Researchers don’t know exactly what causes IBS, but the symptoms indicate that in most cases it comes from problems with how the gut and brain coordinate actions to help the digestive system work. Treatments of IBS must be personalized by a healthcare provider as well as a dietician.
Communication challenges between brain and gut can cause:
- Dysmotility, which is when a person has problems with how muscles in the gut contract and move food through the gastrointestinal (GI) tract. The colon (large intestine) muscle tends to contract more in people with IBS. These contractions cause cramps and pain.
- People with visceral hypersensitivity may have extra-sensitive nerves in the GI tract. People with IBS tend to have a lower pain tolerance than people without it. The digestive tract may be super sensitive to abdominal pain or discomfort.
Other potential causes of IBS include:
- Gut bacteria. Research has shown that people with IBS may have altered bacteria in their GI tract, contributing to symptoms. Studies have shown that the types and amounts of gut bacteria are different in people with IBS than in people without it.
- Severe infections. Some people get diagnosed with IBS after a severe infection affecting their GI tract, suggesting germs may play a role.
- Food intolerance. Sensitivities or allergies to certain foods may contribute to IBS.
- Childhood stress. IBS is more common in people who experienced severe stressors in childhood, including physical, sexual and emotional abuse.
IBS triggers
If a person has IBS, some of the first signs they may have noticed are that certain things or events can trigger symptoms. A trigger doesn’t cause the condition itself, but it can cause or worsen a symptom flare-up. Common triggers include:
- Menstrual periods. Women may notice symptoms worsen predictability according to the menstrual cycle.
- Specific foods. Food triggers vary from person to person. They can differ from person to person, but some common culprits that can trigger an IBS symptom flare-up, such as lactose-rich (dairy) products, foods that contain gluten (like wheat) and foods/drinks that make gas (beer, carbonated soft drinks).
- Stress. Some research suggests that IBS is the gut’s response to stress. Related, this is why IBS is sometimes called “nervous stomach” or “anxious stomach.”
Risk factors for IBS
IBS most often occurs in people in their late teens to early 40s. Women are up to twice as likely to get diagnosed with IBS. Other risk factors include:
- Intolerance to certain foods.
- Severe digestive tract infection.
- History of substance abuse (drugs, alcohol, smoking).
- Diagnosis of anxiety, depression or post-traumatic stress disorder (PTSD).
Many people with IBS can also have other chronic pain conditions. Conditions associated with an increased risk of IBS include:
- Fibromyalgia.
- Chronic fatigue syndrome.
- Chronic pelvic pain.
How is IBS diagnosed?
The first step in diagnosing IBS is a detailed medical history. A healthcare provider will ask about the symptoms. They may ask:
- Is there pain related to bowel movements?
- Has there been a change in how often you have a bowel movement?
- Has there been a change in how the poop looks?
- How often do the symptoms occur?
- When did the symptoms start?
- What medicines are currently being taken?
- Has there been a bout of illness or a stressful event in daily life recently?
Testing for IBS
Depending on the symptoms, a person may need other tests to confirm a diagnosis. There isn’t a single test to diagnose IBS. Instead, a healthcare provider will determine if the person has IBS by:
- Ordering colon cancer screening
- Checking that there aren’t symptoms suggesting other disorders.
- Performing a range of lab tests.
- Most lab tests exclude other conditions that may be causing the symptoms, like an infection, food intolerance or a different digestive condition, like inflammatory bowel disease (IBD), which can often have similar symptoms.
- Blood tests to check for a digestive disease condition or another condition that may cause the symptoms.
- A stool test to check for an infection or signs of inflammation in the bowel caused by a digestive condition.
- A hydrogen breath test to see if there’s an overgrowth of bacteria in the gut (SIBO) or a food intolerance.
Imaging tests
A healthcare provider may need to order imaging procedures to rule out conditions involving inflammation or abnormal growths in the GI tract.
- A colonoscopy can help the healthcare provider determine if you have certain bowel disorders that may be causing the symptoms, including polyps, IBD and cancerous growths. For this procedure, a healthcare provider inserts a scope that allows them to view the entire colon.
- Flexible sigmoidoscopy is similar to a colonoscopy, except a healthcare provider inserts a scope that allows them to view the lining of the rectum and the lower part of the colon only.
- Upper endoscopy can help the doctor diagnose celiac disease or other GI conditions. This procedure uses a scope that allows the doctor to see inside the esophagus (food tube), stomach and the first part of the small intestine (duodenum).
Management and treatment of IBS
There are no specific therapies that work for everyone, but most people with IBS can find a treatment plan that works for them. Typical treatment options include changing the foods they eat and daily routines. Medications along with behavioral health therapy may help. Many of these treatments take time to work. They can help the symptoms, but they may not go away completely.
Dietary changes
A dietitian can help choose foods and modify eating/drinking habits to avoid symptom flare-ups. They may recommend that the patient:
- Increase fiber in the diet. Fiber-rich foods, including fruits, vegetables, grains, prunes and nuts, can help if a person is struggling with constipation. Introducing fiber slowly into the diet gives the gut time to adjust.
