Irritable bowel syndrome
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Irritable bowel syndrome (IBS) is a disorder that leads to pain in abdomen and bowel changes.
IBS is not the same as inflammatory bowel disease (IBD).
Video: Irritable bowel syndrome
IBS Myths and Facts
A common sign of IBS is frequent:
The correct answer is all of the above. IBS symptoms vary from person to person and can range from mild to severe. Talk to your doctor if you have had IBS symptoms on 3 or more days a month for the past 3 months.
Irritable bowel syndrome (IBS) is the same as inflammatory bowel disease (IBD).
The correct answer is myth. IBD includes Crohn's disease and ulcerative colitis, conditions that damage the lining of the digestive tract. IBS causes belly pain and abnormal bowel movements but does not harm the intestines.
IBS is a common disorder.
The correct answer is fact. About 1 in 6 people in the U.S. have symptoms of IBS. It is the most common intestinal problem that brings patients to a bowel specialist (gastroenterologist).
Everyone with IBS has diarrhea.
The correct answer is myth. Some people with IBS have frequent diarrhea, while others tend to have hard stools and be constipated. It's also common to switch between diarrhea and constipation. Bowel problems may get worse for a few weeks and then clear up for awhile. Discuss any changes in your bowel movements with your doctor.
Doctors need to run a lot of tests to diagnose IBS.
The correct answer is myth. There is no test to diagnose IBS, although tests may be done to rule out other problems. Most of the time, your doctor can diagnose IBS based on your symptoms, with few or no tests.
Stress plays a role in triggering IBS symptoms.
The correct answer is fact. Signals go back and forth between the bowel and brain. These signals affect bowel movements. Stress may cause the intestines to be more sensitive and to squeeze more often. Finding ways to relieve stress can help keep symptoms at bay.
There is a special IBS diet that relieves symptoms for most people.
The correct answer is myth. Dietary changes can be helpful. However, no specific diet works for everyone with IBS. This is because the symptoms differ from one person to another. Keeping a food diary can help you figure out which foods make your symptoms worse.
Which foods or drinks are most likely to cause IBS symptoms?
The correct answer is any of the above. These are common triggers, although not everyone with IBS will react to all of these foods. Avoiding caffeine is a good idea for most people with IBS. Caffeine can make the intestines more active.
What type of medicines can treat IBS?
The correct answer is all of the above. Your doctor will recommend medicines based on your symptoms. Always follow your doctor’s instructions when using medicines for IBS. You should not take a different amount or take the medicine more or less often. Doing so can lead to further problems. Low doses of tricyclic antidepressants can help relieve pain and discomfort even if you are not depressed.
It's normal to lose a lot of weight when IBS flares up.
The correct answer is myth. Unexpected weight loss of more than 5 to 10 pounds could be a sign of a more serious problem. Contact your doctor right away if you have weight loss when you are not trying, bloody stools, fever, or severe pain.
IBS; Irritable bowel; Spastic colon; Irritable colon; Mucous colitis; Spastic colitis; Abdominal pain - IBS; Diarrhea - IBS; Constipation – IBS; IBS-C; IBS-D
The reasons why IBS develops are not clear. It can occur after a bacterial infection or a parasitic infection (giardiasis) of the intestines. This is called postinfectious IBS. There may also be other triggers, including stress.
The intestine is connected to the brain using hormone and nerve signals that go back and forth between the bowel and the brain. These signals affect bowel function and symptoms. The nerves can become more active during stress. This can cause the intestines to be more sensitive and contract more.
IBS can occur at any age. Often, it begins in the teen years or early adulthood. It is twice as common in women as in men.
It is less likely to begin in older people above 50 years of age.
About 10% to 15% of people in the United States have symptoms of IBS. It is the most common intestinal problem that causes people to be referred to a bowel specialist (gastroenterologist).
IBS symptoms vary from person to person, and range from mild to severe. Most people have mild symptoms. You are said to have IBS when symptoms are present for at least 3 days a month for a period of 3 months or more.
The main symptoms include:
- Abdominal pain
- Change in bowel habits. Can have either diarrhea (IBS-D), or constipation (IBS-C).
Pain and other symptoms will often be reduced or go away after a bowel movement. Symptoms may flare up when there is a change in the frequency of your bowel movements.
