Irritable Bowel Syndrome (IBS)
Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder that affects the large intestine. Unlike inflammatory bowel disease, IBS doesn't cause changes in bowel tissue or increase the risk of colorectal cancer, but it can significantly impact quality of life through chronic symptoms like abdominal pain, bloating, and altered bowel habits. IBS is considered a disorder of gut-brain interaction, involving factors such as intestinal motility, visceral hypersensitivity, gut microbiome changes, and psychological influences. At Blume Health, our gastroenterology team provides comprehensive, personalized care for IBS patients through an integrated approach addressing both physical symptoms and psychological aspects.
Causes
- Abnormal intestinal muscle contractions that may be stronger or weaker than normal
- Nervous system abnormalities affecting the signals between the brain and digestive tract (gut-brain axis dysfunction)
- Heightened pain sensitivity in the intestines (visceral hypersensitivity)
- Alterations in the gut microbiome (the bacteria that normally live in the intestines)
- Post-infectious IBS developing after a severe gastrointestinal infection
- Food sensitivities or intolerances, particularly to certain carbohydrates (FODMAPs)
- Chronic stress, anxiety, or depression, which can trigger or worsen symptoms
- Hormonal changes (IBS is more common in women and symptoms may worsen during menstrual periods)
- Genetic factors and family history
- Early life stress or trauma
Signs and Symptoms
- Abdominal pain or cramping, typically relieved by bowel movements
- Bloating and abdominal distension
- Excessive gas
- Diarrhea, constipation, or alternating between both (leading to classification as IBS-D, IBS-C, or IBS-M)
- Changes in stool appearance (watery, loose, lumpy, or hard)
- Urgency with bowel movements
- Feeling of incomplete evacuation after bowel movements
- Mucus in the stool
- Symptoms typically worse after meals
- Fatigue and sleep disturbances
- Non-gastrointestinal symptoms like headache, backache, or urinary symptoms in some patients
- Symptoms tend to flare during periods of increased stress
Diagnosis
Clinical Evaluation Using Rome IV Criteria
Diagnosis is primarily based on symptom patterns according to established clinical criteria (Rome IV), which include recurrent abdominal pain associated with defecation and/or changes in stool frequency or form, persisting for at least 3 months.
Exclusion of Other Conditions
Since there is no specific test for IBS, diagnosis often involves ruling out other conditions with similar symptoms. This may include blood tests, stool tests, and imaging studies to exclude inflammatory bowel disease, celiac disease, microscopic colitis, or other disorders.
Limited Endoscopic Procedures
Colonoscopy or upper endoscopy may be performed in patients with alarm features (like weight loss, anemia, or family history of colorectal cancer), older age of onset, or symptoms that don't fit typical IBS patterns, to rule out structural abnormalities.
Specialized Testing
In some cases, additional tests may help characterize the subtype of IBS or identify contributing factors. These might include breath tests for small intestinal bacterial overgrowth or carbohydrate malabsorption, or transit studies to assess how quickly food moves through the digestive tract.
Treatment Options
Dietary Management
Dietary approaches are often first-line treatment for IBS. This may include identifying and avoiding trigger foods, following a low-FODMAP diet (temporarily restricting certain fermentable carbohydrates), increasing soluble fiber for constipation, or reducing insoluble fiber for diarrhea. Our dietitians work closely with patients to develop personalized nutritional plans.
Medications
Various medications may help manage specific IBS symptoms. These include antispasmodics for pain and cramping, laxatives for constipation, anti-diarrheal agents, bile acid sequestrants, serotonin modulators, and low-dose antidepressants (which can help with pain even in patients without depression). Treatment is tailored to predominant symptoms and individual response.
Psychological Therapies
Given the important role of the brain-gut connection in IBS, psychological approaches can be highly effective. These include cognitive behavioral therapy (CBT), gut-directed hypnotherapy, stress management techniques, and mindfulness-based interventions. These approaches help modify pain perception and improve coping strategies.
Probiotics and Gut Microbiome Approaches
Some patients benefit from probiotic supplements that help restore beneficial gut bacteria. While research is ongoing, certain probiotic strains show promise for specific IBS symptoms. Our specialists can recommend evidence-based options appropriate for your symptom pattern.
Home Remedies
Heat Application
Applying a heating pad or hot water bottle to the abdomen may help relieve pain and cramping during symptom flares. The heat helps relax intestinal muscles and provides comforting relief.
Stress Management Techniques
Regular practice of relaxation methods such as deep breathing exercises, meditation, yoga, or progressive muscle relaxation can help manage stress-related symptom triggers and improve overall well-being.
Regular Physical Activity
Moderate exercise like walking, swimming, or cycling can help regulate bowel function, reduce stress, and improve overall symptoms. Aim for at least 30 minutes of activity most days of the week, but avoid intense exercise during symptom flares.
Peppermint Tea or Oil
Peppermint contains menthol that may help relax intestinal muscles and reduce pain. Peppermint tea or enteric-coated peppermint oil capsules (which release in the intestine rather than the stomach) may provide relief for some patients.
Food and Symptom Journal
Keeping a detailed diary of foods consumed and symptoms experienced can help identify personal trigger foods and patterns. This information is valuable for developing an individualized management approach.
Preventive Care
- Maintain a regular meal schedule, eating at consistent times each day
- Stay well-hydrated with water, avoiding excessive caffeine and alcohol
- Develop healthy sleep habits to ensure adequate rest
- Practice regular stress management techniques
- Incorporate physical activity into your daily routine
- Work with healthcare providers to identify and avoid personal food triggers
- Consider a trial of probiotic foods or supplements if recommended by your doctor
- Avoid smoking, which can worsen gastrointestinal symptoms
- Take medications as prescribed, even when symptoms are under control
- Attend regular follow-up appointments with your gastroenterologist to monitor your condition and adjust treatment as needed
Surgical Options
Non-Surgical Condition
IBS is a functional disorder without structural abnormalities, so surgery is generally not appropriate and may worsen symptoms. Effective management focuses on dietary changes, medications, and lifestyle modifications. Any discussion of surgery for IBS-like symptoms requires thorough evaluation to rule out other conditions.
Diagnostic Procedures
While not treatments themselves, endoscopic procedures like colonoscopy may be performed to rule out other conditions that could cause similar symptoms, particularly in patients with alarm features or atypical presentation. These diagnostic procedures help ensure accurate diagnosis before committing to long-term IBS management.
Last Resort Interventions
In extremely rare cases of severe, refractory IBS-C (constipation-predominant) that has not responded to any other treatments and significantly impacts quality of life, procedures like sacral nerve stimulation might be considered. However, this is exceptionally uncommon and would only be discussed after exhaustive non-surgical approaches.
Schedule a Consultation
If you're experiencing symptoms of irritable bowel syndrome (ibs), our expert team is here to help you find the right treatment approach for your specific needs.