What’s the Irritation? Understanding Irritable Bowel Syndrome

woman with digestive issues in bed. irritable bowel syndrome. What is IBS?

Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder that affects your digestive system. It can cause multiple uncomfortable symptoms that affect your digestive tract. 

Functional GI disorders are related to how your gut and brain work together. When your gut-brain interaction is unsynchronized, it can cause a myriad of symptoms, including how your bowel muscles contract, which is one of the leading indicators of IBS. 

It is not uncommon to have regular bowel movements on some days and abnormal ones on others. If you are concerned about having IBS, note the frequency and type of bowel movements you experience and share that information with your doctor. 

IBS presents in three different types, all indicated by different bowel movement contractions. Understanding the type of IBS you are experiencing will help determine your treatment plan. 

  • IBS-C: Constipation is the primary indicator. The stool is hard and lumpy.
  • IBS-D: Diarrhea is the primary indicator. The stool is loose and watery.
  • IBS-M: Mixed combination of constipation and diarrhea happening on the same day.

Who can get IBS?

IBS affects more than 25 million people in the United States and is the second most common cause of missed work each year. That said, it is commonly dismissed by conventional doctors.  Studies show that only 6% of patients suffering with symptoms have an IBS diagnosis.  Those most at risk are women under 50, those with a family history of IBS, or anyone suffering from severe mental health issues related to depression, anxiety, or abuse. 

What causes IBS?

The exact cause of IBS is unknown; however, three factors are frequently tied with an IBS diagnosis. 

Excessive muscle contractions in the intestines that last longer or are more intense can cause bloating and diarrhea. These frequent contractions can eventually exhaust the muscles causing weaker contractions that lead to slow food passage and constipation. 

Nervous system functioning is directly responsible for brain-gut communication. Poor signals between the brain and GI tract can cause your digestive system to over or underperform, resulting in several more common IBS symptoms. 

Severe infection in the GI tract due to bacteria or viruses can cause diarrhea which can then turn into IBS, which the excess bacteria could then exacerbate. 

Signs and Symptoms of IBS

IBS causes the colon muscles to contract more often, so IBS may also be referred to as Spastic Colon. These frequent contractions can cause excessive cramps and pain in the abdomen.

The signs of IBS vary but are usually present over the course of days or even weeks. The most common symptoms include abdominal pain, cramping, bloating, gas, and frequent bowel movements. Frequent constipation may also result in hernias which may lead to rectal bleeding. 

Lesser-known symptoms of IBS are unintentional weight loss, diarrhea at night, iron deficiency, unexplained vomiting, difficulty swallowing, or persistent abdominal pain not relieved by passing gas or a bowel movement. All of these are indications of a disturbance in the gut-brain dynamic and impact how the body processes food through the GI tract. 

You should see a doctor if you have symptoms more than three times per month for 2-3 consecutive months. If you are experiencing symptoms less often but find they interfere with your quality of life, go ahead and seek an appointment with your doctor. 

Getting an IBS diagnosis

Doctors will review symptoms and medical history and perform a physical exam. They may also run a series of tests to rule out other health concerns. 

Seven questions your doctor may ask during your initial appointment:

  • Do you have pain related to bowel movements?
  • Have you noticed a change in how often you have a bowel movement?
  • Has there been a change in how your poop looks?
  • How often do you have symptoms?
  • When did your symptoms start? 
  • What medicines do you take?
  • Have you been sick or had a stressful event in your life recently? 

While reviewing your symptoms, your doctor may look for patterns in frequency or relations to your symptoms; pain directly tied to bowel movements or located in your abdomen are key indicators of IBS. Pain linked with weight loss or rectal bleeding will likely prompt more tests since these can be indicators of other health issues. 

Your family history can help doctors narrow down a diagnosis and even potentially rule out others. Be sure to provide as much information as possible for a more accurate diagnosis. Having a list of medical and food sensitivities can also aid in diagnosing IBS. 

During the physical exam, your doctor will check for bloating, listen for irregular sounds in your abdomen, and check for tenderness or pain. Most cases don’t require tests for an IBS diagnosis, but tests can help rule out other health concerns if you are experiencing some of the less frequent symptoms. Blood and stool tests are the most common ones run, and occasionally a colonoscopy will be ordered if there are concerns related to family health history. 

Seven questions you should ask your doctor during your initial appointment

  • Could another condition be causing my symptoms?
  • What medications can help?
  • What foods should I avoid?
  • What other lifestyle changes should I make?
  • Should I see a gastroenterologist?
  • Should I consult a dietician? 
  • Am I at risk for other health conditions?

The Functional Medicine Approach to IBS Treatment

Unfortunately, conventional medicine has a limited set of tools to successfully treat IBS, and, frankly,  those methods often cause more harm than good. Traditionally, conventional treatment involves laxatives, anti-diarrheal medications, pain medications, and steroids.  

The functional medicine approach involves diagnostic testing to get to the root of the symptoms- whether it be infection, food sensitivities, or other functional issues.  Armed with the right information, we can craft a care plan that includes targeted lifestyle changes and appropriate supplementation that can alleviate your symptoms for good.

Living with IBS

Since there is no known singular cause of IBS, it is difficult to prevent it. After diagnosis, treatment may be trial and error; however, IBS is manageable with assistance and lifestyle changes. It is essential to learn what triggers your personal IBS symptoms in order to avoid flare-ups. Most triggers revolve around food and medication sensitivities. 

If you are experiencing a bout of IBS, take into account anything you’ve consumed within the last 24-36 hours that may be outside of your usual consumption. Consider food tracking for seven days to establish a pattern and identify “safe” foods and others that may incite a GI response. Common food sensitivities for IBS are wheat, dairy, citrus, beans, cabbage, peppers, onion, wine, carbonated drinks, or other forms of caffeine, including chocolate and tea. 

Many living with IBS have seen success by increasing dietary fiber and water intake in their diet. Be sure to note what foods make you feel good and don’t irritate your GI tract. 

Establishing a new baseline for your gut will take time, often weeks or months. It’s important to find support from health professionals like doctors, nutritionists, or counselors.