Irritable Bowel Syndrome
Irritable bowl syndrome (IBS) is a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. IBS is a chronic condition that you’d need to manage long term. Only a small number of people with IBS have severe signs and symptoms. Some people can control their symptoms by managing diet, lifestyle and stress. More-severe symptoms can be treated with medication and counseling. IBS doesn’t cause changes in. bowel tissue or increase your risk of colorectal cancer.
Diagnosis and treatment of Irritable Bowel Syndrome (IBS) may require an appointment with one of our trusted primary care providers or gastroenterologists. If you’re experiencing certain signs or symptoms of IBS (listed below) in Manhattan or throughout NYC, book an appointment with one of our trusted providers.
The signs and symptoms of Irritable Bowel Syndrome vary. The most common include:
- Abdominal pain, cramping or bloating that is typically relieved or partially relieved by passing a bowel movement
- Excess gas
- Diarrhea or constipation — sometimes alternating bouts of diarrhea and constipation
- Mucus in the stool
Most people with IBS experience times when the signs and symptoms are worse and times when they improve or even disappear completely.
The precise cause of Irritable Bowel Syndrome isn’t known. Factors that appear to play a role include:
- Muscle contractions in the intestine. The walls of the intestines are lined with layers of muscle that contract as they move food through your digestive tract. Contractions that are stronger and last longer than normal can cause gas, bloating and diarrhea. Weak intestinal contractions can slow food passage and lead to hard, dry stools.
- Nervous system. Abnormalities in the nerves in your digestive system may cause you to experience greater than normal discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can cause your body to overreact to changes that normally occur in the digestive process, resulting in pain, diarrhea or constipation.
- Inflammation in the intestines. Some people with IBS have an increased number of immune-system cells in their intestines. This immune-system response is associated with pain and diarrhea.
- Severe infection. IBS can develop after a severe bout of diarrhea (gastroenteritis) caused by bacteria or a virus. IBS might also be associated with a surplus of bacteria in the intestines (bacterial overgrowth).
- Changes in bacteria in the gut (microflora). Microflora
arethe “good” bacteria that reside in the intestines and play a key role in health. Research indicates that microflora in people with IBS might differ from microflora in healthy people.
There’s no test to definitively diagnose Irritable Bowel Syndrome. Your doctor is likely to start with a complete medical history, physical exam and tests to rule out other conditions. If you have IBS with diarrhea, you likely will be tested for gluten intolerance (celiac disease).
After other conditions have been ruled out, your doctor is likely to use one of these sets of diagnostic criteria for IBS:
- Rome criteria. These criteria include abdominal pain and discomfort lasting on average at least one day a week in the last three months, associated with at least two of these factors: Pain and discomfort are related to defecation, the frequency of defecation is altered, or stool consistency is altered.
- Manning criteria. These criteria focus on pain relieved by passing stool and on having incomplete bowel movements, mucus in the stool and changes in stool consistency. The more symptoms you have, the greater the likelihood of IBS.
- Type of IBS. For the purpose of treatment, IBS can be divided into three types, based on your symptoms: constipation-predominant, diarrhea-predominant or mixed.
Your doctor will also likely assess whether you have other signs or symptoms that might suggest another, more serious, condition. These signs and symptoms include:
- Onset of signs and symptoms after age 50
- Weight loss
- Rectal bleeding
- Nausea or recurrent vomiting
- Abdominal pain, especially if it’s not completely relieved by a bowel movement, or occurs at night
- Diarrhea that is persistent or awakens you from sleep
- Anemia related to low iron
If you have these signs or symptoms, or if an initial treatment for IBS doesn’t work, you’ll likely need additional tests.
Treatment of IBS focuses on relieving symptoms so that you can live as normally as possible.
Mild signs and symptoms can often be controlled by managing stress and by making changes in your diet and lifestyle. Try to:
- Avoid foods that trigger your symptoms
- Eat high-fiber foods
- Drink plenty of fluids
- Exercise regularly
- Get enough sleep
Your doctor might suggest that you eliminate from your diet:
- High-gas foods. If you experience bloating or gas, you might avoid items such as carbonated and alcoholic beverages, caffeine, raw fruit, and certain vegetables, such as cabbage, broccoli and cauliflower.
- Gluten. Research shows that some people with IBS report improvement in diarrhea symptoms if they stop eating gluten (wheat, barley and rye) even if they don’t have celiac disease.
- FODMAPs. Some people are sensitive to certain carbohydrates such as fructose, fructans, lactose and others, known as FODMAPs — fermentable oligo-, di-, and monosaccharides and polyols. FODMAPs are found in certain grains, vegetables, fruits and dairy products. Your IBS symptoms might ease if you follow a strict low-FODMAP diet and then reintroduce foods one at a time.
A dietitian can help you with these diet changes.
If your problems are moderate or severe, your doctor might suggest counseling — especially if you have depression or if stress tends to worsen your symptoms.
In addition, based on your symptoms your doctor might suggest medications such as:
- Fiber supplements. Taking a supplement such as psyllium (Metamucil) with fluids may help control constipation.
- Laxatives. If fiber doesn’t help symptoms, your doctor may prescribe magnesium hydroxide oral (Phillips’ Milk of Magnesia) or polyethylene glycol (Miralax).
- Anti-diarrheal medications. Over-the-counter medications, such as loperamide (Imodium), can help control diarrhea. Your doctor might also prescribe a bile acid binder, such as cholestyramine (Prevalite), colestipol (Colestid) or colesevelam (Welchol). Bile acid binders can cause bloating.
- Anticholinergic medications. Medications such as dicyclomine (Bentyl) can help relieve painful bowel spasms. They are sometimes prescribed for people who have bouts of diarrhea. These medications are generally safe but can cause constipation, dry mouth and blurred vision.
- Tricyclic antidepressants. This type of medication can help relieve depression as well as inhibit the activity of neurons that control the intestines to help reduce pain. If you have diarrhea and abdominal pain without depression, your doctor may suggest a lower than normal dose of imipramine (Tofranil), desipramine (Norpramine) or nortriptyline (Pamelor). Side effects — which might be reduced if you take the medication at bedtime — can include drowsiness, blurred vision, dizziness and dry mouth.
- SSRI antidepressants. Selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil), may help if you’re depressed and have pain and constipation.
- Pain medications. Pregabalin (Lyrica) or gabapentin (Neurontin) might ease severe pain or bloating.
Qwell gastroenterologists are highly trusted providers based in New York City. Each provider has been recommended by other Qwell providers, providing you the ease of mind of finding a specialist and booking online. To learn more about your GI condition and treatment plans from our Qwell providers, please schedule an appointment with one of our primary care physicians or specialists throughout New York City.