What Is Irritable Bowel Syndrome (IBS)?

Irritable bowel syndrome (IBS) is a condition that causes inconvenient and painful bloating, cramping, gas, and changes to your normal bowel movements.

Irritable bowel syndrome (IBS) is a chronic condition affecting your gastrointestinal (GI) system. Because 100 million nerve cells in your gut communicate back and forth with your brain, some people refer to IBS as a gut-brain disorder.

People with IBS have especially sensitive nerve endings in their bowel walls. If something irritates those nerve endings, you may have bloating, cramping, gas, and abrupt changes to your bathroom habits that can be inconvenient and painful.

In the United States, nearly 12 percent of people have IBS. IBS affects people of any age. But women under 45 are at higher risk than others. If you have IBS and get a monthly period, you may notice that your symptoms worsen during menstrual bleeding. This is because fluctuating hormones during the menstrual cycle can affect bowel function.

IBS isn't life-threatening and doesn't usually lead to additional GI complications. But early diagnosis and treatment can help you manage your symptoms and improve your quality of life.

Types of IBS

People with IBS may be symptom-free and have entirely regular bowel movements on some days. What happens on the other days determines the type of IBS you have.

As awkward as it may be, sharing details about your bathroom experiences with your healthcare provider is essential. Those details will help your healthcare provider decide the best treatment based on your type of IBS.

IBS With Constipation (IBS-C)

Primarily, you may notice lumpy and hard stools during bowel movements. You may also experience other symptoms of constipation, such as:

  • Having fewer than three bowel movements a week
  • Straining or feeling like your bowels are not completely emptying 

IBS With Diarrhea (IBS-D)

You may have primarily loose, watery stools, often due to the overactivity of your gut muscles. When your gut muscles move faster than average, your large intestine doesn't have a chance to absorb water from your food. Occasionally, some people can also get IBS-D after having a gut infection.

IBS With Mixed Habits (IBS-M) 

You experience both hard, lumpy stools and loose, watery stools, maybe even on the same day.

IBS Symptoms

IBS symptoms typically come and go. But when the condition flares, you may experience symptoms like:

  • Abdominal pain or cramps
  • Bloating
  • Bowel movements that are harder or softer than usual
  • Changes in how often you have a bowel movement
  • Diarrhea, constipation, or alternating between both
  • Feeling like you can't finish a bowel movement
  • Gas
  • White mucus in your stool

The severity of symptoms can vary. Some people only have mild symptoms. Others have intense pain or an urgency to get to the bathroom that impacts their entire day.

However, IBS symptoms can be unpredictable, flaring for different reasons. For example, if you get a monthly period, you may notice their symptoms ramp up during that time.

What Causes IBS?

There's no singular cause of IBS. A combination of factors is likely responsible, which can differ between people. Some of those factors may include the following:

  • Genetics: Some evidence suggests that you're about two to three times more likely to have IBS if a family member has it.
  • Gut motility: This is how quickly or slowly food moves through your gut. Muscles that squeeze food through your GI tract line your intestinal walls. Those muscles producing too strong or long contractions may cause gas, bloating, and diarrhea. In contrast, weak contractions result in hard, dry stools.
  • Food intolerances or sensitivities: Many people with IBS feel worse after eating certain foods. Those types of foods are different for each person.
  • Gut infections: Sometimes, a bacterial infection that causes severe diarrhea can bring on IBS.
  • Gut health: Your gut microbiome includes bacteria, viruses, and other microorganisms that support your gut health. People with IBS may have an imbalance of "good" and "bad" bacteria in their gut microbiome.
  • Mental health: Research has found that it's not uncommon for IBS symptoms to get worse when you're stressed. While mental health doesn't necessarily cause IBS, excess stress may cause a flare.
  • Childhood trauma: Some evidence suggests that people who've had a traumatizing experience during childhood, like physical or sexual abuse, are more likely to have IBS.

How Is IBS Diagnosed?

There isn't a specific test that confirms IBS. But your healthcare provider will likely perform a physical exam of your abdomen. They may also ask questions about the following:

  • Your overall health, including other problems you've had
  • Any family history of GI conditions
  • Medications and supplements you take
  • Any recent illness or infections
  • Recent stressful events
  • What your diet is usually like
  • Your current symptoms. If you've had symptoms once per week for at least three weeks, or your symptoms began at least six months prior, that may indicate IBS. 

Your healthcare provider may also diagnose IBS based on whether you have abdominal pain accompanied by at least two of the following:

  • A change in the frequency of your bowel movements
  • Your stool looks different than usual
  • Your abdominal pain connects to your bowel movements

Your healthcare provider may also order additional lab tests or procedures to rule out other GI conditions. For instance, a blood test can help rule out anemia, infection, and digestive diseases. And a stool test may indicate other infections or illnesses.

Additionally, your healthcare provider may use a hydrogen breath test. That tool can examine how your body reacts to or digests certain foods, like lactose. Also, a colonoscopy or upper GI endoscopy can rule out celiac disease, colon cancer, or inflammatory bowel disease (IBD).

Treatments for IBS Flares

There's no cure for IBS. Luckily, your healthcare provider can suggest ways to keep your symptoms from flaring or relieve them once they do. 

