Abdominal Pain: IBS

Irritable bowel syndrome (IBS) is a common, and very bothersome, gastrointestinal condition. It usually causes abdominal pain, bloating and alteration in bowel habits, although nearly any GI symptom can be associated with IBS. IBS is a chronic condition, and symptoms can vary in severity and type throughout life.

The exact cause of IBS is unknown. Healthy practices—eating healthy, exercising and managing stress—can reduce the severity and magnitude of IBS; however, there isn’t a definite way to prevent or cure IBS. Although frequently bothersome, it doesn’t cause damage to the GI tract and doesn’t cause cancer, infections or other serious GI problems. Treatments can be safe and effective.

Symptoms

IBS can mimic most other GI conditions. The symptoms common to IBS—nausea, abdominal pain, diarrhea and constipation, bloating and gas—are common to most other GI conditions. The following is a list of the most common IBS symptoms.

• Gastric distress
• Abdominal pain
• Diarrhea or constipation (these symptoms often alternate)
• Bowel urgency (a feeling of needing to rush to the bathroom)
• Bloating
• Nausea
• Changes in stool caliber and stool consistency
• Excess gas

Because the symptoms of IBS can overlap with other GI conditions, including serious problems like colon cancer, only your doctor can diagnosis you with IBS. If you have major, unintended weight loss, gastrointestinal bleeding, severe abdominal pain or any other concerning sign or symptom, talk to your doctor immediately about your symptoms.

Causes and Risk Factors

The exact cause of IBS is unknown. However, IBS may be caused by issues with the nerves of the GI tract (called the enteric nervous system), bacteria of the GI tract (called the microbiome) or how the brain and the gut communicate (called the gut-brain axis).

Aside from one of the above three items, several factors can worsen IBS symptoms. These factors include the following:

Stress: Stress can severely aggravate IBS symptoms, though it is unlikely to be the sole cause of IBS.
Hormones: Women are twice as likely as men to have IBS, and although the exact reason for this is unknown, hormones are thought to play a big role.
Food: Doctors don’t know why, but certain foods or food allergies can cause or aggravate the symptoms of IBS. Common trigger foods include chocolate, fatty foods, sugar, fruits, vegetables and milk. These “trigger” foods vary from person to person.
Illness: Other diseases, especially gastrointestinal diseases such as viral or bacterial infections, can cause or trigger IBS.

A few other risk factors that have shown some connection to IBS include:

Age: IBS symptoms are usually noted before the age of 45.
Gender: Women are twice as likely to suffer from IBS.
Mental health problems: Anxiety, depression, abuse and personality disorders are all associated with IBS.
Family history: If you have IBS in your family, you are more likely to develop IBS.

Diagnosis

IBS, as it mimics so many GI conditions, is difficult to diagnosis. Eliminating other causes of your symptoms is an important part in diagnosing IBS. The ROME IV criteria, which have been changed and refined over time, are the standard for diagnosing IBS. Again, only your doctor can diagnose you with IBS as other GI conditions must first be ruled out. The following are common tests that can rule out other GI conditions:

Lactose intolerance tests
Colonoscopy
Blood tests including tests for celiac disease
Stool studies
CT scan
Ultrasound
Flexible sigmoidoscopy

Treatment and Prevention

IBS is a life-long, but manageable, condition. IBS treatment is usually tailored to specific symptoms; the focus is on improving these symptoms and not on low-benefit, unnecessary testing. The ultimate goal in treating IBS is to improve quality of life. Several treatments, as below, may improve IBS symptoms:

Probiotics
IBS diets including a low-FODMAPs diet
Medications
Supplements such as ginger or peppermint
Meditation
Counseling

Although IBS can’t be prevented, the severity of symptoms can almost always be improved with help from your doctor. The relationship between symptoms and stress is significant. If you have a family history of IBS, taking measures to lower your daily stress can reduce your risk of acquiring IBS. If you have IBS, finding ways to manage your stress can reduce the frequency and severity of your symptoms.

If you are worried you or a loved one might be suffering from irritable bowel syndrome, talk to your doctor today. IBS symptoms don’t have to control your life. With help from your doctor, you can improve your symptoms and regain control over your life.

I grew up in Utah County and graduated from Brigham Young University. I received my medical degree from the University of Virginia, and I finished my residency in internal medicine at the University of Utah where I also served as chief medical resident. As a doctor, I recognize the tremendous trust my patients place in me, and I do my best to help them understand not only their medical issues but also the plan—the how and why—behind helping them feel better. I love the challenge posed by all gastrointestinal disorders but especially enjoy the challenges and intricacies of Crohn’s disease and Ulcerative Colitis.