If you’ve ever dealt with abdominal pain, bloating, and found yourself dashing to the bathroom – or wishing you could because you’re battling constipation – trust me, you’re not alone! These are common symptoms of Irritable Bowel Syndrome (IBS), a frustrating digestive disorder that can negatively impact your daily life.
IBS plagues about 10-15% of people worldwide and it can seem to come out of nowhere. This gastrointestinal (GI) disorder is characterized by chronic diarrhea and/or constipation, along with other symptoms like gas and bloating. What makes it more frustrating is that unlike many GI disorders, it cannot be tested for with blood work, colonoscopy, or endoscopy. There are no visual markers such as pockets of inflammation, fistulas, or damaged villi in the intestines as are found in other disorders.
While doctors don’t completely understand what causes it, theories say it can be caused by a mix of factors like stress, anxiety, abnormal gut movements, inflammation, heightened sensitivity in the gut, past infections, food poisoning, antibiotic use, and changes in the bacteria that live in our intestines.
What’s tricky about IBS is how differently it can show up for each person. Many find that specific foods — especially those high in sugar, dairy, caffeine, and alcohol — can kick their symptoms into high gear. For others, certain high-fiber carbohydrates referred to as FODMAPs can be major triggers and make them feel awful.
This blog will help you understand what irritable bowel syndrome is, common symptoms, how it’s diagnosed, types of IBS, and how to treat and manage this gastrointestinal disorder.
Symptoms of Irritable Bowel Syndrome (IBS)
Symptoms of irritable bowel syndrome can vary, but common symptoms include:
- Abdominal pain: Often cramping or sharp, usually relieved after a bowel movement.
- Bloating: A feeling of fullness or swelling in the abdomen.
- Gas: Excessive flatulence or belching.
- Diarrhea: Frequent, loose stools, often urgent.
- Constipation: Infrequent or difficult bowel movements.
- Alternating bouts of diarrhea and constipation
- Mucus in stool: Presence of whitish mucus when passing stools.
- Changes in bowel habits: Alterations in the frequency or consistency of stools.
These symptoms and their triggers may change with stress, exercise, certain foods, and other lifestyle changes. Signs and symptoms may also co-occur with conditions like small intestinal bacterial overgrowth (SIBO), inflammatory bowel disease (IBD), or celiac disease.
How to Know if You Have Irritable Bowel Syndrome
When it comes to diagnosing Irritable Bowel Syndrome, it’s crucial to ensure that other, more serious conditions are ruled out. Symptoms of IBS can overlap with other gastrointestinal disorders, such as celiac disease, IBD, and even colorectal cancer, so a thorough evaluation by a healthcare professional is essential.
To begin with, doctors typically gather a detailed medical history and perform a physical examination. They may also recommend certain tests like blood tests, stool tests, or imaging studies to exclude other conditions. Celiac disease, for example, can be identified through specific blood tests and a biopsy of the small intestine if necessary. Similarly, IBD, which includes Crohn’s disease and ulcerative colitis, may require endoscopic procedures to visualize the intestines and confirm a diagnosis.
If other conditions are ruled out, the question becomes, is it IBS? Doctors typically rely on your symptoms and history rather than a single test. They often refer to guidelines like the Rome IV criteria, which focus on how frequently you experience symptoms and how long they’ve been a problem.
Working with a gastroenterologist is particularly important in this context. Gastroenterologists specialize in disorders of the digestive system and can provide a comprehensive assessment that considers both IBS and other potential diagnoses. They can guide the patient through the diagnostic process, recommending appropriate tests and interpreting their results within the context of the patient’s symptoms.
What if You’re Diagnosed with IBS?
If irritable bowel syndrome is confirmed, a tailored treatment plan will be developed. This approach not only ensures that individuals receive the right diagnosis, but also provides peace of mind by addressing any underlying health concerns that may be contributing to their symptoms. Collaborating closely with a gastroenterologist can dramatically enhance the management of IBS and improve overall well-being.
This plan should also include the help of a qualified Registered Dietitian to help you rule out food triggers to reduce symptoms and help regulate bowel movements. If your doctor only advises pharmaceuticals without referring you to a dietitian, you may want to ask for this referral to improve your outcomes and stop the guessing game with foods. IBS can result in nutrient deficiencies or malnutrition due to people only eating “safe foods” and eliminating nutrient-rich foods. A dietitian who specializes in IBS can help you better understand which foods may cause triggers and why, and help you personalize a diet that allows you to enjoy food without the pain.
A treatment team may also include a therapist who can work with you on any underlying stress, anxiety or mental health issues contributing to GI upset.
