IBS Basics: Demystifying IBS

Irritable Bowel Syndrome, or IBS, affects an estimated 5-10% of the global population. That’s somewhere between 380 and 760 million people! (Including me- read more about my story here.) Those who are over the age of 45 or female are statistically more likely to have IBS. It majorly impacts quality of life, yet less than 50% of us seek medical attention for our symptoms.

Why?

It can be hard to recognize that your symptoms are abnormal, there’s no straightforward treatment, and most people don’t like to talk about their bowel habits. All very understandable. Pretty much nobody likes to talk about poop except for dietitians! (It’s true, ask any dietitian).

IBS is tricky because one person’s experience can be very different from another’s. So there’s often confusion around what it actually is. And it begs the question, “Do I have IBS, or is it all in my head?”

So today, I’m demystifying IBS. IBS 101, shall we say! I’m dishing out honest, up front, and easy-to-understand information about one of the most common but least understood gastrointestinal conditions. All the highlights you’d find in a scientific study, but easier to read, I promise 🙂 Let’s get started!

Demystifying IBS: What is it?

“IBS is a condition characterized by unexplained abdominal discomfort or pain that is associated with changes in bowel habits. It is classified as a functional disorder because tests show no diagnostic abnormalities and therefore, diagnosis depends on symptoms.” -Heizer et al.

Translation: there’s nothing visibly or structurally wrong with the digestive system, but for an unknown reason you’re experiencing uncomfortable and abnormal GI symptoms.

The most common symptoms of IBS are:

Gas or bloating
Heartburn
Abdominal pain
Diarrhea
Constipation

Of course, some people experience symptoms that are not on this list as well. But usually you’ll experience at least one of these. IBS symptoms are generally chronic in nature, although they may come and go or vary in intensity depending on the person.

Diagnosing IBS

IBS is very difficult to officially diagnose because there is no “test” to identify it. It is usually diagnosed based on symptoms alone. The official criteria for IBS, known as the “Rome IV Criteria”, are:

1. Recurrent abdominal pain, on average more than one day per week, for the past three months either related to defecation (pooping) or associated with a change in stool form or frequency.
2. Symptoms recurring for the past three months, with the initial onset at least six months ago.

Translation: if you have frequent abdominal pain and more/less stools than usual for at least 3-6 months, you may have IBS.

IBS Sub-Types

There are three sub-types of IBS. Generally, most people with IBS fall into one of these categories:

IBS-C: IBS with Constipation (least common in the US)
IBS-D: IBS with Diarrhea
IBS-M: IBS Mixed Type (most common in the US)

As the names suggest, whether you primarily suffer from constipation, diarrhea, or both is what determines what group you fit into. IBS can range from mild to severe, and your sub-type may change over time.

IBS Causes

There are many factors, both genetic and environmental, that impact your risk for IBS. Because IBS is a broad term that we use to describe a group of symptoms (ex: abdominal pain and diarrhea), it can actually be triggered by something different in each person. Such as:

Genetics
Gut-brain dysregulation (miscommunication)
Hormones
Psychological factors (ex: stress)
Diet
Gastrointestinal physiology

Without getting too far into the weeds, there are many proposed ideas about how these factors interact with the digestive system to cause the symptoms of IBS. But, unfortunately, the “how” is mostly unknown. We do know for sure that people with IBS have “visceral hypersensitivity” (a gut that sends more pain signals than normal), “altered motility” (a gut that moves faster or slower than normal), and a different gut microbiome than those without IBS.

IBS Treatment

As you can imagine, treating IBS is a challenge. You can categorize IBS therapies into several groups: food, medications, and lifestyle factors. It’s best to use a multidimensional treatment approach that is personalized for you.

Food

IBS symptoms usually get worse after eating. So, a natural place to start is with food (says the dietitian)! These are a few of the most commonly studied food-related IBS treatments:

Strong evidence: low-FODMAP diet
Mixed evidence: fiber supplements, prebiotics, probiotics, gluten-free diet, lactose-free diet
Weak evidence: peppermint oil, turmeric

Medications

There are several prescription IBS medications on the market such as Linzess, Amitiza, and Trulance. There are also over-the-counter medications that some may use for symptom relief such as anti-diarrhea meds or laxatives. It’s always important to consult with a gastroenterologist before considering long-term use of any medications for IBS treatment.

Lifestyle Factors

Often ignored but possibly most important, the brain-gut balance has huge potential to influence IBS symptoms. And by “brain-gut balance” I mean the complex connection between your central nervous system and digestive system. Ever noticed that when you’re scared or nervous, you feel it in your stomach?

There’s strong evidence that stress can trigger or worsen IBS symptoms, so any intervention that reduces stress can be an effective therapy! This may look different for everyone, but some commonly suggested approaches are:

Exercise
Relaxation techniques (meditation, yoga, etc.)
Adequate sleep
A work-life balance that’s balanced
Making time for hobbies, friends, and family
Removing stressors that cause anxiety or depression

Where Next?

IBS is ironically so common, but yet so poorly understood. There’s still tons of ongoing research about possible causes and treatments, so I’m excited for progress towards demystifying IBS in the coming years!

In the meantime, thanks for making it to the end of this post! It’s a TON of information, and this is only the tip of the iceberg. It took serious restraint for me to limit the “dietary approaches to IBS” section to one small paragraph. Hehe. There is plenty more to dive into. Stay tuned for more evidence-based and practical information from the “IBS Basics” series!

 

References

• Chey, et al. Irritable Bowel Syndrome: a clinical review. JAMA. 2015;313(9):949-958. Access here.
• Harris, et al. Modulation of the gut microbiota: a focus on treatments for Irritable Bowel Syndrome. J Postgrad Med. 2017;129(8):872-888. Access here.
• Heizer, et al. The role of diet in symptoms of Irritable Bowel Syndrome in adults: a narrative review. J Acad Nutr Diet. 2009;109(7):1204-1214. Access here.
• Konturek, et al. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011;62(6):592-599. Access here.
• Pauls, et al. Symptoms and dietary practices of IBS patients compared to healthy subjects: results of a US national survey. J Acad Nutr Diet. 2017;117(10):A130. Access here.
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*As always, this is not intended as medical advice. Please see my disclaimer for more information.