- Add supplemental fiber to the diet, like Metamucil or Citrucel.
- Limit dairy products, like cheese and milk. Lactose intolerance is more common in people with IBS. If you cut back on dairy, make sure to eat nondairy foods rich in calcium, like broccoli, spinach or salmon.
- Limit foods that can increase gas in the colon. Foods like beans, brussels sprouts and cabbage are notorious for causing gas, but carbonated sodas and even chewing gum can also make a person gassy. Reduce these foods to go easier on the gut.
- Avoid gluten. People with IBS, even those without celiac disease, tend to be more sensitive to gluten. If the option for a gluten-free diet is taken, work with a healthcare provider to ensure that you’re getting enough of the key vitamins and minerals (like fiber, iron and calcium) often missing from foods without gluten.
- Try the low FODMAP diet. This food plan reduces the amount of hard-to-digest carbohydrates you eat. It recommends alternatives that allow the patient to get the nutrients needed while going easier on the GI tract.
- Drink plenty of water. The target is to drink around eight glasses of water a day. Water keeps the GI tract lubricated and can help treat or prevent constipation.
- Keep a food diary. The doctor may recommend that you to keep note of the foods that are eaten, and times/quantity to determine which foods trigger IBS flare-ups and then bring this to the attention of a nutritionist.
Activity changes
Changing daily activities can help, too. A doctor may recommend that you:
- Exercise regularly. Aim for 150 minutes of moderate exercise weekly. This is about 30 minutes a day, five days a week. “Moderate” means raising the heart rate to around 150% of the resting rate.
- Try relaxation techniques. Daily yoga, meditation and other de-stressing techniques can help calm an overtaxed nervous system and a “nervous gut.” Sometimes, a behavioral therapist can help.
- Get enough sleep. Aim for seven to nine hours of quality sleep each night. Go to bed at the same time each night. A good night’s rest is one of the most powerful de-stressors available. Reach out to a doctor if you’re having trouble sleeping.
- Keep an activity diary. Record the activities that help you manage IBS and compare notes with a provider.
Psychological therapy
Many people with IBS benefit from seeing a therapist. Therapy can help a person get a handle on stress and conditions such as anxiety and depression that contribute to IBS. Some people find relief through:
- Cognitive behavioral therapy (CBT).
- Hypnotherapy.
- Biofeedback.
Medications
A healthcare provider may prescribe medications to provide symptom relief, including:
- Antidepressants, when a person has feelings of depression and anxiety along with significant abdominal pain). Medications including tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) like Trintellix are the standard treatment in most cases.
- Medications to ease constipation (including fiber supplements and prescribed laxatives such as Laxin Forte).
- Medications to firm stools (anti-diarrheals).
- Medications to help with intestinal spasms.
Although research into their effectiveness is ongoing, a doctor may recommend probiotics. These “good bacteria” may help relieve IBS symptoms.
Medications specifically used to treat IBS include:
- Bentyl – anticholinergic and antispasmodic medication
- Linzess – to treat chronic idiopathic constipation
- Trulance
- Xifaxan – for the the treatment of digestive system infections caused by bacteria (SIBO)
Is there a cure for IBS?
There is no cure for IBS. Most people try to limit the symptoms by avoiding triggers and taking medications when necessary.
Take-away knowledge about IBS from IsraelPharm
IBS symptoms, like stomach pain, diarrhea, constipation and gas, are uncomfortable and can interfere with daily life. But IBS is manageable. A person can improve symptoms by changing what they eat and adjusting daily habits to better handle triggers. If there are stomach symptoms that don’t clear up, talk to a healthcare provider. Together, you can find an IBS treatment plan that works for you.
Frequently asked questions about IBS
Does having IBS increase my risk of developing serious gastrointestinal problems?
No, IBS doesn’t put you at higher risk of developing conditions such as colitis, Crohn’s disease or colon cancer.
What changes should I expect if I have IBS?
Living with IBS can be challenging because symptoms come and persist throughout life. Treatment often involves trial and error. But the good news is that nearly everyone with IBS can find a treatment that helps them over time.
Usually, changing diet and activity levels improve symptoms with time. A person may need some patience to figure out the triggers and the proper steps to take to avoid them. The symptoms may not completely disappear. But, after a few weeks or months, a person can notice a significant improvement in how they feel.
Can I prevent IBS?
Since there’s no known cause for IBS, you can’t prevent or avoid it. If you have IBS, you can keep symptoms from flaring up by avoiding triggers.
When should a person consult with a healthcare provider?
Anyone feeling frequent and recurring symptoms of stomach discomfort should see a healthcare provider if the symptoms continue for more than three months or if they’re getting worse. If the symptoms occur less frequently, but they interfere with daily life, it’s still a good idea to talk to a primary care provider.
Some symptoms may indicate a more serious problem. Contact a doctor as soon as possible if there are some common IBS symptoms alongside:
- Fever.
- Vomiting.
- Rectal bleeding.
- Unexplained weight loss.
- Diarrhea is so severe it wakes you up at night.
- Severe abdominal pain, especially that doesn’t improve when there’s a proper bowel movement or pass gas.