People with IBS may go back and forth between having constipation and diarrhea or have or mostly have one or the other.
- If you have IBS with diarrhea, you will have frequent, loose, watery stools. You may have an urgent need to have a bowel movement, which may be hard to control.
- If you have IBS with constipation, you will have a hard time passing stool, as well as fewer bowel movements. You may need to strain with a bowel movement and have cramps. Often, only a small amount or no stool at all will pass.
The symptoms may get worse for a few weeks or a month, and then decrease for a while. In other cases, symptoms are present most of the time.
You may also lose your appetite if you have IBS. However, blood in stools and unintentional weight loss are not a part of IBS.
Exams and Tests
There is no test to diagnose IBS. Most of the time, your health care provider can diagnose IBS based on your symptoms. Eating a lactose-free diet for 2 weeks may help the provider identify lactase deficiency (or lactose intolerance).
The following tests may be done to rule out other problems:
- Blood tests to see if you have celiac disease or a low blood count (anemia)
- Stool exam for occult blood
- Stool cultures to check for an infection
- Microscopic exam of a stool sample for parasites
- Stool exam for a substance called fecal calprotectin
Your provider may recommend a colonoscopy. During this test, a flexible tube is inserted through the anus to examine the colon. You may need this test if:
- Symptoms began later in life (over age 50)
- You have symptoms such as weight loss or bloody stools
- You have abnormal blood tests (such as a low blood count)
Other disorders that can cause similar symptoms include:
- Celiac disease
- Colon cancer (cancer rarely causes typical IBS symptoms, unless symptoms such as weight loss, blood in the stools, or abnormal blood tests are also present)
- Crohn disease or ulcerative colitis
The goal of treatment is to relieve symptoms.
In some cases of IBS, lifestyle changes can help. For example, regular exercise and improved sleep habits may reduce anxiety and help relieve bowel symptoms.
Dietary changes can be helpful. However, no specific diet can be recommended for IBS because the condition differs from one person to another.
The following changes may help:
- Avoiding foods and drinks that stimulate the intestines (such as caffeine, tea, or colas)
- Eating smaller meals
- Increasing fiber in the diet (this may improve constipation or diarrhea, but make bloating worse)
Talk with your provider before taking over-the-counter medicines.
No one medicine works for everyone. Some that your provider may suggest include:
- Anticholinergic medicines (dicyclomine, propantheline, belladonna, and hyoscyamine) taken about a half-hour before eating to control intestinal muscle spasms
- Loperamide to treat IBS-D
- Alosetron (Lotronex) for IBS-D
- Eluxadoline (Viberzi) for IBS-D
- Low doses of tricyclic antidepressants to help relieve intestinal pain
- Lubiprostone (amitiza) for IBS-C
- Bisacodyl to treat IBS-C
- Rifaximin, an antibiotic
- Linaclotide (Linzess) for IBS-C
Psychological therapy or medicines for anxiety or depression may help with the problem.
IBS may be a life-long condition. For some people, symptoms are disabling and interfere with work, travel, and social activities.
Symptoms often get better with treatment.
IBS does not cause permanent harm to the intestines. Also, it does not lead to a serious disease, such as cancer.
When to Contact a Medical Professional
Call your provider if you have symptoms of IBS or if you notice changes in your bowel habits that do not go away.
Aronson JK. Laxatives. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Philadelphia, PA: Elsevier; 2016:488-494.
Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol. 2014;6:71-80. PMID: 24523597 www.ncbi.nlm.nih.gov/pubmed/24523597.
Ferri FF. Irritable bowel syndrome. In: Ferri FF, ed. Ferri's Clinical Advisor 2019. Philadelphia, PA: Elsevier; 2019:798-801.
Ford AC, Talley NJ. Irritable bowel syndrome. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 122.
Mayer EA. Functional gastrointestinal disorders: irritable bowel syndrome, dyspepsia, chest pain of presumed esophageal origin, and heartburn. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 137.
Wolfe MM. Common clinical manifestations of gastrointestinal disease. In: Benjamin IJ, Griggs RC, Wing EJ, Fitz JG, eds. Andreoli and Carpenter's Cecil Essentials of Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 33.