Signs and Symptoms of Irritable Bowel Syndrome
- Abdominal pain, cramping, or bloating
- Excess gas
- Diarrhea or constipation, or alternating bouts of each
- Mucus in your stool
- IBS with diarrhea (IBS-D), which may involve loose, watery stools
- IBS with constipation (IBS-C), which may involve stools that are lumpy and hard
- IBS with mixed bowel habits (IBS-M), which includes both diarrhea and constipation symptoms
Causes and Risk Factors of Irritable Bowel Syndrome
The Brain and Gut Connection
“When we describe our emotions, we tend to say that we feel sickened or nauseated, or [it is] gut-wrenching, which makes sense since our emotions seem to occur from our gut,” says Judith Scheman, PhD, the director of behavioral medicine at Cleveland Clinic’s Digestive Disease and Surgery Institute in Ohio.
Some experts think that IBS is caused when there’s a glitch in that communication. “We all respond to stress physically, and some of us physically react with our gut, as with diarrhea or constipation, while others get headaches or back pain,” Dr. Scheman says.
The problem is that the stress response in the gut can create a vicious cycle, in which the stress causes symptoms and vice versa, also known as a feedback loop. “Each time you go around it gets worse, like a downward spiral,” Scheman says.
An Imbalance of Microbes in the Gut
Risk Factors for IBS
There’s also evidence that people with IBS tend to suffer from mood disorders such as depression or anxiety. “There is a high overlap between the two,” says Jeffrey Baumgardner, MD, a gastroenterologist in Santa Rosa, California. “A significant number of people with IBS also have a history of some kind of abuse — emotional, physical, or sexual.”
Dr. Baumgardner also thinks that IBS has something to do with how people process stress, though research hasn’t shown why yet.
Potential Triggers of Irritable Bowel Syndrome
- Certain foods or food ingredients such as milk and dairy products, citrus fruits, cabbage, wheat, and carbonated beverages.
- Stress: While not a direct cause of symptoms, research suggests it may aggravate symptoms, causing them to be more severe and frequent.
- Hormones: Taking estrogen therapy before or after menopause increases your risk of IBS.
While it may take some trial and error to figure out what’s causing symptoms, your doctor can help you manage them.
Quiz: IBS vs. IBD
How Is Irritable Bowel Syndrome Diagnosed?
According to the latest revision, the Rome IV, symptoms such as abdominal pain should occur, on average, at least one day per week within the previous three months, accompanied by at least two of the following other symptoms:
- Abdominal pain related to a bowel movement
- Changes in the frequency of stools
- Changes in the appearance of stools
Duration of Irritable Bowel Syndrome
Treatment and Medication Options for Irritable Bowel Syndrome
There’s no one-size-fits-all treatment for IBS. Most people with IBS try different treatments before they find one or a combination of a few that work. One way to start is to develop a sense of how your IBS affects your diet, mood, and stress level, as well as other areas of your life.
Your doctor will likely recommend the following strategies:
- Dietary changes
- Psychotherapy (talk therapy)
- Complementary and integrative medicine approaches like acupuncture and meditative techniques
Depending on your symptoms, any combination of these options may be part of your treatment strategy.
- Viberzi (eluxadoline), which reduces muscle contractions and fluid in the intestine, and improves muscle tone in the rectum.
- Xifaxan (rifaximin), an antibiotic that can decrease bacterial overgrowth.
- Amitiza (lubiprostone) and Linzess (linaclotide) work to increase fluid secretion in your small intestine to help you pass stool.
Alternative and Complementary Therapies
Modifying Your Diet
For people with IBS, figuring out which foods tend to cause symptoms can be tricky. A food diary may help you identify foods you should avoid.
A low-FODMAP diet involves eating fewer foods containing lactose (found in dairy); fruits such as apples, pears, and cherries; cruciferous vegetables like broccoli and cauliflower; beans; and sugar-free gums and mints.
Prevention of Irritable Bowel Syndrome
Complications of Irritable Bowel Syndrome
Life with IBS can be complicated and challenging enough on its own. While IBS doesn't permanently damage the digestive tract, it can take an emotional and psychological toll, especially when it comes to your sex life. Symptoms can strike at any moment, causing you to fear an embarrassing incident and easily killing the mood.
Consider some of these suggestions:
- Talk with your partner about your anxieties.
- Learn stress-management techniques to help you relax.
- Avoid trigger foods on the days when you plan to get intimate.
- Take medications to help relieve pain, gas, and diarrhea so you have one less thing to worry about.
Research and Statistics: Who Has Irritable Bowel Syndrome?
Research into IBS is ongoing — we still don't know what causes it, and even diagnosing it can be difficult, because symptoms overlap with other conditions and there's no definitive test. But Barry Marshall, MD, an Australian physician who won the Nobel Prize for discovering the link between stomach ulcers and the bacteria Helicobacter pylori, has devised a way to diagnose IBS by listening to the sounds of the digestive tract. In the Noisy Guts Project, Marshall and his research team are testing an acoustic belt that listens to and records what’s going on in the gut. The recordings are then fed into an artificial intelligence engine that compares the sounds of an IBS gut with a healthy gut.
Related Conditions and Possible Causes of IBS
Research suggests that the chronic pain disorder fibromyalgia may also be connected to IBS.
IBD, usually categorized as either Crohn’s disease or ulcerative colitis, is linked to an abnormal reaction by the body’s immune system. The lining of the intestines becomes inflamed and ulcerated, which causes permanent damage to the digestive tract over time. These conditions often require medication and may even lead to hospitalization and surgery.
Resources We Love
The IFFGD, a nonprofit organization, works with patients, families, healthcare providers, and researchers to increase awareness and understanding of gastrointestinal issues and to improve digestive health. Their page Living with IBS delves into the challenges that people with IBS may face, from traveling to navigating holidays to being pregnant.
This online community is great for IBS patients looking for support and connection. Community forums directly address a range of IBS issues, and you can also find resources on living with IBS, including patient diaries, and a podcast that includes conversations with patients, researchers, GI doctors, and dietitians.
For clear, accurate health information, the Mayo Clinic is one of Everyday Health's trusted go-to sources. Their comprehensive coverage of IBS goes beyond the basics, with tips on how to prepare for an appointment to discuss IBS with a gastroenterologist and what questions to ask.
In addition to in-depth review of symptoms, treatment, and how to manage IBS, the NIDDK's site also offers the latest on clinical trials potentially available to IBS patients.
Additional reporting by Christina Vogt.
Editorial Sources and Fact-Checking
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