Irritable Bowel Syndrome (IBS) Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention, Home Remedies, Diet

Irritable Bowel Syndrome (IBS) Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention, Home Remedies, Diet


What Is Irritable Bowel Syndrome?


Irritable bowel syndrome (IBS) is a digestive disorder that many people have, but few people talk about. It is estimated that IBS affects up to 15% of the population with its symptoms of chronic abdominal pain and major disturbance of bowel functioning. IBS can entail bouts of urgent diarrhea, episodes of chronic constipation, or a pattern of alternating between the two. IBS is considered a functional disorder, in that it involves a malfunction in how the intestinal system works, but doesn’t show up in any visible disease process or tissue damage. If you have IBS, you know first hand how intense the disorder can be and how it can cause significant disruption in the ability to attend to the tasks of daily life.

Irritable bowel syndrome has also been called spastic colon, functional bowel disease, and mucous colitis. However, IBS is not a true "colitis." The term colitis refers to a separate group of conditions known as inflammatory bowel disease (IBD).

Irritable bowel syndrome is not contagious, inherited, or cancerous. It is estimated that 20% of adults in the U.S. have symptoms of IBS. It occurs more often in women than in men, and the onset occurs before the age of 35 in about half of the cases.

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Irritable Bowel Syndrome Causes


The cause of irritable bowel syndrome is currently unknown. IBS is thought to result from an interplay of abnormal gastrointestinal (GI) tract movements, increased awareness of normal bodily functions, and a change in the nervous system communication between the brain and the GI tract. Abnormal movements of the colon, whether too fast or too slow, are seen in some, but not all, people who have IBS.

Irritable bowel syndrome has also developed after episodes of gastroenteritis.

IBS can occur at any age, but it often begins in the teen years or early adulthood. It is twice as common in women as in men.

About 1 in 6 people in the U.S. have symptoms of IBS. It is the most common intestinal problem that causes patients to be referred to a bowel specialist (gastroenterologist).

It has been suggested that IBS is caused by dietary allergies or food sensitivities, but this has never been proven.

Symptoms of irritable bowel syndrome may worsen during periods of stress or menses, but these factors are unlikely to be the cause that leads to the development of IBS.

Irritable Bowel Syndrome Symptoms


Symptoms range from mild to severe. Most people have mild symptoms. Symptoms are different from person to person.

For some people, the symptoms may get worse for a few weeks or a month, and then decrease for a while. For other people, symptoms are present most of the time.

People with IBS may also lose their appetite.

The hallmark of IBS is abdominal discomfort or pain. The following symptoms are also common: 

  • Abdominal cramping and pain that are relieved with bowel movements 
  • Alternating periods of diarrhea and constipation 
  • Change in the stool frequency or consistency 
  • Gassiness (flatulence) 
  • Passing mucus from the rectum 
  • Bloating 
  • Abdominal distension
The following are NOT symptoms or characteristics of IBS (but should still be brought to the attention of a physician since they may be signs and symptoms of other conditions):

  • Blood in stools or urine
  • Black or tarry stools
  • Vomiting (rare, though may occasionally accompany nausea) 
  • Pain or diarrhea that interrupts sleep 
  • Fever 

When to see a doctor 


It's important to see your doctor if you have a persistent change in bowel habits or if you have any other signs or symptoms of IBS. These may indicate a more serious condition, such as an infection or colon cancer.

Your doctor may be able to help you find ways to relieve symptoms as well as rule out other more-serious colon conditions, such as ulcerative colitis and Crohn's disease, which are forms of inflammatory bowel disease.

Risk factors of Irritable Bowel Syndrome (IBS)


Many people have occasional signs and symptoms of irritable bowel syndrome. However, you're more likely to have IBS if you:

  • Are young. IBS symptoms first appear before the age of 35 for about half of those with the disorder.
  • Are female. More women than men are diagnosed with this condition.
  • Have a family history of IBS. Studies have shown that people who have a first-degree relative — such as a parent or sibling — with IBS are at increased risk of the condition. It's not clear whether the influence of family history on IBS risk is related to genes, to shared factors in a family's environment, or both.

Tests and diagnosis of Irritable Bowel Syndrome (IBS)


A diagnosis of irritable bowel syndrome depends largely on a complete medical history and physical exam.

