Q: What is Irritable bowel syndrome?
A: Irritable bowel syndrome (IBS) is a disorder that can cause abdominal discomfort or pain along with a range of symptoms, including diarrhea, constipation, or alternating episodes of both. Other symptoms may also be present, such as bloating. IBS is fairly common, with varying degrees of severity from person to person.
Q: What causes IBS?
A: While IBS isn't fully understood and causes can vary from person to person, it is now believed that IBS is the result of altered movement patterns of the intestines, and altered/heightened sensitivity of the intestines for presence of gas. The same amount of bloating/gas that doesn't bother a person without IBS could have a major effect on a person with IBS.
Another theory that is gaining in popularity, and I particularly believe in, is that it develops after some people have some type of acute gastroenteritis event, such as a stomach bug (viral or bacterial infections, such as food poisoning, salmonella, noroviruses, etc.). Following these infections, even though the virus or bacteria has been cleared from the body, changes can take place in the intestines that could result in altered movement and sensitivity patterns, resulting in IBS. Sometimes these symptoms can resolve in a few days to weeks, but in a few individuals, symptoms could last months or years. Not everyone who gets a "stomach bug" will develop IBS, but it does seem to be more common after a severe infection.
Q: Who is most commonly affected by IBS?
A: IBS is most common in women, and is most common in women under 50. However, men or women at any age can be diagnosed. It does occur in children, but is far more common in adults.
Q: How is IBS diagnosed and treated?
A: IBS diagnosis is based upon medical history and symptoms. It has traditionally been a condition that's diagnosed through exclusion, meaning that other problems are ruled out first. Most of the time people have symptoms that could indicate other disorders, so often a scope test of the colon and possibly stomach is appropriate. National and international experts state that the diagnosis can be made without extensive testing, and can often be based simply upon the symptoms and how long they've been present.
IBS doesn't have any specific medications for the condition itself, but instead, physicians try to manage the symptoms of IBS through medications based upon that person's individual symptoms.
People may need laxatives to assist with constipation; those with diarrhea may need anti-diarrheal medications. Of people who have intermittent severe pain, a small minority may get relief with anti-spasm medications. Some people who have constant pain that interferes with their life may actually get some relief from certain low dose antidepressant medications. Even though they're antidepressants, they're not being used for the purpose of depression, but the idea is that they alter some pain perception to improve the quality of life.
Q: Can changing my diet help control IBS?
A: When I work with an IBS patient, there are some recommendations I often make. If their symptoms are mainly diarrhea and bloating, certain foods may make the situation worse. Foods to consider limiting include beans, onions, celery, carrots, Brussels sprouts, milk and milk products. Some people have more trouble with certain foods than others.
If someone has symptoms of constipation, I usually recommend a fiber supplement and eat more foods with fiber, such as fruits, vegetables and whole grains. It can be a difficult balance to get the right amount of fiber in the diet that doesn't cause constipation (from too little) or bloating and gas (from too much).
Keeping a food diary can help in figuring out individual "trigger foods." You may start to notice a pattern of IBS symptoms related to certain foods. A food diary is actually one of my primary recommendations to patients.
There are a variety of diets being recommended by different practitioners. Something that has gained popularity is the "FODMAP diet." Basically, this diet includes a list of carbohydrates to limit. These foods are poorly absorbed and can result in increased gas/bloating and possibly diarrhea.