Irritable Bowel Syndrome: The Facts
By Kevin Hein PA-C
One of the most common conditions treated in a primary care office is irritable bowel syndrome. You may not be familiar with the name, but I suspect many, if not all of you have suffered from this condition’s classic symptoms at some point in your lives.
Symptoms
Abdominal pain
Cramping
Bloating
Gas
Altered bowel habits - diarrhea and/or constipation
While these symptoms can occur acutely in anyone, one of the hallmarks of irritable bowel syndrome (IBS) is that these symptoms become chronic and recurrent. Symptoms generally present themselves in early adulthood, though symptoms can develop in adolescence as well. It is twice as common in women and some estimates suggest that 10-20% of the population may suffer from this, though only a small portion of patients seeks medical care for their symptoms. IBS is often classified as either diarrhea-predominant or constipation-predominant.
Irritable Bowel Syndrome Causes
An established cause has not been identified, though there are several theories. The leading theory is that patients with IBS have increased sensitivity in the intestines to otherwise normal sensations due to overactive nerves in the intestines. This results in perceived pain with movement of fluids and gas through the intestines. Other theories include food intolerance/allergies, stress/anxiety, and sequelae from severe gastrointestinal infection.
Diagnosis
Making the diagnosis can be challenging. Your doctor may order blood tests and stool tests to rule out conditions like infectious diarrhea (like salmonella or E coli) or inflammatory bowel disease (Crohn’s disease or Ulcerative Colitis). If you are older in age, a colonoscopy may be recommended as well to evaluate for conditions like ischemic/infectious colitis and colorectal cancer. If all of these tests are negative, the diagnosis can be made comfortably.
Treatment
IBS can be challenging to manage, but several treatments are available. The first thing I have my patients do is to record all of their meals and subsequent symptoms. Many patients may find that certain foods or food groups exacerbate their symptoms. Eliminating foods that seem to cause more issues may be the only change a patient needs to make to keep their symptoms manageable. Addition of Fiber and/or over-the-counter constipation or anti-diarrheal medications is often helpful for symptoms as well, and are probably the most commonly used treatments.
When the above treatments are not successful, we will turn to prescription medications for symptom relief. Medications directed at either slowing down the intestines or speeding them up are the mainstays here.
The good news is that nearly all patients with irritable bowel syndrome will find ways to manage their symptoms - either by themselves or with the assistance of their medical provider. If you are suffering from symptoms like persisting abdominal pain/cramping, bloating, diarrhea, or constipation, make an appointment with your medical provider to discuss this further.
Wald, Arnold MD et. al. (2018) Patient Education: Irritable Bowel Syndrome (Beyond the Basics). Up To Date.