Irritable Bowel Syndrome Subtypes
As mentioned, Irritable Bowel Syndrome (IBS) is not a one-size-fits-all diagnosis; there are different types, each defined by the predominant symptoms a person is experiencing.
The main types of IBS include:
1. IBS with Diarrhea (IBS-D): This type is characterized primarily by frequent loose or watery stools. People with IBS-D may experience urgent bowel movements, along with abdominal cramping and discomfort. Symptoms can often flare up after meals, particularly after consuming high-fat or spicy foods.
2. IBS with Constipation (IBS-C): In contrast to IBS-D, those with IBS-C primarily struggle with infrequent or difficult bowel movements. These individuals experience symptoms such as days without a bowel movement, straining on the toilet,, hard or lumpy stools, and abdominal pain or bloating. IBS-C may be aggravated by a low-fiber diet or inadequate fluid intake.
3. Mixed IBS (IBS-M): Individuals with mixed type experience a combination of both diarrhea and constipation. They may alternate between episodes of diarrhea and constipation, making management more challenging. This may actually be IBS-C in some cases, and the diarrhea is happening due to constipation back-up/blockage. Triggers may vary, such as stress or certain foods, and may change over time.
4. IBS Unsubtyped (IBS-U): Some people won’t fit neatly into any of the above categories, leading to a diagnosis of IBS-U. Symptoms can be inconsistent, making it difficult to pinpoint predominant issues. Individuals may exhibit a mix of symptoms without a clear pattern.
The differences between these types of IBS highlight the need for personalized treatment plans. Each type may respond differently to dietary changes, medications, and lifestyle interventions. For instance, while a Low FODMAP diet (more on this below) might be more beneficial for those suffering from IBS-D, increasing fiber intake could help those with IBS-C. By identifying the specific type of IBS, a registered dietitian can better help you plan the right diet for you, and healthcare providers can offer more targeted support, ultimately leading to better management of symptoms and improved quality of life.
Irritable Bowel Syndrome Treatment and Management
When it comes to managing IBS, there’s no one-size-fits-all solution. It usually involves a combination of dietary modifications, lifestyle changes, and possibly therapy and/or medications.
1. Stress
IBS tends to be linked with stress, anxiety, and/or dysfunction in the gut-brain axis, so it is important to address stress as part of treating and managing IBS. Stress and anxiety can trigger changes in gut function, leading to symptoms like abdominal pain, bloating, and changes in bowel habits. When a person is stressed, the body releases hormones that can affect digestion and gut motility.
Stress can also heighten sensitivity in the gut, making it more reactive to normal digestive processes. This can amplify the pain and discomfort associated with irritable bowel syndrome. Additionally, when stressed, individuals may turn to comfort foods, often high in sugar or fat, which can exacerbate IBS symptoms. Stress may also lead to disrupted eating patterns, such as skipping meals or overeating, further aggravating digestive issues.
Chronic stress can affect other lifestyle factors that are important for managing IBS, such as sleep and physical activity. Poor sleep quality and lack of exercise can worsen symptoms, creating a cycle that can be difficult to break.
Studies have shown that stress reduction techniques, such as mindfulness, prayer, yoga, meditation, cognitive-behavioral therapy (CBT), and regular exercise, can significantly improve symptoms in individuals with IBS. These techniques can help train the body to respond better to stress, thereby reducing the impact on digestive health.
2. Diet
Many people find success with the Low FODMAP diet, which stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. The diet is specifically designed to help manage the symptoms of IBS by reducing the intake of certain fermentable carbohydrates that are poorly absorbed in the small intestine.
Here’s a closer look at each component:
- Oligosaccharides: Found in foods like wheat, onions, and garlic.
- Disaccharides: Lactose is the most common example, found in dairy products. Many people with IBS have lactose intolerance, which can exacerbate symptoms.
- Monosaccharides: Fructose, found in high amounts in honey and certain fruits, can lead to symptoms if not balanced with glucose.
- Polyols: Sugar alcohols like sorbitol and mannitol are found in some fruits and artificial sweeteners.
Why the Low-FODMAP Diet Helps with IBS
1. Identifying Triggers: The Low-FODMAP diet is typically followed in three phases: elimination, reintroduction, and personalization. Initially, you eliminate high-FODMAP foods for a period (usually about 2-6 weeks) to see if symptoms improve. If they do, you can gradually reintroduce FODMAPs one at a time to identify which specific types trigger your symptoms. A registered dieititan can show you exactly how to do this, as well as how to properly reintroduce foods. They can also help you decide if a full elimination diet is necessary, or if a “gentle approach” would be more appropriate for lifestyle and health situation.