For example, based on your symptoms, your healthcare may suggest or prescribe some of the following medications:

  • Medicines that regulate how your large and small intestine function
  • Over-the-counter (ITC) products like fiber supplements, probiotics, or peppermint capsules
  • Laxatives
  • Antidiarrheal medicines
  • Drugs that stop bowel spasms
  • Antidepressants—for example, a low dose can help reduce pain and general IBS symptoms
  • Pain medication

It may also help to avoid foods that trigger your symptoms. For instance, some people with IBS feel better if they skip foods with gluten. Instead, your healthcare provider may suggest that you eat more foods with fiber.

Others may notice an improvement while following a low-FODMAP diet. FODMAPs—fermentable oligosaccharides, disaccharides, monosaccharides, and polyols—are sugars. FODMAPs are found in various foods like cow's milk, chickpeas, lentils, and some fruits and vegetables.

Additionally, counseling may help. Cognitive behavioral therapy (CBT) helps you become more aware of negative thought patterns. Therefore, you can better cope with stressful situations. Some evidence suggests that CBT can help improve the physical symptoms of IBS. CBT may also have positive effects on your overall quality of life.

Other mental health interventions include gut-directed hypnotherapy and relaxation training. Gut-directed hypnotherapy involves using hypnosis to relax your body. Relaxation training teaches you how to relax muscles that may contribute to IBS symptoms.

In addition to reducing stress, some evidence suggests that exercising and getting quality sleep may help relieve symptoms.

How To Prevent IBS Flares

To prevent IBS symptoms from flaring, it may help to eat foods that are gentle on your gut. For many people with IBS, those foods may include the following:

  • Fruits like bananas, apples, kiwis, and raspberries
  • Vegetables like carrots, red bell peppers, and spinach
  • Milk alternatives 
  • Lactose-free yogurt
  • Gluten-free bread

In contrast, it may help to avoid or limit your intake of foods that could set off your IBS symptoms, like:

  • Fat
  • Spicy foods
  • Artificial sweeteners, like sorbitol 
  • Insoluble fibers, like whole grains, brown rice, beans, and legumes
  • Coffee, tea, and alcohol

Other techniques that may help prevent IBS symptoms may include the following:

  • Get on a schedule: Try to avoid skipping meals or going too long without eating. It's best for your bowel to have regular meals and snacks.
  • Stay hydrated: To keep things moving smoothly, aim for eight glasses of water or other non-caffeinated or non-alcoholic drinks daily.
  • Find ways to manage your stress: Regular exercise or listening to music can help calm your nerves. You may also want to experiment with meditation or deep breathing exercises.
  • Think ahead: If you live with IBS, it's always good to be prepared for a flare, especially if you're traveling. Keep medication on hand. You can also download an app that points you toward the nearest public bathroom.

Comorbid Conditions

IBS largely cooccurs, or is comorbid, with anxiety and depression. Research has indicated that 54% to 94% of people with IBS also have mental health conditions. Symptoms of anxiety and depression may cause IBS flares.

IBS is also comorbid with several conditions that affect the GI tract, such as:

  • Dyspepsia
  • Heartburn
  • Celiac disease
  • IBD, which includes Crohn's disease and ulcerative colitis

Additionally, IBS may be comorbid with other conditions that also cause chronic pain but do not affect the GI tract, like:

  • Fibromyalgia
  • Interstitial cystitis
  • Migraines
  • Pelvic pain
  • Temporomandibular syndrome (TMJ)
  • Chronic fatigue syndrome

Living With IBS

IBS can be a difficult and painful condition. Unexpected changes in your bowel movements can create obstacles to completing daily activities. Luckily, some ways to cope with your condition help improve your quality of life. 

The International Foundation for Gastrointestinal Disorders recommends eight guidelines that may improve living with IBS, which include:

  1. If you are experiencing IBS symptoms and think you may have the condition, consult your healthcare provider for a diagnosis.
  2. Learn about IBS, including different treatment plans. Educating yourself about your condition can help you properly manage your symptoms. 
  3. Keep up-to-date with developments in treating IBS.
  4. Find out what triggers cause your symptoms to flare. For example, try tracking what foods do and do not help alleviate your symptoms in a food journal.
  5. Consider experimenting with therapies like special diets, gut-directed hypnotherapy, and relaxation training.
  6. Try complementary and alternative treatments, like herbal teas, acupuncture, and meditation. 
  7. Consult your healthcare provider about medications that may alleviate your IBS symptoms. 
  8. Communicate with your healthcare provider about what treatments do or do not work. Through trial and error, you can eventually develop a treatment plan that works for you.

A Quick Review

Nearly 12% of people in the United States experience IBS, which causes inconvenient and painful bloating, cramping, gas, and changes to your regular bowel movements. Different types of IBS may cause constipation, diarrhea, or a mix of both symptoms.

IBS can impact your daily activities and negatively affect your quality of life. But early diagnosis and treatments can help alleviate or prevent flares of IBS symptoms.

For instance, many people with IBS have symptoms of anxiety and depression, which increase flares. Counseling and other relaxation techniques may help improve your mental health while alleviating IBS symptoms.

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Sources
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