The Mystery Disease
Irritable Bowel Syndrome, or IBS, is the most common gastrointestinal disease in the United States, affecting as many as one in five adults. It is by far the most common intestinal problem that sends patients to a specialist (gastroenterologist) for diagnosis. Despite how common the disease is, it is very difficult to diagnose. There is no one definitive test for IBS and not everyone has the same symptoms.
There is no known single cause for IBS. What the medical community does know is that an abnormal bowel structure is present, that IBS is a lifelong disease that is usually diagnosed in the teen years or early adult hood, and twice as many women as men report suffering the symptoms of IBS and seek treatment for it.
The most common symptoms of IBS are:
- Abdominal Pain
- Gas and bloating
- Diarrhea
- Constipation
Those diagnosed with irritable bowel syndrome have symptoms present most of the time. To meet the definition of irritable bowel syndrome patients must have the above symptoms at least three times per month.
For some, gas and abdominal pain with diarrhea are the most troublesome symptoms. For others, gas and pain with constipation are worse. IBS sufferers can also go back and forth between diarrhea and constipation, which makes treating the disease difficult.
Doctors usually diagnose IBS with little or no testing. Depending on your age and family history, you may be tested to rule out other problems such as anemia, lactose intolerance or deficiency, have a stool culture taken to check for intestinal infections or have a colonoscopy to rule out cancer. It is important to understand the IBS is not the same as Inflammatory Bowel Disease, Crohn’s Disease or Ulcerative Colitis, but they can all have some of the same symptoms. If you are experiencing rectal bleeding, sever diarrhea, unexplained weight loss or a fever, these things are generally not associated with IBS.
What causes IBS is still largely a mystery. Don’t misunderstand; irritable bowel syndrome is a real disorder and not just the result of eating too much fried food or caused by a stomach virus. Those who suffer from it usually have daily symptoms and it often interferes with normal activities. IBS has even been linked to depression and anxiety since it is a chronic disease with reoccurring symptoms that can vary from day to day. Some suffer much more debilitating symptoms than others and the disease does seem to worsen with age.
The Different Kinds of IBS
The medical community has identified four types of IBS based on the prevalence of certain symptoms. IBS with constipation (IBS-C) is the diagnosis for patients who suffer from hard and/or lumpy bowel movements more frequently than they have diarrhea. IBS with diarrhea (IBS-D) is diagnosed when a patient has loose, watery bowel movements more often than constipation.
People who have an equal mix of constipation and diarrhea have mixed irritable bowel syndrome (IBS-M) and finally; there are those who don’t consistently have symptoms but when they do it is equally loose bowel movements or constipation. This is called unsubtyped IBS (IBS-U).
It’s crucial that a physician classify which type of IBS their patient is afflicted with in order to determine the best possible treatment to relieve the most troublesome symptoms with their stool.
The Gastrointestinal Tract
Irritable bowel syndrome originates in the GI tract and changes the way it works. However, IBS does not cause damage to the GI tract per se. Since it is a group of symptoms that occur together in the GI tract, it is called a disorder, not a disease. Past names for IBS include, colitis or mucous colitis, nervous or spastic colon and spastic bowel. These names have been discarded because IBS is considered a disorder with physical and mental causes.
The GI tract is a long twisting tube made up of a series of hollow organs. It includes the mouth, esophagus, stomach, small and large intestines, appendix, cecum (a pouch at the opening of the large intestine) colon and rectum or anus. Intestines are also referred to as the bowels and the term lower GI tract refers to the large intestine where it connects to the anus. Digestion of our food occurs with the movement of muscles along the length of the GI tract, which releases hormones and enzymes that aid in digestion.
Water is absorbed by the large intestine and any remaining nutrients from food that has been mostly digested by the stomach and small intestine. The role of the large intestine is to change liquid waste to a solid (stool) and pass it from the colon to the anus. Somewhere in this process the symptoms of IBS occur.
IBS In Women
There are several theories and a lot of speculation as to what causes IBS, but there is no one known cause. It is believed that it’s a combination of mental and physical problems that lead to IBS.
The brain sends signals to the nerves of the large and small intestines, which controls how they work. It is problems with those signals that is a possible cause of IBS, causing changes in how the bowel functions and leading to mild discomfort to sever pain. This brain to bowel connection is why IBS is thought to have a mental aspect as well as the physical symptoms.
The fact that it seems to afflict twice as many women as men has led to classifying IBS as generally a feminine health disorder, despite the fact that men have been diagnosed with it, too. The question then is; why are far more women diagnosed with the disorder than men?
