Irritable Bowel Syndrome

Happy Monday, and welcome to Medical Mondays! …In addition to being Alcohol Awareness Month and Sexual Assault Awareness Month, April also happens to be IBS Awareness Month! (D-damn, April! You got a lot goin’ on! :O )

What is IBS, you ask?

Well, it’s right in the title of the post–IBS is Irritable Bowel Syndrome. IBS is very often confused with IBD (Inflammatory Bowel Disease, which encompasses Crohn’s Disease + Ulcerative Colitis)–I’ll get to the latter in May.

Irritable Bowel Syndrome (IBS) is a benign idiopathic disorder that’s characterized by abnormal activity of the GI tract while at rest, and is often associated with depression and anxiety.

It is not caused by stress, but is often associated with it due to the connection between the brain + the gut.

IBS affects ~10-15% of the U.S. population, and can range from mild inconvenience to severe debilitation. Individuals with moderate to severe IBS often struggle with symptoms that impair their physical, emotional, and social well-being.

Symptoms

• Include a combination of diarrhea, constipation, abdominal pain, and/or abdominal bloating
• Notably relieved by defecation

“Red-flag” symptoms that might suggest a more serious condition include:

• Anemia
• Bleeding
• Weight loss
• Early satiety

Classification

IBS can be split into 4 different classifications:

• Constipation-predominant
• Diarrhea-predominant
• Alternating
• Post-infectious

Diagnosis

For the diagnosis of IBS, a patient must have the following:

• Recurrent abdominal pain/discomfort for >3 days/month in the past 3 months AND 2+ of the following:
  • Improvement with defecation
  • Onset associated with change in stool frequency
  • Onset associated with change in stool appearance

IBS is a diagnosis of exclusion, meaning that other causes must be ruled out first with lab tests + stool exams, and clinical suspicion for IBS is needed.

Tests may range from a colonoscopy (especially with patients > 50 year olds who’ve never had one, to rule out colorectal cancer) to biopsies to lactose breath tests (to rule out lactose intolerance) or blood tests for celiac disease.

Treatment

The best treatment is stress management, although dietary* + lifestyle modifications for symptomatic relief may be beneficial. This includes:

• Fiber supplementation
• Increased water intake (for predominant constipation)
• Lactose-free diet
• Exclusion of gas-producing foods (e.g. beans, broccoli, cabbage, cauliflower, carbonated drinks)
• Avoidance of caffeine to limit anxiety/symptom exacerbation

*Carbohydrates that are poorly absorbable and highly gas-forming can exacerbate IBS symptoms. These are known as “FODMAPS” (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, Polyols), and include:

• Fruits with fructose in excess of glucose (e.g. apples + pears)
• Raffinose-containing foods (lentils, cabbage)
• Sorbitol-containing foods (e.g. plums + artificial sweeteners)
• Fructan-containing foods (e.g. onions, asparagus, large amounts of wheat)

If medications are indicated, options include:

• Diarrhea-predominant
  • Anti-diarrheals (e.g. loperamide, diphenoxylate hydrochloride + atropine sulfate)
  • Antibiotics (e.g. rifaximin) for severe IBS w/o constipation that does not respond to other treatments
  • TCA’s (tricyclic antidepressants, e.g. amitriptyline, imipramine)
  • Anti-spasmodic agents (e.g. dicyclomine hydrochloride, hysocyamine sulfate)
  • Serotonin receptor antagonists (e.g. alosetron)
• Constipation-predominant
  • Laxatives (e.g. lubiprostone, methylcellulose, linaclotide)
  • Chloride channel activators
  • Guanylate cyclase C agonists

For a great post on someone’s personal experience with IBS medications, check out Amber’s post on IBS medication options! (She also has a great one for possible natural remedy options that may help!)

Probiotics may also help to improve IBS symptoms, and psychological + behavioral therapies (e.g. cognitive behavioral therapy, hypnosis, relaxation training) may be effective in certain individuals.

For a great post by someone who’s a registered dietitian and thus actually licensed to talk about nutrition, check out The Spicy RD’s post on simple diet + nutrition tips for IBS!

There’s apparently a free mobile app that includes topics related to IBS and constipation, so if you’re interested in gaining a better understanding of either (or both), go check out the app! (Note: I haven’t actually downloaded it, but I came across it whilst doing research for this post, so there you go. :O )

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Disclaimer: This is where I reiterate that I am merely a medical student struggling through the world that is her clinical rotations. The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)