It’s the thing no one really wants to talk about, but it affects 10-15% of adults. It can be so disabling that those who suffer from it miss work, school, and social events. In fact, only the common cold results in more missed workdays. It can severely affect your quality of life. April is Irritable Bowel Syndrome (IBS) Awareness Month, so let’s talk about it!
What is it?
According to the International Foundation for Functional Gut Disorders (IFFGD), IBS can be a long-term or a recurring digestive disturbance. It usually affects the large intestine, impacting motility and sensation. It results in abdominal pain, diarrhea, and constipation (sometimes both). The pain can be worse after eating and in the morning. It is usually relieved by going to the bathroom. Other symptoms include bloating, mucus in the stool (typically white or yellow in color), the sensation that you haven’t entirely passed stool, and urgency to get to the bathroom.
What causes it?
The causes of IBS are not fully understood. There may be a genetic component, but there are likely also other triggers, such as sensitivity to certain foods, emotional upset, stress, and GI infection. There is likely also a disruption between signals in the brain and the gut, also known as the brain-gut axis. The brain and gut work together to maintain proper functioning of the bowel, and IBS results in alterations of this communication pathway. New research is looking into gut bacteria, which also may play a role.
How is It Diagnosed?
IBS is diagnosed using the Rome Criteria, which evaluates symptoms and the duration of the symptoms. You can read more about the criteria here. It is important to note that there are other symptoms that may be experienced which are NOT typical of IBS. These are known as "alarm symptoms" and should prompt a visit to your doctor. They include blood in the stool, unexplained weight loss, anemia, fever, symptoms beginning after the age of 50, or family history of more severe conditions such as colon cancer, celiac disease, or inflammatory bowel disease (Crohn’s or colitis).
How is It Treated?
IBS can be treated with lifestyle changes and medication if needed. Lifestyle changes may involve a change in diet (see below), or stress management, including getting enough exercise and rest. Medications may be necessary if lifestyle changes are ineffective, or when symptoms flare up. You can read more about medications here.
What About Diet and Food Sensitivities?
Much has been written about various dietary strategies for dealing with IBS. One important thing to remember is that what triggers one person may be well tolerated by another. It’s difficult to say which plan would work for you, so a bit of trial and error may be in order. A daily food diary may be helpful in figuring out what your trigger foods are. You can find an example here.
Some people are sensitive to large, high fat meals, or too much caffeine. Alcoholic beverages may also cause symptoms in others. Foods that can increase gas and bloating include beans, gas-forming vegetable such as broccoli or cauliflower, and dried fruits. If constipation is your main issue, consider a psyllium-based supplement. Lactose intolerance can aggravate IBS—if you think you are lactose intolerant, try removing dairy from your diet for a few weeks, and then reintroducing it. Cow’s milk and ice cream contain a lot of lactose, so just eliminating those may be enough. You can also use lactose-reduced products or take an over the counter lactase enzyme product.
I Heard About Some Diet Called FODMAPs. What is that?
Recently, there has been a lot of interest in the low FODMAP diet for the management of IBS, which may be very effective for many patients with IBS. We'll take a look into that in our next blog post later this week...