Irritable bowel syndrome (IBS) is a condition characterized by abdominal pain (usually cramping), bloating or gas sensation, and change in bowel habits (constipation, diarrhea, or the alternation of both). Other names used for this disorder include nervous colitis, spastic colon or simply “colitis.” It is a common condition affecting up to 20% of adults, which means that about 1 in 5 people have symptoms related to IBS. It is more frequent in women than in men, and symptoms usually start before the age of 35. IBS may cause individuals to avoid social events or traveling, and it may even affect their performance at work; however, it is important to know that IBS doesn’t lead to more serious conditions such as cancer.
The cause of IBS is not clear but it seems to be related to an extra sensitive bowel in these individuals, which causes the intestinal muscle to have intense contractions causing pain or to have too frequent contractions causing diarrhea. Bowel distention caused by intestinal gas and fluid may not be noticeable for most people; however, it may elicit pain and cramping in patients with IBS.
The diagnosis is mostly made with the presence of typical symptoms (table) and the exclusion of more serious intestinal conditions, such as inflammatory bowel disease (ulcerative colitis or Crohn’s disease), colon cancer, infectious diseases, diverticulosis, etc., for which diagnostic evaluation with an imaging study (barium enema) or colonoscopy is usually needed. This is important especially if “alarm signs” are present, such as rectal bleeding, weight loss, anemia, worsening of symptoms, or if they appear after the age of 35. Colonoscopy is the test of choice to rule out those conditions as it allows us to look at the colonic mucosal lining as well as take tissue samples (biopsies) if needed.
The treatment of IBS consists of controlling the symptoms with diet, stress management and prescribed medications. Diet includes avoiding foods that make symptoms worse such as caffeine products (coffee, sodas, chocolate, and medications that contain caffeine), dairy products (especially if lactose intolerant), certain sugar–free sweeteners (sorbitol or mannitol), and alcohol. Foods that might make gas–related symptoms worse include beans, lettuce, cabbage, cauliflower and broccoli. Also, chewing gum can lead to swallowing air, causing more gas and bloating sensation. Fatty foods and large meals may also be a problem. Having small frequent meals, increasing fiber supplements and increasing fluid intake may help to prevent and alleviate symptoms.
Stress management includes relaxation techniques, having an adequate amount of sleep and regular exercise, which also improves bowel motility. Medications used vary and are aimed to control the most frequent symptoms; they include antispasmodics for abdominal pain, stool softeners or mild laxatives for constipation, and antimotility agents for diarrhea. Occasionally antianxiety or antidepressive medications are also needed.
Common IBS Symptoms:
- abdominal pain, often relieved by or associated with a bowel movement
- diarrhea, constipation, or a combination of both
- whitish mucus in the stool
- bloating or swollen abdomen
- the feeling that you have not finished a bowel movement