Do I have IBS?
Irritable bowel syndrome (IBS) is a functional bowel disorder in which abdominal pain is associated with changes in bowel habits. Overall, IBS is the most common disorder of the gastrointestinal tract. The prevalence of IBS in the general population can vary largely ranging from 3% to 22% in different studies. The reason for this variation could be due to diversity of the IBS definitions being used and the methods that each individual study has been performed. IBS accounts for a significant portion of gastroenterology office visits and is also a common reason for primary care physicians office visits. IBS causes a lot of emotional distress and lower quality of life for a large group of individuals and also consumes a large portion of the health-care costs. IBS remains a disorder that is not fully understood. This is despite our increasing knowledge of body and its diseases.
- Functional Gastrointestinal Disorder (gross abnormalities, like a tumor, ulcer or inflammation, or microscopic abnormalities; non-ulcer dyspepsia, painless constipation, painless diarrhea, irritable esophagus and chronic abdominal pain...)
- IBS Definition (pain, diarrhea, bowel movements, bloating...)
- The Rome Criteria for IBS (criteria for the diagnosis of IBS...)
- Organic Gastrointestinal Disorder (peptic or intestinal ulcers, Inflammatory Bowel Diseases - Ulcerative Colitis and Crohn’s Disease, ischemicboweldisease, infectious and parasitic GI diseases, celiac disease or several other uncommon disorders...)
Is IBS usually associated with other disorders?
Yes. IBS is usually associated with several disorders out of your gastrointestinal tract. Extra-intestinal IBS symptoms include Migraine headaches, palpitations, frequent urination (urinary frequency), painful menstruation (dysmenorrhea) and cold hands. IBS is also commonly associated with Fibromyalgia (diffuse muscular pain) and Chronic Fatigue Syndrome (sense of lack of energy and tiredness all the time).
- Fibromyalgia (pain is usually associated with fatigue and stiffness and generally persists for months at a time...)
- Chronic Fatigue Syndrome (similar to flu symptoms that exhaust the energy...)
How do I get IBS?
IBS is the result of a sensitive bowel which responds abnormally to irritant stimuli. In fact, IBS symptoms origin from a blend of abnormal intestinal motility (i.e., abnormal movement of intestinal muscles) and abnormal intestinal sensation (i.e., abnormal feelings experienced in the intestine).
- Intestinal motility (movement of intestinal muscles...)
- Intestinal Sensation (increased sensitivity of the bowel...)
- Brain Gut Axis (when the bowel is irritated, these receptors convey this information to the brain through the afferent pathway of the BGA...)
- The Effect of Stress on the Gastrointestinal Tract (stress activates the Brain-Gut Axis and this activation results in release of numerous chemical mediators in the gastrointestinal tract...)
- Lactose Intolerance (lactose intolerance or lactase deficiency is another disorder that must be seriously considered when diagnosing a patient as having IBS...)
- Bacterial Overgrowth (a significant group of IBS patients have bacterial overgrowth as the cause of their symptoms...)
How do you diagnose IBS?
You may ask "how do doctors diagnose IBS despite lack of any specific diagnostic test?â€? The diagnosis of IBS is based on a detailed history and a thorough physical examination. Rome Criteria is a diagnostic framework that should be used in all clinical setting and its use eliminate the need for many unnecessary diagnostic studies. Occasionally, some tests are required to rule out organic GI disorders or other potential diagnoses. Unfortunately, there is no diagnostic test that enables the doctors to diagnose IBS. In fact the diagnostic tests are being used to exclude other diagnoses such as inflammatory bowel disease (IBD) which includes Crohnâ€™s Disease and Ulcerative Colitis, and celiac disease or other organic GI disorders.
- Upper GI Tract Endoscopy (an endoscope is a fiberoptic instrument that enables doctors to have a close look at the GI mucosa...)
- Colonoscopy (used to diagnose inflammatory bowel disease, a colonic polyp or colon cancer...)
- Video Capsule Endoscopy (a very small camera that can fit into a pill size capsule and can record images of the entire stomach and the small bowel...)
- Blood Tests (can detect anemia as a culprit of organic GI disorders...)
- Barium enema or Virtual Colonoscopy (they are alternatives to a colonoscopy...)
- Stool Tests (can be used to detect an intestinal parasite...)
- Breath tests (for diagnosis of lactose intolerance and Bacterial overgrowth...)
- Need for Follow-up (diagnosing IBS by monitoring the patient over a period of time with periodic clinical exams and simple lab tests...)
Symptoms of IBS
At first glance, the symptoms of IBS may seem to be limited to the gastrointestinal tract. However, there are numerous symptoms outside of the GI tract that are also associated with IBS. These extra-intestinal symptoms are mainly related to an underlying generalized anxiety. As you see in the picture, IBS symptoms include a wide range of complaints such as abdominal pain, cramps, bloating, fullness, abdominal distension, constipation, diarrhea, incomplete bowel evacuation, flatulence, nausea and belching. Extra-intestinal IBS symptoms include headaches, palpitations, frequent urination (urinary frequency), painful menstruation (dysmenorrhea) and cold hands. IBS is also commonly associated with fibromyalgia (diffuse muscular pain) and chronic fatigue syndrome (sense of lack of energy and tiredness all the time).
- Abdominal Pain (abdominal pain in IBS can present in different ways and the quality and frequency of the pain can change from time to time...)
- Diarrhea (the exact definition of diarrhea has always been a topic for discussion...)
- Constipation (the definition of constipation is even more controversial than that of diarrhea...)
- Gas and Bloating (the intestine of people with IBS is similar to a thick balloon, in which a minimal increase in air creates a lot of pressure...)
- Red Flag (Red Flag symptoms are almost always signs of an organic disorder...)
What are the treatment strategies for IBS?
There are several options for treatment modalities for management of IBS including conventional medicine, dietary restriction, behavioral and psychological approaches, relaxation therapy, meditation, hypnosis, herbal remedies, alternative medicine and homeopathy. When there are several treatment option for treatment of a particular disease, you can safely assume that none one of the options is ideal. If there was an ideal treatment for this condition, there would be no need for alternatives. That being said, there are many treatments that significantly reduce symptoms. You should know that there is no cure for IBS. The remedies, therefore, are geared toward the relief of symptoms. Treatment options generally decrease stimuli, increase the sensory threshold in response to the stimuli or offset the effects of stimuli.
- Fibers (fiber improves bowel movements by increasing the frequency and bulk of stool as well as decreasing the pressure inside the colon...)
- Spasmolytics (or Antispasmodics are medications that relax the bowel muscle and frequently prescribed for IBS patients with diarrhea and pain...)
- Antidiarrheal (Antidiarrheal agents are helpful in the management of diarrhea and pain in IBS...)
- Laxatives (laxatives improve bowel motility or change stool consistency...)
- Antibiotics (Xifaxan - rifaximin, a lumenal antibiotic, could alleviate the symptoms of IBS...)
- Probiotics (are beneficial live bacteria that survive the digestion process and therefore are able to populate in the gastrointestinal tract...)
- Psychotropic Agents (group of antidepressant medicines that are typically used to treat psychiatric symptoms, such as anxiety and depression...)
- Stress Management (progressive muscle relaxation, meditation, yoga, music therapy, biofeedback, cognitive behavioral therapy, hypnotherapy - hypnosis, and psychodynamic psychotherapy...)
RESOURCES FOR INFORMATION ON IBS
There are a number of sources of information on the internet regarding irritable bowel syndrome. The following are recommended, well-respected sites: