Irritable Bowel Syndrome

What is Irritable Bowel Syndrome (IBS)?
Irritable Bowel Syndrome, previously called “Spastic Colon”, is a term that encompasses a variety of abnormal digestive issues mainly including abdominal pain followed by some form of diarrhea, constipation, or a mixture of both.

Irritable bowel syndrome is a functional gastrointestinal disorder, meaning that symptoms are caused by changes in how the gastrointestinal (GI) tract works. Though you may suffer from symptoms often, your intestine is actually not damaged.

There are 3 types of IBS categories that patients fall into:
    IBS-C – The “C” stands for constipation
    A patient will be classified with IBS-C if they suffer from hard, infrequent stools at least 25% of the time.

    IBS-D – The “D” stands for diarrhea
    A patient is classified with IBS-D if they suffer from loose, watery stools at least 25% of the time.

    IBS-M (or IBS-A) - The “M” stands for mixed and “A” stands for alternating
    Those with IBS-M suffer from a mixture of both constipation and diarrhea alternating at least 25% of the time.
Who is affected by IBS and how common is it?
Studies have shown that IBS affects roughly 3 to 20 percent of adults. However, only 5 to 7 percent of the adult population has actually been diagnosed with the condition. IBS is more common in women than men by twice the amount and is seen more frequently in younger aged people.

What are the symptoms of IBS?
Symptoms of IBS coincide with the category you fall under, but typically patients must have two of the following symptoms in order to be diagnosed with IBS:
  • Relief of symptoms after having a bowel movement.
  • Onset of symptoms coincide with a change in bowel patterns – too often or not as often as usual.
  • Onset of symptoms coincide with a change in bowels - stool that is loose and watery, or harder and lumpy.
Other symptoms of IBS may include:
  • The feeling of having an incomplete bowel movement.
  • Diarrhea and/or constipation
  • Mucous in your stool—a clear liquid made by the intestines that coats and protects tissues in the GI tract.
  • Abdominal bloating
Symptoms may often occur after eating a meal and, to meet the definition of IBS, symptoms must occur at least three times a month.

What causes IBS?
IBS is a disorder that has puzzled many experts, but many have agreed the problem arises from a combination of factors including your physical and mental health.

Small Intestinal Bacterial Overgrowth (SIBO)
This occurs when the small intestine is essentially overloaded with too much bacteria. This extra bacteria will cause you to have gas, diarrhea, and pain. It’s not a direct link to IBS, but many researchers believe SIBO has the possibility of leading to IBS.

GI Tract Motility
Patients with IBS may not have the same GI tract motility as normal individuals. When the bowel movements are slow, then the patient will most likely suffer from constipation. On the other hand when it’s too fast, then the individual will suffer from diarrhea complications. Many people with IBS will experience intestinal hyperactivity, which is when the bowel movements directly respond to stress levels and behavior.

Brain Signal Problems
Your stomach and brain are connected. Sometimes, the signals that are sent from the brain to your gut become mixed up. When this happens, you will see changes in your bowel habits. Psychological problems such as anxiety, panic disorder, depression, or post-traumatic stress disorder (PTSD) have been associated with development or expression of IBS.

Bacterial Gastroenteritis
Patients who have suffered from infection or irritation of the intestines caused by bacteria may develop abnormalities in their digestive system, leading to IBS.

Some studies have shown that IBS is more common in families with members who suffer from digestive disorders.

Sensitivity to Foods
Certain people will exhibit symptoms of IBS based on certain foods they eat such as spicy foods, fatty or greasy foods, caffeine, alcohol, or others. It’s important to figure out what foods trigger your symptoms so that you can limit or eliminate those foods altogether.

Anyone can become affected by IBS. The good news is that IBS is not classified as a serious disease/illness. While those who suffer may believe their digestive system is being damaged in some way, it actually is not.

How is IBS diagnosed?
IBS is normally diagnosed when other serious problems have been ruled out through testing. Dr. Khorrami will ask you many questions regarding your medical history including any family history of digestive disorders, infections, your current medications, and any high stress events that have happened in your life. Additional diagnostic tests may include:
    Blood tests
    commonly performed to measure many variables in diagnosing IBS or other disorders.

    Stool tests
    These are commonly done to rule out other causes of GI diseases, such as infection. Stool tests can also show if there is bleeding in the intestines.

    Lower GI series
    A lower GI series may be performed to look at your large intestine. A laxative or enema may be used before the test. A laxative is medication that loosens stool and increases bowel movements. An enema involves flushing water, a laxative, or sometimes a mild soap solution into the anus using a special squirt bottle.

    Sigmoidoscopy or Colonoscopy
    These tests are used to rule out other conditions such as Crohn’s disease and colitis, and to determine how much of your digestive tract is affected, if any. Colonoscopy is the most commonly used test to specifically diagnose Crohn’s disease and colitis. Colonoscopy is used to view the ileum, rectum, and the entire colon, while sigmoidoscopy is used to view just the lower colon and rectum. Colonoscopy is recommended for people who are older than age 50 to screen for colon cancer.

    A procedure that involves taking a small tissue sample of intestinal lining for examination with a microscope. The process is painless and you will not feel the biopsy.
How is IBS treated?
There is no cure for IBS but the symptoms can be treated with a combination of:
  • Dietary and lifestyle changes
  • Medications
  • Probiotics
  • Mental health therapy
The most important thing an IBS patient can do is find his or her “triggers” or symptoms that can spark an episode. Typically changes to diet, medications, probiotics, and mental health therapies can go a long way in limiting IBS symptoms.

Medications include antibiotics to kill off bacteria, especially in cases where Dr. Khorrami believes that you may have SIBO. If you suffer from constipation, then a laxative will be prescribed. Anti-diarrheal medication is prescribed if you suffer from diarrhea. Antidepressants may help you if you suffer from anxiety or depression. There are also new medications that have been formulated and FDA approved specifically for the treatment of constipation predominant IBS.

Probiotics have been studied quite a bit nowadays and may support improvement of IBS symptoms. You have two types of bacteria in your gut: bad bacteria and good bacteria. Probiotics are the good bacteria. It’s optimal for you to have a healthy balance of gut bacteria.

Mental health therapies include cognitive behavioral therapy, psychodynamic therapy, hypnotherapy to relax your body, and mindfulness training to help with managment of stress and anxiety.

Eating, Diet, and Nutrition
It is recommended that those with IBS eat smaller meals throughout the day, as large meals have been associated with cramping and diarrhea. Foods that are low in fat and high in carbohydrates may help your symptoms. Examples include rice, pasta, whole-grain breads, fruits, and vegetables. You may want to limit certain foods and drinks that have been known to cause, or “trigger”, symptoms:
  • Foods that are high in fat
  • Milk products
  • Alcohol or caffeine
  • Artificial sweeteners
  • Beans, cabbage, and other foods that may cause gas
It is recommended that you keep a running food diary to find out which foods need to be excluded or reduced and which are acceptable.

If you suffer from constipation, then dietary fiber may provide relief from IBS symptoms. Fiber softens stool allowing it to move smoothly through your colon. Adults are advised to consume 21 to 38 grams of fiber a day. However, fiber may not be the ideal treatment for everyone since it sometimes cause gas and triggers symptoms in some people with IBS.

What other conditions are associated with IBS?
It is common for people to experience other conditions with IBS. Conditions such as gastroesophageal reflux disease (GERD) and dyspepsia are more common in people with IBS than the general population. GERD is a condition in which stomach contents flow back up into the esophagus. Dyspepsia, also known as indigestion, is upper abdominal discomfort that usually occurs after eating. Symptoms of dyspepsia include a feeling of fullness, bloating, and nausea.

Other conditions sometimes found in people with IBS include:
  • Chronic fatigue syndrome—a disorder that causes extreme fatigue, which is tiredness that lasts a long time.
  • Chronic pelvic pain
  • Temporomandibular joint disorders—problems or symptoms of the chewing muscles and joints that connect the lower jaw to the skull.
  • Depression
  • Anxiety
  • Somatoform disorders—chronic pain or other symptoms with no physical cause that are thought to be due to psychological problems.
Keeping in Touch with a Gastroenterologist
Dr. Khorrami will work with you to discover exactly what is causing your IBS symptoms and then gradually work towards a solution. He’s an experienced gastroenterologist who has been in practice for over 15 years having seen many cases of patients with IBS. Get in touch with him today to see what actions you need to take.

Source contains material from the National Digestive Diseases Information Clearinghouse (NDDIC).


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About Dr. Khorrami

Dr. Payman Khorrami is a UCLA graduate, has been in practice since 1996, and is double board certified. Undergraduate Education at University of California, Berkeley, Medical School at University of California, San Francisco, Internal Medicine Training at University of California, San Diego Read Full Bio