A whole new body of research has attempted to explain why IBS might be more prevalent in women than in men. The first thought is that hormones play a significant role in causing IBS and worsen the symptoms at certain time of the month. Since IBS usually starts in young women in their teens, and this is also the normal time for the onset of menstruation, it seemed likely there is a connection. Researchers speculate that female hormones like estrogen and progesterone may be responsible for flare-ups of IBS symptoms and that male hormones might offer them protection from the disorder. If high levels of male hormones in the body somehow prevent men from suffering IBS symptoms science has yet to offer any explanation as to why. One study did show that men with lower male hormone levels were prevalent in men who had been diagnosed with irritable bowel syndrome, but there is not enough clinical data to make any definitive connections between hormones (specifically in women) and the onset or worsening of IBS.
The answers may not lie in the physical differences between men and women, but in their psychological differences. There does seem to be a strong correlation between IBS and psychological conditions, despite researchers being unable to say why exactly. The new thinking is that the emotional differences between males and females may have something to do with why more women than men are diagnosed with IBS and suffer more sever and frequent flare-ups of symptoms.
Depression and anxiety is more common in women that in men, so could this explain why more women have the disorder? In one startling discovery it seemed that women with a history of physical and sexual abuse reported higher rates of IBS.
The answers could also lie in the way men and women perceive pain. Women seem to be more sensitive to pain that originates in internal organs. So what feels like debilitating pain to a woman may only be perceived as minor discomfort in a man.
There is also the fact that women tend to visit their doctors more often to receive yearly pap smear screenings, have their hormone levels checked and may be more likely to report the symptoms of IBS, specifically changes in their bowel movements. This could mean more women are referred to specialists, gastroenterologists, and receive the diagnosis more readily. Men tend to visit their primary care doctors less frequently and are less likely to report IBS symptoms unless they are really sever. Occasional gas discomfort and changes in their bathroom habits most likely go unreported.
The general consensus is that a lot more research must go into the gender differences in relation to the incidences of IBS symptoms before any real conclusions can be reached.
Other Possible Causes of IBS
Gastrointestinal problems such as, low or high motility (movement) is most likely occurring in persons with IBS. Slow movement of the colon can lead to constipation. High motility, conversely, causes waste to pass through the large intestine too quickly so that it remains watery and becomes diarrhea.
A spasm (strong random muscle contractions) can cause dramatic changes in the motion of the bowels and be a source of pain and discomfort. This is particularly bothersome because it could be brought on by anxiety or stress. Or it could be a result of an unusually large or heavy meal.
There is also a sensitivity component to determining who and how badly one suffers from the symptoms of IBS. People with the disorder may be more sensitive to the pain caused when the smooth muscles lining the GI tract stretch or spasm than those who don’t. The pain signals may be processed differently by the brain of IBS suffers. This way of thinking gives weight to the idea that mental problems may be a direct cause of IBS.
Psychological problems like panic disorder, chronic anxiety, depression, and PTSD (post traumatic stress disorder) are very common in people who have been diagnosed with IBS, too. Research has yet to provide a clear answer about the link between those mental disorders and a physical disorder like IBS. The connection cannot be disregarded because IBS is often times reported by those who have suffered physical and mental abuse. There is science to support the idea that people who have been subjected to abuse tend can express psychological stress with physical symptoms.
Bacteria may also be a cause of IBS. Bacterial gastroenteritis is an infection in the stomach and bowels. Why this infection leads to IBS in some but not in others is just another frustrating mystery about IBS. There is also a bacterial disorder that occurs in the small intestine. Normally a small amount of bacteria live in the small intestine all the time. An increase in the amount of bacteria present in the small intestine causes changes in the way it functions. People with this problem have reported excessive gas, diarrhea and even weight loss. Some patients have found relief from their IBS symptoms when the bacterial overgrowth was stemmed with antibiotics. Unfortunately this does not help the majority of people who have been diagnosed with it, though.
Food sensitivities are also thought to be a cause of IBS, though certainly not the only one. There seems to be a correlation between the consumption of foods with a lot of carbohydrates, spicy foods, high fat foods like sausage or hamburgers, coffee and other caffeinated beverages and alcohol and IBS symptoms. It’s important to point out that the IBS symptoms are a result of food sensitivities or intolerances, not actual food allergies, which can be life threatening and are not linked to IBS in any way.
More and more research is supporting a link between allergies and the onset of IBS. It has been noted in one study out of the Rush Medical Center those with hay fever were twice as likely to have IBS. Worse, those diagnosed with allergic skin reactions seem to be four times more likely to have symptoms of IBS. More research has to be done in this area as well before the medical community can say for sure that developing allergies makes you more likely to develop IBS, though, since there is a large percentage of those with the disorder who do not have allergies of any kind.
IBS and Genetics
There is a link between irritable bowel syndrome and genetics. Research conducted at The Institute of Human Genetics in Heidelberg University did show a frequent gene mutation common in IBS patients was prevalent in their family history. Research done on identical twins separated at birth gave more weight to the theory that IBS has a genetic component. However, plenty of people with no family history of gastrointestinal disorders of any kind have been diagnosed with IBS.
