Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine (colon). Symptoms include abdominal pain, bloating, gas, diarrhea, and constipation. IBS is a chronic condition that requires long-term management. Here is an overview of how doctors diagnose and treat IBS.
What is IBS?
IBS is a functional gastrointestinal (GI) disorder, meaning there is no structural damage to the GI tract. Instead, the colon is extra sensitive and overreacts to triggers like stress, foods, hormones, and medications. This leads to abnormal motility and secretions in the colon, causing the symptoms of IBS.
IBS is classified into four main subtypes based on the stool pattern:
- IBS with constipation (IBS-C) – hard, lumpy stools; straining
- IBS with diarrhea (IBS-D) – loose, watery stools
- IBS with mixed bowel habits (IBS-M) – alternating constipation and diarrhea
- IBS unclassified (IBS-U) – insufficient abnormality of stool consistency to meet other IBS criteria
Up to 20% of adults have IBS symptoms, making it one of the most common GI disorders. It affects more women than men and tends to develop in early adulthood.
What causes IBS?
The exact cause of IBS is unknown, but several factors likely play a role:
- Brain-gut interactions – Communication problems between the brain and nerves of the colon lead to abnormal GI function and motility.
- Inflammation – Some people with IBS have chronic low-grade inflammation in the GI tract that alters gut function.
- Altered gut microbes – IBS patients have different populations of gut bacteria and other microbes compared to healthy people.
- Food sensitivity – Certain foods like FODMAPs (fermentable carbohydrates) may trigger IBS symptoms.
- Stress and emotions – Stress, anxiety, and depression affect gut function and worsen IBS.
In many cases, IBS develops after a bout of acute gastroenteritis (stomach flu) that causes persistent changes in the gut. Genetics and family history can also increase IBS risk.
Diagnosing IBS
Since there are no definitive tests for IBS, doctors diagnose it based on a thorough medical history, physical exam, and ruling out other conditions. Diagnostic criteria include:
- Recurrent abdominal pain related to defecation and/or associated with a change in stool frequency or form
- Symptoms present for at least 3 days per month over the last 3 months
- Symptom onset at least 6 months prior to diagnosis
Doctors will ask about your bowel habits, pain patterns and severity, other symptoms, diet, stress levels, family history, and potential triggers. They will examine your abdomen to check for tenderness, bloating, and masses.
You may need blood tests to rule out celiac disease, inflammatory bowel disease, and thyroid disorders. A stool test can check for parasites, infection, and blood. Colonoscopy is generally only needed if you have red flag symptoms like weight loss, bleeding, or significant diarrhea.
Treating IBS with Medications
Since IBS cannot be cured, treatment focuses on managing symptoms. Doctors often use a multi-pronged approach with lifestyle changes, medications, dietary adjustments, stress management, and sometimes psychological counseling.
Medications that may be prescribed for IBS include:
| Medication | Uses |
|---|---|
| Antispasmodics | Relax intestinal muscles to reduce spasms and cramping |
| Tricyclic antidepressants | Modify pain signaling between the gut and brain |
| Laxatives | Treat constipation by increasing stool frequency and softening stools |
| Rifaximin | Antibiotic that reduces bloating by altering gut bacteria |
| Lubiprostone | Chloride channel activator that increases fluid secretion to soften stools |
| Eluxadoline | Mixed opioid drug that slows gut motility and reduces visceral pain |
Your doctor will tailor medication choices to your predominant symptoms. For example, antispasmodics and laxatives treat cramping and constipation in IBS-C, while antidiarrheals and bile acid sequestrants help diarrhea in IBS-D. Combining medications that work in different ways often provides better relief than single drugs.
Lifestyle and Dietary Changes
Making certain lifestyle adjustments and learning to manage stress can significantly improve IBS symptoms:
- Increase fiber intake – Soluble fiber supplements like psyllium help normalize stools.
- Follow low FODMAP diet – Avoiding foods high in fermentable carbs can reduce gas, pain, and diarrhea.
- Take probiotics – Probiotic supplements contain beneficial gut bacteria that improve digestive health.
- Exercise regularly – Physical activity reduces GI symptoms and stress levels.
- Improve sleep habits – Getting enough quality sleep prevents stress-related flare-ups.
- Practice relaxation techniques – Yoga, meditation, deep breathing, and CBT therapy manage stress and anxiety.
- Quit smoking – Smoking exacerbates IBS symptoms.
Identifying and avoiding personal trigger foods is also important. Food triggers vary but often include dairy, beans, cruciferous vegetables, fried foods, alcohol, caffeine, carbonated beverages, and artificial sweeteners.
Psychological Treatment
Cognitive behavioral therapy (CBT) can help manage the brain-gut interactions in IBS. CBT trains you to replace negative thought patterns with more positive coping strategies. It may involve:
- Learning to ease anxiety and stress through relaxation techniques
- Modifying catastrophic thinking about IBS symptoms
- Setting reasonable goals and expectations
- Identifying personal triggers
- Developing problem-solving skills
Studies show CBT meaningfully reduces IBS symptoms, even when used without medications. It can help break the brain-gut dysfunction cycle by changing how your mind interprets and responds to GI symptoms.
Other Treatments for Severe IBS
For people with severe IBS who don’t respond adequately to standard treatments, doctors may recommend:
- Prescription pain medications – Opiates like tramadol provide short-term relief of abdominal pain and diarrhea.
- Antidepressants – SSRIs can reduce visceral hypersensitivity independent of their psychological effects.
- Peppermint oil – Menthol has antispasmodic effects and relaxes smooth intestinal muscle.
- Alternative therapies – Acupuncture, hypnosis, and biofeedback may complement conventional IBS therapy.
- Fecal microbiota transplant (FMT) – Restoring normal gut flora with healthy donor stool can reduce IBS symptoms long-term.
As a last resort for disabling IBS, some patients undergo surgeries like colectomy to remove part or all of the colon. However, outcomes are inconsistent and complications common, so surgery is very rare.
Summary
In summary, IBS treatment relies on a multifaceted approach tailored to the individual:
- Medications like antispasmodics, laxatives, antibiotics, and mixed agents to target predominant symptoms
- Dietary changes such as increased fiber, probiotics, and eliminating trigger foods
- Stress management through exercise, sleep, relaxation techniques, and counseling
- Additional therapies like CBT, peppermint oil, and FMT for severe IBS
While frustrating to manage, IBS is very treatable. Working closely with your doctor to find the right combination of lifestyle changes, medications, and other therapies can successfully control symptoms and improve quality of life.
Frequently Asked Questions
How do doctors test for IBS?
There are no specific tests that confirm IBS. Doctors diagnose IBS based on symptoms, physical exam, medical history, and ruling out other conditions. You may need blood work, stool studies, or colonoscopy to check for other causes.
What OTC medications help IBS?
Over-the-counter medications that can help IBS include laxatives for constipation, anti-diarrheals for diarrhea, antacids for pain, peppermint oil capsules, probiotic supplements, and fiber supplements like psyllium.
How long does IBS last?
IBS is a chronic, lifelong condition. Symptoms tend to flare up and go into remission periodically. With proper treatment, many people achieve long remission periods with minimal symptoms.
Can you cure IBS?
There is currently no medical cure for IBS, but symptoms can be well-managed with medications, dietary changes, stress reduction, and other therapies. This multifaceted approach can induce long-term remission in many IBS patients.
Can IBS cause weight loss?
IBS itself does not directly cause weight loss. But symptoms like diarrhea, nausea, and abdominal pain may reduce appetite and food intake, leading to some unintended weight loss. Severe or prolonged weight loss warrants medical evaluation.
Does IBS get worse with age?
IBS often first appears in young adulthood and symptoms come and go over time. Some studies show IBS symptoms remaining consistent or improving slightly with age. Proper management can help control symptoms throughout adulthood.
Can IBS cause bleeding?
IBS alone does not cause bleeding from the GI tract. Rectal bleeding or bloody stools could indicate a more serious condition like ulcerative colitis, infection, or colon cancer. See your doctor right away if you have bleeding along with IBS symptoms.
Can IBS cause nausea?
Nausea affects about 20-30% of IBS patients. Contributing factors can include abnormal gut contractions, visceral hypersensitivity, stress and anxiety, certain trigger foods, and medications used to treat IBS symptoms.
Does IBS put you at risk for other conditions?
IBS itself does not increase risk for serious bowel diseases like cancer or IBD. But some studies correlate IBS with greater incidence of other functional disorders like fibromyalgia, chronic fatigue syndrome, temporomandibular joint disorder, and migraine.
Can men get IBS?
Yes, IBS affects men too. But it is twice as common in women compared to men. Reasons for this gender difference are not fully understood, but sex hormones may play a role.
Conclusion
IBS is a complex disorder with a wide variety of symptoms and severity. Diagnosis relies on a thorough medical workup and exclusion of other conditions. Treatment is tailored to each patient and aims to control symptoms through medications, dietary and lifestyle modifications, stress reduction techniques, and sometimes alternative therapies. While symptoms fluctuate over time, proper management can greatly improve quality of life for people with IBS.