Irritable Bowel Syndrome....... not a topic that most like to openly discuss. However, for those of us who deal with IBS all the time, it's something that needs to be better understood! And today is the perfect time to be writing on the topic due to the fact that April is IBS Awareness Month. Spreading awareness is one of the only ways we can help the world to better understand this life altering conditions. People in general don't understand that it's not just having periodic abdominal pain, constipation or diarrhea. It really is a condition that impacts many parts of your life, not just your health. Awareness may help to explain to others why we only eat certain food or that you absolutely can't eat others. And help people around us to understand why you can't eat out of the house without issues or why you never eat out. Awareness also helps everyone understand and learn a person's triggers and needs for treatment. Everyone is going to have a different experience with the condition, and the triggers for one person won't necessarily be the trigger for another. Examples of IBS triggers could be change in routine, or anxiety/nerves or even certain kinds of food. That being said like many other conditions everyone who has IBS will have a different journey and story to tell.
Let's look at some statistics! Irritable Bowel Syndrome (IBS) is said to be the most common of the functional gastrointestinal (GI) disorder NOT only in the US but also worldwide! And an estimated $1.6 Billion is spent yearly on healthcare for those with the condition. IBS is said to have an estimated prevalence rate of 10-25%. There is such a large range because a lot of people will not seek care for IBS symptoms until it is really impacting their life. According to the Statistics only about 30% of people who have symptoms will actually consult a doctor. One bit of information i found to be interesting is that IBS has a higher prevalence rate in women and people who work in professional or managerial roles. IBS can really be found in any person at any age but research shows that most people will experience their first symptoms before the age of 35. That being said IBS can really happen at any age, but the peak ages for dealing with IBS is between 25 and 54 years. IBS is also found to have a genetic link. Anyone who has a biological relative with IBS is TWICE as high than those who have no family with the condition.
So what really causes this extremely prevalent disorder? Sadly even though we live in a time of research, the exact cause of IBS isn't known. Researchers believe that a faulty communication between the brain and GI system could be a cause. In some cases the miscommunication can cause abnormal spasms or cramping of the intestines. Those spasms may increase or decrease the passage of stool causing constipation or diarrhea! People with IBS may have symptoms caused by:
- Eating (even though no particular foods have been directly linked with IBS)
- Stress &/or issues like anxiety or depression
- Hormonal changes such as the menstrual cycle in women.
- Medications (especially antibiotics)
- Infection of the intestines like Salmonella or E. Coli
- Genetics, (as noted above in the discussion of statistics) IBS is more likely to occur in people who have a family history of the condition.
Now that we know we aren't alone in our struggle with IBS, and we know the potential causes, what are the symptoms to watch for?!?! Everyone will have different symptoms, that's why knowing the symptoms of IBS is an important way to help determine which of the three types of the condition you may have. Everyone has stomachaches and trouble going to the bathroom from time to time. But for people who have IBS these symptoms can be disabling.
The following are general symptoms:
- Abdominal pain
- Constipation (may alternate with diarrhea)
- Diarrhea (may alternate with constipation)
- Bowel movements that feel uncontrollably urgent, difficult to pass or incomplete!
- Passing clear or white mucous with the stool.
I mentioned above that there are three types of IBS, while looking at the symptoms let's also look at the types of IBS before diving into how to diagnose.
- IBS with constipation- People suffering with this kind of IBS will present with stomach pain & discomfort, bloating, bowel movements that are abnormally infrequent or delayed and may be lumpy or hard!
- IBS with diarrhea- People who have this type of IBS will likely complain of stomach pain & discomfort (just like the above type), an urgent need to move your bowels, very frequent bowel movements, loose &/or watery stools
- IBS with alternating constipation & diarrhea. This kind requires no real description. A person with this type of IBS will experience a combination of the symptoms noted above with the other two types of IBS.
Lets take a moment to look at how a person is diagnosed with this condition. In order for a doctor to properly diagnose IBS, there are certain criteria that a person must meet. A person must meet TWO of the THREE following criteria in order to be diagnosed.
- A bowel movement that relieves the stomachs and suffering.
- There is a change in how often you have bowel movements.
- The stool looks different.
The above standard diagnostic guidelines for IBS is called the Rome IV criteria. This criteria states that in order to be diagnosed with IBS a person must have the above stated symptoms for at least 1 day a week over the last three months, and that the symptoms must have started at least 6 months prior. If you start having symptoms and believe it could be IBS doctors encourage people to start keeping a symptom journal/diary. This is important because keeping a journal can not only help diagnose the condition, it can also be show patterns in symptoms. The journal may also show if there is a dietary link to the symptoms. The following are recommended topics to be included in a symptom journal!