Criteria for making a diagnosis 


Because there are usually no physical signs to definitively diagnose irritable bowel syndrome, diagnosis is often a process of elimination. To help in this process, researchers have developed diagnostic criteria, known as Rome criteria, for IBS and other functional gastrointestinal disorders. These are conditions in which the bowel appears normal, but doesn't function normally. According to these criteria, you must have certain signs and symptoms before a doctor diagnoses irritable bowel syndrome.

The most important symptom is:

  • Abdominal pain and discomfort lasting at least 12 weeks, though the weeks don't have to occur consecutively
You also must have at least two of the following:

  • A change in the frequency or consistency of your stool — for example, you may change from having one normal, formed stool every day to three or more loose stools daily, or you may have only one hard stool every few days
  • Straining, urgency or a feeling that you can't empty your bowels completely
  • Mucus in your stool
  • Bloating or abdominal distension
Your doctor will likely assess how you fit these criteria, as well as whether you have any other signs or symptoms that might suggest another, more-serious condition. Some red flag signs and symptoms that might prompt your doctor to do additional testing include:

  • New onset after age 50
  • Weight loss
  • Rectal bleeding
  • Fever
  • Nausea or recurrent vomiting
  • Abdominal pain, especially if it's not completely relieved by a bowel movement
  • Diarrhea that is persistent or awakens you from sleep
If you have these red flag signs or symptoms, you'll need additional testing to further assess your condition.

If you fit the IBS criteria and don't have any red flag signs or symptoms, your doctor may suggest a course of treatment without doing additional testing. But if you don't respond to that treatment, you'll likely require more tests.

Additional tests 


Your doctor may recommend several tests, including stool studies to check for infection or malabsorption problems. Among the tests that you may undergo to rule out other causes for your symptoms are the following:

Flexible sigmoidoscopy.

This test examines the lower part of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope).

Colonoscopy.

In some cases, your doctor may perform this diagnostic test, in which a small, flexible tube is used to examine the entire length of the colon.

Computerized tomography (CT) scan.

CT scans produce cross-sectional X-ray images of internal organs. CT scans of your abdomen and pelvis may help your doctor rule out other causes of your symptoms.

Lactose intolerance tests. 

Lactase is an enzyme you need to digest the sugar (lactose) found in dairy products. If you don't produce this enzyme, you may have problems similar to those caused by irritable bowel syndrome, including abdominal pain, gas and diarrhea. To find out if this is the cause of your symptoms, your doctor may order a breath test or ask you to exclude milk and milk products from your diet for several weeks.

Blood tests. 

Celiac disease (nontropical sprue) is sensitivity to wheat protein that also may cause signs and symptoms like those of irritable bowel syndrome. Blood tests may help rule out that disorder.

Irritable Bowel Syndrome Treatment


The goal of treatment is to relieve symptoms.

Lifestyle changes can help in some cases of IBS. 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:
  • Avoid foods and drinks that stimulate the intestines (such as caffeine, tea, or colas)
  • Avoid large meals
  • Increase fiber in the diet (this may improve constipation but make bloating worse)
Talk with your doctor before taking over-the-counter medications.

No one medication will work for everyone. Medications your doctor might try include:

  • Anticholinergic medications (dicyclomine, propantheline, belladonna, and hyoscyamine) taken about a half-hour before eating to control intestinal muscle spasms
  • Bisacodyl to treat constipation
  • Loperamide to treat diarrhea
  • Low doses of tricyclic antidepressants to help relieve intestinal pain
  • Lubiprostone for constipation symptoms
  • Rifaximin, an antibiotic
Therapy may help in cases of severe anxiety or depression.

Prevention for Irritable Bowel Syndrome (IBS)


Anyone may experience digestive upset from worry or anxiety. But if you have irritable bowel syndrome, stress-related problems such as abdominal pain and diarrhea tend to occur with greater frequency and intensity. Finding ways to deal with stress may be helpful in preventing or alleviating symptoms:

Counseling


In some cases, a psychologist or psychiatrist may help you learn to reduce stress by looking at how you respond to events and then working with you to modify or change your response.

Biofeedback


This stress-reduction technique helps you reduce muscle tension and slow your heart rate with the feedback help of a machine. You're then taught how to produce these changes yourself. The goal is to help you enter a relaxed state so that you can cope more easily with stress.

Progressive relaxation exercises


These help you relax muscles in your body, one by one. Start by tightening the muscles in your feet, then concentrate on slowly letting all of the tension go. Next, tighten and relax your calves. Continue until the muscles in your body, including those in your face and scalp, are relaxed.

