Almost everyone deals with occasional gas and bloating. But for approximately 10% to 15% of the population, these discomforts come far too frequently.
The condition is called irritable bowel syndrome, or IBS, and its hallmarks are abdominal pain, plus diarrhea and/or constipation, and often bloating. Symptoms fluctuate over time.
“The key with IBS is that when the patient has abdominal pain, he has a change in bowel habits, so they’re linked together,” said Lin Chang, director of the Digestive Health and Nutrition Clinic at David Geffen School of Medicine, University of California Los Angeles. Generally, once the patient has a bowel movement, the pain improves.
Symptoms of IBS can range from mild to severe. People with mild IBS may not experience too much disruption of their daily lives, Chang said, but for those with moderate-to-severe IBS, symptoms can be more debilitating and may lead to absences from school or work. Also, because symptoms can be unpredictable and sometimes noisy, IBS can be isolating, anxiety provoking, and embarrassing.
People with IBS may not want to go out because they have to know there is a bathroom nearby at all times, which can make life hard, said Doug Drossman, MD, co-director emeritus at the UNC Center for Functional GI and Motility Disorders at the University of North Carolina School of Medicine, Chapel Hill.
Drossman’s research group, in collaboration with patient organization International Foundation for Functional Gastrointestinal Disorders (IFFGD), conducted focus groups of people with IBS, concluding that even when people are not having IBS symptoms, they still are thinking about it and trying to deal with it. “It’s an overarching problem that is both physical and psychological,” Drossman said.
IBS can affect anyone at any age, but the rate of incidence falls off after age 65, Chang said. It affects both men and women, but women are more likely to see a doctor for the uncomfortable symptoms.
Just over 50% of people with IBS never see a doctor and just manage it at home with lifestyle modifications and over-the-counter remedies, Chang said. They might try laxatives if they are constipated and probiotics for digestive health, or remove dairy or gluten from their diets in an effort to ease pain.
When symptoms become very bothersome, it is time to see a doctor, Chang said, because managing IBS is like losing weight. “There might be quick fixes, but sustained improvement takes hard work, patience and persistence, and doing the right thing.”
People with IBS should know they are not alone, Drossman said. The treatment outlook is very good, and many new drugs are on the market.
Take the following quiz to learn more about IBS and what you can do for it.
1. IBS involves a dysregulated brain/gut interaction.
True or false
2. Men and women are equally bothered by their IBS symptoms.
True or false
3. IBS is at least partly psychosomatic.
True or false
4. Which of these have the potential to help IBS symptoms? (Choose all that apply)
A. Try a diet low in foods such as onions, garlic and pears.
B. Don’t overeat.
C. Avoid fried or fatty foods.
D. Drink a lot of water.
E. Skip meals.
5. To maximize treatment, it is important to know what subtype of IBS you have.
True or false
(Scroll down for the answers.)
1. True. While IBS is considered a heterogeneous condition — there are many contributing factors — it generally is accepted that the common thread is an alteration in how the brain communicates with the gut, according to Chang.
The brain-gut pathway is dysregulated in IBS. This alteration leads to changes and a “more heightened awareness of gut sensations,” she said.
Chang said certain risk factors increase one’s vulnerability to developing IBS. While the condition tends to run in families, there is no single gene that strongly predicts it. Since there is not one mutated gene, it is not considered a classic genetic disorder; rather, a person can have a genetic predisposition to it. There likely are environmental factors (e.g., stress, infections) that also increase the risk of IBS, she said. Altered bacteria in the gut also may pose a risk for IBS, Drossman added.
Chang understands people might want to avoid seeing a doctor because of unnecessary tests, cost, and a discomfort discussing the topic.
Managing it at home is OK, she said, but a doctor can educate you about what condition you have and offer guidance on how best to manage the symptoms.
2. False. At least in Chang’s experience, women suffer more emotionally from the symptoms of IBS than men.
“They’re more bothered by their bloating and getting distended and looking six months pregnant,” she said. “They don’t want to pass gas.” Women also find all the grumbling noises embarrassing, which could explain why women are more likely than men to seek medical attention for their IBS symptoms.
While men may be less bothered by passing gas and frequenting the bathroom, both men and women feel uncomfortable talking about their bowels, Chang said. “It still has a stigma.”
But a physician tries “to see how it’s affecting [the patient’s] life and work together on strategies,” Drossman said.
He advises choosing the right type of doctor. If you have mild IBS, a primary care doctor should be fine. But for more severe cases, patients should find a specialist who works in functional gastroenterology.
3. False. Most people seem to think of IBS as a psychiatric problem, Drossman said, but it is not. IBS is an interaction of the nerves between the brain and the gut. “It has to do with the way the brain and the intestines talk to each other,” he said.
Often, he said, when patients have routine testing, doctors generally don’t see anything.
“There’s an assumption that there’s nothing wrong or that it’s psychiatric, and neither of those is really true,” he said.
4. A, B, C. To help your IBS, try eating three regular meals per day, don’t overeat, avoid fried and fatty foods, and try a low FODMAP diet, suggested Chang.
FODMAP stands for Fermentable Oligo-Di-Monosaccharides and Polyols. FODMAP foods include honey; certain fruits such as apples and pears; wheat; garlic; onion; sweeteners containing sorbitol; legumes; and stone fruits such as apricots, cherries, nectarines, and avocados. The idea is to avoid these and other highly fermentable foods which, when broken down by bacteria, create hydrogen methane, which can cause distension in the bowel. People with IBS are likely to have more gas and bloating after eating these foods.
Not everyone will want to eliminate every FODMAP food. Generally, patients try to remove all FODMAP foods for four to six weeks and, if symptoms improve, then can try reintroducing items slowly to determine what foods they can tolerate, Chang said. Consulting a dietitian could be helpful.
While gluten also may exacerbate symptoms, Chang does not advise patients to maintain a gluten-free diet unless they truly feel symptoms improve when they avoid gluten.
Probiotics also may help but are not a “cure all,” she said. “It might help more mild symptoms, maybe bloating, but I don’t think it’s for everybody.”
Research has shown that exercise helps IBS as well, Chang said.
While mild IBS may be managed at home with dietary and/or lifestyle changes and certain treatments (over-the-counter drugs that slow gut movements to treat diarrhea, or fiber for constipation, for example), don’t rule out seeing a physician.
“Really, the cornerstone is the education and reassurance from your physician or your provider,” Chang said. Your doctor can reassure you that you do not have a more serious condition and provide educational resources. Chang often refers patients to the American Gastroenterological Association, the American College of Gastroenterology, and the patient group IFFGD.
5. True. Different subtypes of IBS focus on the predominant symptom. To know how to treat moderate-to-severe IBS, it is imperative that the patient know his or her IBS subtype. IBS is classified according to “bowel habit subtype,” Chang said, the three main subtypes being IBS associated with diarrhea, IBS associated with constipation, and IBS associated with both. Patients also might transition among the various subtypes, she said. Women are more prone to having the constipation subtype, most likely in part due to female hormones, while both men and women get the diarrhea subtype, Chang said.
Knowing the subtype is important for treatment purposes. “A lot of the treatment is to normalize the bowel habit,” she said. “So you don’t want to give a medication to lessen diarrhea to a constipated person.”
Many new drugs are available, added Drossman, and the treatment outlook is positive.