- Date and time symptom started and ended.
- Description of symptoms (what symptoms are experienced during the current flare).
- Where were you and what were you doing when the symptoms started.
- Food eaten the hours leading up to the attack.
- Amount of food eaten (using a 1-10 scale, with 1 being a very small amount and 10 being an excessive amount)
- Any meds taken to help relieve symptoms.
- Any and all suspected triggers.
There are also more definitive testing that can be done to diagnose the condition. Doctors can order stool studies, lab work and even X-rays and other imaging to help rule out other conditions, and decide if IBS is the issue.
- Stool studies- ordered to check for and rule out infection or problems with the intestines ability to absorb nutrients.
- Flexible Sigmoidoscopy- This imaging study is done to examine the lower part of the colon (the sigmoid colon) with a flexible, lighted tube.
- Colonoscopy- The doctor uses a small, flexible lighted tube to examine the entire length of the colon.
- X-ray or CT Scan- These tests are ordered so the dr can see images of the abdomen and pelvis to rule out potential causes of abdominal pain. The doctor can also order a Lower GI Series, which consists of filling the large intestine with an opaque liquid (known as barium) so they are able to see any potential problems on an X-ray
Once the diagnosis has been decided treatment is started. But what exactly is the treatment for IBS?? Well, treatment really focuses on relieving symptoms so that you can live as normal a life as possible. Symptoms for many can often be controlled by learning to manage stress, and making changes in diet and lifestyle. Common ideas for doing so:
- Avoid foods that you have noted to trigger your symptoms.
- Eat foods that are high in fiber.
- Drink lots of water
- Try to exercise regularly
- Get recommended hours of sleep.
Your doctors may also suggest eliminating certain types of food as well. The foods that you might be asked to eliminate:
- High-gas producing foods- If you experience gas or bloating you might try avoiding carbonated and alcoholic beverage, caffeine, raw fruit, cabbage, broccoli and cauliflower, to see if doing so will reduce symptoms.
- Gluten- research has shown that some with IBS have reported improvements in diarrhea if they stop eating gluten (wheat, barley and rye) even if they don't have celiacs disease.
- FODMAPs- some people have found they are sensitive to certain carbs such as fructose, fructans, lactose, and some others known as FODMAPs. That stands for fermentable oligo-, di-, and monosaccharides and polyols. FODMAPs can be found in some grains, vegetables, fruits and dairy. IBS symptoms may ease up if a strict low-FODMAP diet and slowly introduce food one at a time, in order to determine which foods cause more issues.
Some people find it easier to see a dietician to help to make these dietary changes. Also, depending on symptoms a doctor may suggest some of the following medications.
- Fiber supplements - these may help to control constipation.
- Laxatives- these may be encouraged to help manage constipation if fiber supplements don't help. Milk of Magnesia or Miralax might be prescribed.
- Anti-diarrheal meds- A Doctor May suggest over-the-counter medications to help with diarrhea, such as Imodium. The doctor might also recommend meds like bile acid binders, like Prevalite, Colestid or Welchol.
- Anticholinergic meds- These medications can help to relieve spasms of the bowels, and diarrhea.
- Tricyclic antidepressants- These medications can benefit those with IBS in two ways. They can help relieve depression, as well as working to inhibit the activity of neurons that control the intestine to help reduce pain.
- SSRI antidepressants- These medications work to treat anxiety and depression, as well as pain and constipation.
- Pain Medications - can be used to ease severe pain or bloating
When people heard about IBS in the past most thought that is was just a coverall diagnosis for anyone with abdominal pain and bowel issues. That it was a diagnosis when the doctors don't know what the real problem was. However, now we know that IBS is a real condition that causes real issues for many many people. And that it can truly be impacted by stress and anxiety! Over the last decade diagnosis and treatment options for those with IBS has greatly improved. Now people with the condition no longer have to suffer quietly. In years past it was almost considered taboo to speak openly about issues you might be having with your bowels simply because many felt like it was a topic that shouldn't be discussed. Now there are all kinds of support groups and Facebook groups where people can go an openly discuss these issues. People no longer have to suffer quietly and feel alone. As discussed above we now know there are many potential causes for IBS, since that discovery has been made treatment options are much better. I know when I was diagnosed 15 plus years ago I was told that it was was NOT a condition that is impacted by diet or stress level. Now that we know that this is not the case, those of us who suffer know how to better treat the symptoms and make life changes. Like any condition we are only going to continue to learn more about the causes, the diagnosis and treatment through research. We can hope that one day we will be talking prevention and not just treatment.