Deep breathing


 Most adults breathe from their chests. But you become calmer when you breathe from your diaphragm, the muscle that separates your chest from your abdomen. When you inhale, allow your belly to expand. When you exhale, your belly naturally contracts. Deep breathing can also help relax your abdominal muscles, which may lead to more-normal bowel activity.

Lifestyle and home remedies for Irritable Bowel Syndrome (IBS)


In many cases, simple changes in your diet and lifestyle can provide relief from irritable bowel syndrome. Although your body may not respond immediately to these changes, your goal is to find long-term, not temporary, solutions:

Incorporate fiber into your diet, if possible


When you have irritable bowel syndrome, dietary fiber can have mixed results. Although it helps reduce constipation, it can also make gas and cramping worse. The best approach is to gradually increase the amount of fiber in your diet over a period of weeks. Examples of foods that contain fiber are whole grains, fruits, vegetables and beans. If your signs and symptoms remain the same or worse, tell your doctor. You may also want to talk to a dietitian.

Some people do better limiting dietary fiber and instead take a fiber supplement that causes less gas and bloating. If you take a fiber supplement, such as Metamucil or Citrucel, be sure to introduce it gradually and drink plenty of water every day to minimize gas, bloating and constipation. If you find that taking fiber helps your IBS, use it on a regular basis for best results.

Avoid problem foods


If certain foods make your signs and symptoms worse, don't eat them. Common culprits include alcohol, chocolate, caffeinated beverages such as coffee and sodas, medications that contain caffeine, dairy products, and sugar-free sweeteners such as sorbitol or mannitol. If gas is a problem for you, foods that might make symptoms worse include beans, cabbage, cauliflower and broccoli. Fatty foods may also be a problem for some people. Chewing gum or drinking through a straw can both lead to swallowing air, causing more gas.

Eat smaller meals


If you have diarrhea, you may find that eating small, frequent meals makes you feel better.
Take care with dairy products. If you're lactose intolerant, try substituting yogurt for milk. Or use an enzyme product to help break down lactose. Consuming small amounts of milk products or combining them with other foods also may help. In some cases, though, you may need to eliminate dairy foods completely. If so, be sure to get enough protein and calcium from other sources. A dietitian can help you analyze what you're eating to make sure you're getting adequate nutrition.

Drink plenty of liquids


Try to drink plenty of fluids every day. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, and carbonated drinks can produce gas.

Exercise regularly


Exercise helps relieve depression and stress, stimulates normal contractions of your intestines and can help you feel better about yourself. If you've been inactive, start slowly and gradually increase the amount of time you exercise. If you have other medical problems, check with your doctor before starting an exercise program.

Use anti-diarrheal medications and laxatives with caution. 


If you try over-the-counter anti-diarrheal medications, such as Imodium or Kaopectate, use the lowest dose that helps. Imodium may be helpful if taken 20 to 30 minutes before eating, especially if the food planned for your meal is likely to cause diarrhea. In the long run, these medications can cause problems if you don't use them appropriately. The same is true of laxatives. If you have any questions about them, check with your doctor or pharmacist.

Irritable Bowel Syndrome Diet


Diet and lifestyle changes are important in decreasing the frequency and severity of IBS symptoms.

The first thing your doctor may suggest is to keep a food diary. This will help you figure out foods that trigger your symptoms.

1. Limit foods that contain ingredients that can stimulate the intestines and cause diarrhea, such as: 

  • Caffeine
  • Alcohol
  • Dairy products
  • Fatty foods
  • Foods high in sugar
  • Artificial sweeteners (sorbitol and xylitol)

2. Some vegetables (cauliflower, broccoli, cabbage, brussels sprouts) and legumes (beans) may worsen bloating and gassiness and should be avoided. 

3. Dietary fiber may lessen symptoms of constipation. 

4. Drink plenty of water, and avoid carbonated drinks such as soda, which may cause gas and discomfort. 

5. Eat smaller meals and eat slowly to help reduce cramping and diarrhea. 

6. Low fat, high carbohydrate meals such as pasta, rice, and whole-grain breads may help (unless you have celiac disease).

In addition to dietary changes, there are some healthy habits that may also help reduce IBS symptoms.

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Irritable Bowel Syndrome (IBS) Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention, Home Remedies, Diet