2. Reducing Fermentation: FODMAPs are highly fermentable, which means they can create gas, bloating, and cramping when broken down in the gut. Reducing high-FODMAP foods that are triggers for you can minimize these uncomfortable feelings.
3. Enhancing Quality of Life: By following a Low-FODMAP diet and identifying trigger foods, individuals often find that their symptoms become more manageable. This can lead to a greater sense of control and improved social interaction, mental health, work performance, and overall quality of life.
4. Nutritional Awareness: The process of navigating a Low-FODMAP diet encourages individuals to become more aware of what they eat. This heightened awareness can lead to healthier eating patterns and better digestion, even beyond the limitations of the diet itself.
Get our Low-FODMAP Meal Plan and Guide with recipes, meal-prep tips to help you make sense of the diet and help you get started with recipes that won’t upset your digestion!
However, it is important to note that while the Low-FODMAP diet can be very effective for many individuals with IBS, it’s best undertaken with support from a healthcare professional or a registered dietitian. They can help ensure you’re still getting a balanced diet and necessary nutrients during the elimination phase and can guide you through the reintroduction phase effectively. It is best to usde the meal plan and reference guide alongside help from a registered dietitian.
3. Exercise
Regular exercise can play a huge role in keeping your gut happy, promoting good gut bacteria, and help reduce stress — a factor that can worsen irritable bowel syndrome. The best options include enjoyable movement like long walks, yoga, Pilates, dance, strength training, light jogging, easy cycling, swimming, and other low-intensity exercise. It may be best to hold back from frequent high-intensity or long-endurance exercise while working to reduce symptoms of IBS because these can be more stressful on the gut and digestion.
Many endurance runners struggle with IBS as well, and some don’t have the disorder but will experience similar symptoms due to lack of blood flow and inflammation during running. This may look like bloating, diarrhea, or stomach cramps for some runners. As a stubborn runner myself with GI upset myself, I know that runners are rarely the type to simply stop running and turn to walking or yoga instead. If this sounds like you, enroll in our online course, A Runner’s Guide to Reducing Gastrointestinal Symptoms for endurance runners and triathletes to learn how to reduce and manage GI upset while optimizing performance, whether you have IBS or just “runner’s stomach”.
4. Holistic Symptom Management
Many people find symptom relief by incorporating holistic treatments as well. For instance, peppermint oil has become popular for its benefits in easing IBS symptoms, particularly its ability to soothe the stomach and relax intestinal muscles. It’s often taken in enteric-coated capsules to avoid any gastrointestinal side effects.
Simple pleasures like singing and humming can also help to activate the vagus nerve.The vagus nerve plays a crucial role in the body’s parasympathetic nervous system, which helps regulate digestion, heart rate, and mood. It connects the brain to various organs, including the gut. Activating the vagus nerve through vocalization like singing can lead to improved digestion and reduced stress.
Herbal laxatives like senna or psyllium husk can help with constipation and related bloating.
Other alternatives, like acupuncture, herbal supplements, and probiotics, are being studied for their potential to help improve gut health, although research is still evolving, and their use should be under the guidance of a health professional.
5. Medications
In more severe cases, medications might be necessary. There are various options available, including antispasmodics for pain and anti-diarrheal medications. Some prescription treatments are specifically approved for IBS, which may also help if other diet and lifestyle changes or gentle supplements have not solved the problem.
You Can Find Relief!
While having IBS can be a very difficult challenge, finding the right mix of diet, stress management, body movement, holistic and medical treatments can lead to a much better quality of life. By collaborating with healthcare providers and taking a well-rounded approach to managing symptoms, individuals with IBS can regain control and start feeling more like themselves again.
If you’d like more help or guidance, contact us for a free consult at [email protected]
Sources:
1. Lacy, B.E., et al. (2020). “Rome IV Criteria for IBS Diagnosis.” American Journal of Gastroenterology.
2. O’Sullivan, M., et al. (2020). “The Low FODMAP diet: A practical approach for IBS.” Clinical Gastroenterology and Hepatology.
3. Buchan, I.E., et al. (2018). “Cognitive Behavioral Therapy for IBS: A Review.” Journal of Gastroenterology.
4. Miguel, M., et al. (2020). “Probiotics and IBS: An updated review.” Journal of Clinical Gastroenterology.
5. Shabboo, R. et al. (2019). “Peppermint oil for the treatment of irritable bowel syndrome: A systematic review and meta-analysis.” World Journal of Gastroenterology.
