Irritable bowel syndrome (IBS) symptoms & treatment

Irritable bowel syndrome (IBS) affects up to 20% of people worldwide. It’s usually a long-term condition that can result in abdominal pain or discomfort, cramping, bloating, constipation and diarrhea. The good news is that IBS doesn’t cause any permanent damage to the colon or increase the risk of colon cancer. It usually can be managed with simple changes to your daily routine.

Doctors don’t know exactly what causes IBS, but it may be related to abnormalities in the functioning of the nerves and muscles of the GI tract and communication signals between the brain and the gut.

Types of IBS

There are four types of IBS:

• IBS with constipation (IBS-C)
• IBS with diarrhea (IBS-D)
• Mixed IBS (IBS-M) alternates between constipation and diarrhea
• Unsubtyped IBS (IBS-U) for people who don't fit into the other types

IBS symptoms

The most common symptoms of IBS are pain in your abdomen, often during bowel movements, and changes in your bowel movements over time. Other IBS symptoms vary and can be mild or severe. They may include:

• Diarrhea
• Constipation
• Constipation alternating with diarrhea
• Cramping, usually in the lower half of the belly, that gets worse after meals and feels better after a bowel movement
• Harder or looser stools than normal (pellets or flat ribbon stools)
• Bloating and gas
• Mucus in your stool
• Fatigue
• Stress
• Anxiety
• Depression
• Heartburn and indigestion
• Headache

If you’re concerned about your potential IBS symptoms, contact your doctor to schedule an appointment.

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IBS diagnosis

To diagnose IBS your doctor will do a physical exam and then review your potential IBS symptoms and medical and family history. Diagnosis of IBS is a process of looking for patterns to rule out more serious conditions such as celiac disease, ulcerative colitis and colon cancer. There is no test to confirm a diagnosis of IBS.

Depending on what's discovered with your history and examination, the doctor may recommend several tests, including stool studies, to check for infection. Stool studies also can show your intestine's ability to take in the nutrients from food. The doctor might also order a lactose intolerance test to find out if your symptoms may be related to eating dairy products.

Diagnostic procedures for IBS

Additional tests might include the following:

• Colonoscopy: Your provider uses a small, flexible tube to examine the entire length of the colon, looking for polyps or other abnormalities. Tissue samples can also be taken.

• CT scan: This test produces images of your abdomen and pelvis that might rule out other causes of your potential IBS symptoms, especially if you have belly pain.
• Esophagogastroduodenoscopy (EGD): For this procedure, also called an upper endoscopy, a long, flexible tube is inserted down your throat and into the esophagus (the tube that connects your mouth and stomach). A camera on the end of the tube shows images of your upper digestive tract. During an endoscopy, a tissue sample (biopsy) may be collected. A sample of fluid also may be collected to look for overgrowth of bacteria.

IBS treatment

If you have IBS, your Aurora care team will focus on treating IBS symptoms to help improve your quality of life. We’ll help you find the right treatment plan, which may include changes to your diet, dietary supplements or mental health therapies to help you manage stress. You may have to try a few treatments to see what works best for you.

Common treatments for IBS include:

• Eliminating foods that cause gas
• Antibiotics (if you have an infection)
• Fiber supplements
• Anti-diarrheal medication
• Anti-cholinergic medication, which relieves bowel spasms
• IBS-specific medication for severe cases that aren’t relieved by other treatments

Dietary changes for IBS symptoms

Your doctor may refer you to a dietitian and recommend changes to your diet to help with IBS treatment. It’s often a trial-and-error process to find the foods that affect your symptoms.

Low FODMAP diet

By following the low FODMAP diet, you reduce or avoid foods that contain carbohydrates that are hard to digest. FODMAP is an acronym for these types of carbohydrates: fermentable oligosaccharides, disaccharides, monosaccharides and polyols. The low FODMAP diet temporarily restricts these carbohydrates, relieving uncomfortable symptoms and giving your digestive system a rest.

With the low FODMAP diet, you’ll stop eating these foods:

• Apples, apricots, blackberries, cherries, mango, nectarines, pears, plums and watermelon or juice containing any of these fruits
• Canned fruit in natural fruit juice, large amounts of fruit juice or dried fruit
• Artichokes, asparagus, beans, cabbage, cauliflower, garlic, lentils, mushrooms, onions and sugar snap and snow peas
• Dairy products such as milk, milk products, soft cheeses, yogurt, custard and ice cream
• Wheat and rye products
• Honey
• Foods with high-fructose corn syrup
• Candy, gum and other products with sweeteners ending in “ol,” such as sorbitol, mannitol, xylitol and maltitol

Your doctor may suggest trying the low FODMAP diet for a few weeks to see if it helps with your symptoms. If your symptoms improve, your doctor may recommend slowly adding back foods that contain FODMAPs to see if your symptoms return. You may be able to eat some foods with FODMAPs without having IBS symptoms.

Eating more fiber

Increasing your fiber intake to 20 to 35 grams per day may improve IBS with constipation because it softens stool and makes it easier to pass. Soluble fiber is found in beans, fruit and oat products. Insoluble fiber is found in whole grains and vegetables. Soluble fiber is more helpful in relieving IBS symptoms. Add fiber slowly to help prevent gas and bloating.

Removing gluten from your diet

Your doctor may recommend staying away from foods that contain gluten, a protein found in wheat, barley and rye. Some people with IBS have more symptoms after eating gluten. Most cereals, breads, baked goods and pasta contain gluten; however, many gluten-free options are available.

Adopting healthy routines and managing stress

• Exercise regularly and get plenty of sleep.
• Do something fun as often as you can. Listen to music, read, find a new hobby or take a walk.
• Learn techniques to calm yourself and relax with therapy, yoga or relaxation exercises.