IBS: Here’s What’s Behind the Gut-Churning Grip of Irritable Bowel Syndrome

The symptoms that make up irritable bowel syndrome (IBS) do not constitute a disease—but that doesn’t mean you’re not sick.

ibs

IBS, or irritable bowel syndrome, affects somewhere between 25 million and 45 million Americans.

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Those who suffer from IBS, a.k.a. irritable bowel syndrome, may find their guts churning just a little more when they find out that IBS is not actually considered a disease. In order to be a disease, a condition needs an established cause, common physical changes due to the disorder, and consistent symptoms. Just the fact that IBS can cause one person to experience horrible diarrhea and another to experience constipation is enough to disqualify it as a disease. Plus, IBS actually does little to no bodily harm.

Its status as a syndrome rather than a disease isn’t stopping researchers from looking at IBS. Studies that attempt to gain a greater understanding of IBS are everywhere. That may be due to the fact that 25 to 45 million people in the United States suffer from IBS, according to the International Foundation for Functional Gastrointestinal Disorders (IFFGD).

Most who suffer from IBS are female (two out of three people), and the disorder mostly hits people under the age of 50. Usually, IBS is first experienced by the time the person turns 20.

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Alphabet Soup: IBS Is Not IBD

The Centers for Disease Control (CDC) cautions us that IBS is not IBD, which is inflammatory bowel disease. The organization further explains that IBD is—as its name tells us—an inflammatory disease while IBS is not: “IBD should not be confused with irritable bowel syndrome or IBS. Although people with IBS may experience some similar symptoms to IBD, IBD and IBS are very different. Irritable bowel syndrome is not caused by inflammation, and the tissues of the bowel are not damaged the way they are in IBD. Treatment is also different.”

That doesn’t make IBS any less of a problem. “When someone who doesn’t have IBS gets a gastrointestinal infection, it can be quite disabling and routine daily activities often slow down or stop,’’ said Douglas A. Drossman, MD, Drossman Gastroenterology, Chapel Hill, N.C. “Try thinking about that happening every day or several times a week; that’s what IBS is—a condition that affects your life on a daily basis.”

The IFFGD believes IBS may be due partially to abnormalities in gut motility, sensation, and secretion, activities that are regulated by the brain. “Altered gut immune activation, intestinal permeability, and altered gut bacteria have also been identified in some IBS patients,” explains the IFFGD. In June 2017, researchers at the University of Adelaide linked IBS to exhaustion of the immune system.

The good news is that IBS is not linked to cancer nor does IBS cause permanent damage to the intestines or cause intestinal bleeding—but you still feel dreadful.

IBS Symptoms and Triggers

The colon of someone with IBS is more sensitive than normal. It reacts—actually overreacts!—to stimuli by moving contents too quickly through the colon (diarrhea) or too slowly (constipation).

Typical symptoms of IBS are:

  • Bloating
  • Cramps and abdominal pain
  • Diarrhea and/or constipation
  • Feeling of incomplete evacuation
  • Gas
  • Passage of mucus
  • Straining
  • Urgency

For anyone with a sensitive GI tract, IBS is a nightmare. Even if you can handle the pain, the impact on your life is significant because of the bloating and disruption of your bowel habits.

There is no confirmed exact cause of IBS, although emotional stress is sometimes blamed. Stress does worsen the symptoms, and women can experience worse symptoms during menstrual periods, which may indicate a hormone trigger.

Medical professionals have noted that these foods and beverages can cause IBS symptoms:

  • Alcohol
  • Barley
  • Caffeine
  • Carbohydrates
  • Chocolate
  • Dairy
  • Fat
  • Insoluble fiber in wheat and bran
  • Large meals
  • Rye
  • Sorbitol and other sugar alcohols
  • Wheat
FYI

RED-FLAG SYMPTOMS THAT MAY ACCOMPANY IBS

The International Foundation for Functional Gastrointestinal Disorders (IFFGD) lists these “red flag” signs that call for special attention:

  • Anemia and other abnormal blood tests
  • Blood in the stools
  • Change in the individual’s typical IBS symptoms (like new and different pain)
  • Family history of other GI diseases, like cancer, inflammatory bowel disease, or celiac disease
  • Fever
  • New symptom onset at age of 50 or older
  • Nighttime symptoms that awaken the person
  • Recent use of antibiotics
  • Unintentional weight loss

IBS Treatment from Your Doctor

The IFFGD says that 20 to 40 percent of visits to the gastroenterologist are due to IBS. Sadly, though, a doctor can really only confirm the diagnosis and treat the symptoms. There is no reliable cure.

That said, many people control IBS with diet and lifestyle changes. Others need medications, although they don’t always work. FDA-approved drugs for IBS include: alosetron (Lotronex), rifaximin (Xifaxan), and eluxadoline (Viberzi).

Your doctor may try anti-diarrheal agents, laxatives, and/or antispasmodics (to reduce bowel spasms and pain). Antidepressants may also relieve pain. Relaxation techniques, biofeedback, or cognitive behavior therapy can ease IBS symptoms.

Diet’s a Strong Factor

A September 2017 study at Yale University found that IBS patients who used individualized diets based on food-sensitivity blood tests experienced fewer symptoms. The Yale team conducted a double-blind, randomized clinical trial of 58 patients with IBS. The research team found that the individuals on diets consistent with blood-test-noted food insensitivities fared better overall and in terms of symptom severity.

“We didn’t expect results like this,” said Ather Ali, first author and assistant professor of pediatrics and of medicine at Yale School of Medicine. “The people who consumed the diet consistent with the test did significantly better than people on the sham diet.”

For further reading, see these University Health News posts:

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