Overview

In 1997, the International Foundation for Gastrointestinal Disorders designated April as Irritable Bowel Syndrome (IBS) Awareness Month.

IBS is a disorder of the digestive system characterized by chronic, recurrent, abdominal pain and change in bowel habits. Patients may also experience other symptoms like fatigue, bloating, headaches, and lack of sleep.

IBS is a world-wide condition with an estimated 30 million (10-15%) affected by it in the United States. However, only 15% of those affected seek medical help. The prevalence in women is higher than men and women are more likely to have constipation-predominant IBS compared to men.

IBS is the second highest cause of work absenteeism behind the common cold.

There is no specific test to detect IBS. The diagnosis of IBS is based on symptom criteria established by a consensus panel of experts under the Rome Foundation. Those criteria were updated in 2016.

Rome IV criteria:

  • Recurrent abdominal pain on average, at least one day per week in the last three months
  • Associated with two or more of the following criteria:
    – Related to defecation
    – Associated with a change in stool frequency
    – Associated with change in stool form (appearance)

Classifications

In clinical practice IBS is categorized based on stool frequency, and consistency using the Bristol stool form scale (BSFS) as follows:

  • IBS-D patient report diarrhea with frequent bowel movement (type 6-7 on BSFS)
  • IBS-C is the type of IBS in which constipation is more common (type 1-2 on BSFS)
  • IBS-Mixed bowel movements are usually both constipation and diarrhea.
  • IBS- Unclassified patients cannot be categorized into one of the other three subtypes.

Bristol stool form scale (BSFS)

Signs and Symptoms

Patient symptoms may vary greatly and may include, but are not limited to:

  • Bloating
  • Abdominal pain
  • Cramping
  • Urgency
  • Diarrhea
  • Constipation
  • Feeling of incomplete emptying
  • Fatigue
  • Headache
  • Sleep disturbances

IBS vs IBD (crohn’s, ulcerative colitis)

IBS

  • May be caused by miscommunication between the GI tract and the brain
  • Does not cause GI inflammation
  • No sign of diseas or abnormality on exam of the colon, CT scan or lab
  • Common symptoms: Bloating, abdominal pain, diarrhea, constipation, urgency
  • No increased risk of colon cancer

IBD

  • Caused by an abnormal immune response
  • Can cause GI inflammation and permanent harm
  • Disease can be seen on exam, CT scan and lab changes
  • Additional symptoms may include bleeding, anemia, weight loss, or fever
  • Increased risk of colon cancer

Diagnosis and Testing

Currently there are no diagnostic tests available, so diagnosis is made based on presenting symptoms. Although some tests may be performed to rule out other conditions with similar symptoms.

Treatment

To be successful in the management of patients with IBS it is important to build a strong patient-clinician relationship. All patients’ concerns and fears should be addressed. Patients should be informed about the chronic nature of this disease with symptoms that may come and go over time.

Having a functional disease like IBS does not decrease life expectancy and does not increase the likelihood of cancer. Treatment options should be reviewed based on the severity of the symptoms and the effects on quality of life. Sometimes patients might be able to identify triggering factors and learn how to avoid them.

Any treatment should include dietary measures, exercise, supplements, stress management, and at times medications to alleviate symptoms. In severe cases psychological evaluation may be warranted and cognitive behavioral therapy, dynamic psychotherapy or hypnotherapy may be effective.

Diet

The production and passage of gas is a natural bodily function. It’s usually caused by some foods as they are digested or air you’ve swallowed. Gas is usually produced 4 to 6 hours after eating. No one diet change will help everyone, so here are some general tips to try to improve symptoms.

It is always a good idea to increase the amount of fiber in your diet. Do this slowly, too much fiber at once can cause more gas and discomfort. Soluble fiber has been found best for patients with IBS 10-25 g per day, while insoluble fiber may increase gas.

Adjust eating habits to small meals or snacks every 3-4 hours, chew well, and eat slowly

Do not recline after meals. Sit upright, stand or take a short walk after eating

Reduce greasy and fried foods Limit or eliminate dairy products

Keep a food diary to identify “trigger” foods

Common foods that cause gas:
Beans, legumes (peas, lentils), broccoli, cauliflower, brussel sprouts, cabbage, asparagus, apples, pears, apricots, peaches, watermelon, prunes, raisins, whole grain breads and cereals, starchy foods (pasta, potatoes), onion, garlic, artificial sweeteners, carbonated beverages

Foods that may help reduce gas:
Lean meats, eggs, fish, lettuce, zucchini, spinach, celery, cucumber, tomato, grapes, oranges, banana, rice, apple cider vinegar, ginger, chamomile or peppermint tea

Sleep

Adequate sleep fuels our mind and body, it is necessary for a properly functioning GI system. Adults should be aiming for a goal of at least 7 hours of sleep per night.

Exercise

We know that 30 minutes of moderate activity with a goal of 5 days per week can improve our natural hormones to decrease pain receptors in the GI tract.

Stress

Managing stress through physical activity, meditation, yoga, or other ways to nurture yourself can lead to better symptom control.

We also know that having IBS can be stressful, learning ways to manage pain with this chronic condition through cognitive behavioral therapy and deep breathing exercises has been helpful to many of our patients.

Medications

Dietary measures and changes in behavior are the most important factors in managing IBS symptoms, but there are some medications that can also help when these measures are not enough. Selecting which medication may work for you is based on symptoms, there is not one medication that will “cure” IBS or make the symptoms go away completely.

  • Peppermint oil may decrease the overall symptoms of IBS, but may increase heartburn in some patients. There are many products available that contain peppermint oil.
  • Imodium™ (loperamide) may decrease diarrhea and improve the consistency of stools, but does not help with pain or bloating
  • Iberogast is an herbal supplement that can be used to improve symptoms of IBS including abdominal discomfort and bloating
  • Lactaid™ or Dairy Ease™ to help digest dairy products.
  • Beano™ or similar generic product to reduce the amount of gas produced.
  • Charcoal tablet s to help absorb the gas. Make sure to space this medication from other medication
  • Simethicone to break up gas bubbles in your stomach (Gas-X™, Mylanta™, Mylicon™)

If over-the-counter measures are not enough, consult your regular medical provider to discuss further treatment options. Prescription options may be needed to obtain relief of symptoms.

So if you’ve had nausea, heartburn, indigestion, upset stomach or diarrhea (and Pepto Bismol™ did not help 😀)…call our office, we are eager to listen to your concerns and find a treatment plan that will work best for you.

For a good gut feeling

For a Good Gut Feeling

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