characterized by extreme fatigue that is not relieved by rest. Many people with CFS also have IBS.
Gastroesophageal reflux disease (GERD): GERD is a condition in which acid from the stomach flows back into the esophagus, causing symptoms such as heartburn and chest pain. It is estimated that up to 50% of people with GERD also have IBS (10).
Anxiety and depression: Anxiety and depression are common mental health conditions that can be associated with IBS. Up to 60% of people with IBS also experience anxiety or depression (11).
Inflammatory Bowel Disease (IBD): Meta-analyses report that up to 40% of patients with IBD have IBS symptoms as well (12).
Treatment of IBS
There are several treatment options that can help manage the symptoms of IBS. The choice of treatment(s) will depend on the type and severity of symptoms, as well as individual needs. Some of the most common treatments are (13):
Dietary changes: Diet can play a significant role in managing the symptoms of irritable bowel syndrome (IBS) (14).
Eat small, frequent meals: Large meals can put a strain on the digestive system, so it may be helpful to eat smaller, more frequent meals throughout the day.
Avoid trigger foods: Common trigger foods include caffeine, alcohol, spicy foods, dairy, gluten, and high-fat foods. It may be helpful to keep a food diary to identify trigger foods.
Fiber intake: Fiber promotes regular bowel movements and may help manage constipation. However, some people with IBS may find that high-fiber foods exacerbate symptoms. Gradually increase fiber intake and monitor symptoms to determine the right amount of fiber for your individual needs.
Stay hydrated: Drinking plenty of water and other fluids can help to prevent constipation and promote regular bowel movements, especially while increasing fiber.
Low FODMAP diet: FODMAPs are fermentable carbohydrates that can be difficult for some people to digest. A low FODMAP diet is an elimination diet that removes high FODMAP foods from the diet for a period of time, then gradually reintroducing them to determine which ones trigger symptoms. Some examples of high FODMAP foods include wheat, onions, garlic, apples, and legumes. To ensure proper implementation, it’s best to work with a nutritionist while following this diet (15).
Probiotics: Probiotics are live microorganisms that can help to restore the balance of gut bacteria. Some studies have shown that probiotics may be helpful in managing IBS symptoms.
Medications: Common medications used to help to manage IBS symptoms include antispasmodics, laxatives, and certain antidepressants- which impact serotonin levels.
Psychological therapies: Psychological therapies such as cognitive behavioral therapy (CBT) and hypnotherapy can help to reduce stress and improve symptoms of IBS.
Alternative therapies: Some people with IBS find relief through acupuncture or herbal remedies. Please consult a healthcare professional before trying any alternative therapies, as some may be harmful or interact with medications.
Other treatments: There are several other treatments that may be helpful in managing IBS symptoms, including biofeedback therapy and nerve stimulation.
Manage stress: Stress can exacerbate IBS symptoms in some people. Relaxation techniques such as deep breathing, meditation, and yoga may help to reduce stress levels.
Exercise regularly: Regular exercise can help to improve gut motility and reduce stress levels. Walking, swimming, and yoga are good options.
Get enough sleep: Getting enough sleep is important for overall health and can help to reduce fatigue and stress levels.
Working with a Nutritionist
As you can see, there are a lot of ways to manage IBS. With so many options and individual needs, finding a plan that works for you can be a challenge! Seeing a functional nutritionist for IBS support can be highly beneficial.
Here are some reasons why:
Personalized dietary recommendations
Education about nutrition
Support and accountability
Coordination with healthcare providers
Holistic approach
Summary
It is important to note that there is no cure for IBS, and treatment is aimed at managing symptoms and improving quality of life. Working closely with a qualified nutrition professional who can develop a treatment plan that meets your individual's needs can be an effective way to manage your IBS symptoms.