Treating IBS
An important first step in treating IBS is to visit your doctor for a thorough examination and carefully detailing all of your symptoms, the frequency that which they occur, if the condition manifests itself daily, and how long a flare-up usually lasts. As written before, there is no one test or series of tests to diagnose the condition, but it sometimes other problems like food intolerances or colon cancer can mimic the symptoms. Your doctor might order tests for those diseases to rule them out depending on your age and family history, but in general an explanation of your symptoms is enough to make an IBS diagnosis.
Once it has been determined that you have IBS it is then time to pinpoint exactly which of the four kinds you are suffering from. Do you have diarrhea more than constipation or an equal mix of the two?
Sometimes it is helpful for the patient to keep a record of their symptoms, what they are, when they occur and record everything they eat, feelings of stress and anxiety, etc. This can help your doctor discern any patterns that could be interrupted to bring relief from your symptoms.
Since certain foods are know triggers for flare-ups it might be necessary to eliminate things like dairy, fatty meats, high-carbohydrate foods, and caffeine from your diet for up to two weeks to see if symptoms lessen.
Those who suffer from diarrhea the most should avoid dairy products, fruit, anything with high amounts of sugar (especially high fructose corn syrup) and artificial sweeteners like sorbitol or xylitol. If constipation is more of an issue, eating foods high in fiber like cashews, peanuts and vegetables could bring relief.
Caffeine is frequently associated with IBS symptoms so cutting back or eliminating it from your diet all together has shown to lessen the severity of those symptoms and the frequency with which they occur.
Regular exercise has been proven to help IBS suffers. Since it is also a good way to relieve stress, another IBS trigger, increasing the frequency and duration that you engage in physical activity will most likely have a positive affect on symptoms.
Using Drugs To Treat IBS
If lifestyle changes like cutting out certain types of foods, drinking less alcohol and getting more exercise are not enough there are several prescription medications that can help. To be clear, medications will most likely not clear up all your symptoms, but lessen the most sever ones like diarrhea or painful gas that can interfere with daily life.
If diarrhea is the worst of your symptoms anticholinergics (drugs that inhibit spastic movement in the GI tract) are often prescribed such as: dycyclomine, propantheline and hyoscyamine.
If constipation is the main issue consuming more high fiber foods can help. However, large amounts of fiber can worsen the problem of gas and bloating so it is important to slowly introduce more fiber into your diet and to drink plenty of water with foods high in fiber.
Laxatives are also another way to relieve the constipation associated with IBS, but not all of them are safe to take on a regular basis so you must discuss the use of those with your doctor. Osmotic laxatives like Milk of Magnesia, and MiraLax are available over the counter.
Prescription drugs like Linzess can help manage the symptoms of IBS-C (with constipation) but it can have some nasty side effects like causing diarrhea, increasing bloating and gas pain and it is not safe for children.
Sometimes an antibiotic like Rifaximin is prescribed if it is determined that you have an overgrowth of bacteria in the small intestine.
The Mental Component
While the link between mental disorders and the onset of IBS is not clear, getting help for them can really help get rid of the worst IBS symptoms. Seeking counseling to learn how to cope with stress and anxiety is a good first step if it is determined your IBS symptoms have a mental component. Those suffering from depression and IBS often will get relief from both problems when they are prescribe anti-depressants. Exercising, meditation, and making time for relaxing and fun activities can improve your mental health and relieve some of your IBS symptoms.
Alternative Therapies
In recent years alternative therapies have been tested to see if they could help with the treatment of the worst symptoms. Acupuncture is one of the most popular non-medicinal ways to treat IBS. Patients have claimed to lessened their pain from bloating and gas. Others have said their constipation was relieved or that diarrhea cleared up after a few acupuncture treatments. Despite those success stories it has not proven to really work as an effective treatment for the majority of those with the disorder.
Supplements, and oils have also been touted as a way to treat IBS. However claims that fish oil, and evening of primrose have been effective alternative treatments for IBS are unsubstantiated.
An Australian study did find some evidence that peppermint provided soothing relief to the muscles in the colon, which lessened diarrhea for IBS patients. Other studies have gotten mixed results so there is much more research to be done before using peppermint can be prescribed as a realistic treatment for IBS.
The Best Way To Treat IBS
Since no two people suffer IBS symptoms the same, and there is no one test or drug to get rid of IBS, a commitment to a series of treatments that include cleaning up your diet, managing your stress and finding the right medication is the best way to free yourself from the restrictions of the disorder and keep it from worsening. While you may never be completely free of the symptoms, consistent monitoring of your diet, your mental health and the medications prescribed by your doctor are your best bet for managing your IBS symptoms and improving your quality of life.
