Irritable Bowel Syndrome (IBS) | Symptoms, Causes, Diagnosis & Treatment

Irritable Bowel Syndrome is a functional gastrointestinal disorder that is characterized by chronic abdominal complaints such as abdominal pain or extreme discomfort associated with changes in the frequency of bowel movements.

IBS, as the syndrome is more commonly referred, does not necessitate the presence of any biochemical or structural defect for its development. Additionally, the fact that some, if not most, of its associated symptoms are shared by numerous gastrointestinal ailments complicates the accuracy of its diagnosis.

Over time, various criteria have been proposed that allow a positive diagnosis based on which symptom or combination of symptoms has a greater predictive and diagnostic value. This is extremely important because frequently patients suffering from more harmful conditions such as celiac disease, ulcerative colitis, Crohn’s disease, and even colon cancer, are misdiagnosed with IBS.

Irritable Bowel Syndrome is not fatal, nor does it increase the risk of developing conditions with high rates of mortality, such as cancer. However, it does have the potential to have a significant impact on the quality of life of those who suffer from it.

As such, it is important that we learn to recognize its symptomatology and seek medical attention if its presence is suspected.

1) Stomach Pain

One of the defining symptoms of Irritable Bowel Syndrome is stomach, or abdominal pain. However, the pain varies considerably in location as well as intensity. Nevertheless, some patterns are common across a wide range of IBS patients. For example, recurring IBS-associated abdominal pain tends to be acute, with attacks lasting less than a day. Additionally, pain is typically most intense after eating with a significant relief after defecation.

2) Abdominal Bloating

Patients with IBS frequently experience abdominal bloating. Abdominal bloating can be best described as a sensation of fullness or tightness in the belly. In patients with IBS, abdominal bloating is typically accompanied by intense cramping. Bloating sometimes contributes to poor bowel motility, which in cases of IBS signifies the possibility of developing constipation.

3) Diarrhea

Diarrhea is a common Intestinal manifestation of a wide variety of disorders, and it can be best described as an acute increase in the frequency, fluidity, and volume of bowel movements. In other words, if you have diarrhea, you will have more frequent and more watery stools than normal. Diarrhea caused by IBS may appear suddenly and last for 2 to 4 days. To treat diarrhea, patients may rely on over-the-counter anti-diarrhea medications or probiotic therapy to balance the gut microbiota.

4) Constipation

Irritable Bowel Syndrome may be Diarrhea-predominant or Constipation-predominant. In cases in which constipation is the predominant symptom, patients experience infrequent or difficult defecation. A constipation diagnosis is generally arbitrary because it depends to a significant degree on the patient’s perception of a normal defecatory frequency.

A normal bowel movement frequency may range between 3 times a day to only a few times per week depending on the individual. Therefore, individual perception of normal frequency is what is significant to a proper diagnosis. Furthermore, other subjective perceptions that impact the relevance of constipation as a symptom of IBS are the consistency and volume of the patient’s fecal matter. Nevertheless, healthy bowel movements are effortless, so strained defecation should be cause for concern.

5) Flatulence

It is perfectly normal that along with the ingestion of food, some air is ingested as well. It is also completely normal to belch this excess gas as a way to decrease tension in the stomach and abdomen. However, it is abnormal to experience prolonged and sustained eructation. Additionally, the interplay between digestive secretions and intestinal fermentation of patients with IBS is abnormal, and as such, it is common to expel gas through the rectum excessively. To treat flatulence, various therapeutic measures can be used depending on the case.

6) Presence of Mucus in Stool

Mucus is a slippery substance that naturally covers the various mucous membranes of the body. Mucus serves many purposes, and in the case of the gastrointestinal tract, it helps stools move through the intestines. Intestinal mucus is usually produced in small quantities, just enough to lubricate the lining of the intestines, so when it becomes possible to observe mucus mixed with fecal matter using only the naked eye, it usually indicates the presence of pathology such as IBS.

7) Fatigue

Curiously enough, many people are shocked to learn that fatigue is a common symptom of Irritable Bowel Syndrome. However, fatigue stands as one of the top extraintestinal symptoms associated with IBS. Fatigue is best described as a sensation of extreme tiredness, exhaustion, or lack of energy. It is normal to feel slightly fatigued after a bad night’s sleep, or a bout of intense physical exertion. However, many illnesses cause abnormal fatigue that must be addressed by a medical professional. If fatigue occurs in conjunction with other more severe symptoms, or if it lasts more than two weeks without apparent cause, a visit to the doctor is highly recommended.

8) Nausea

Nausea is a very frequent symptom of various pathologies and a primary reason behind many gastroenterology consultations. Nausea is the term used to describe the extremely unpleasant sensation that suggests an imminent episode of vomiting. The sensation of nausea is loosely located in the epigastrium or throat and may or may not always culminate in vomiting. In cases of IBS, it is very likely that inflammation and distention of the gastrointestinal organs are responsible for generating the nervous impulses that create a sensation of nausea.

9) Backache

Irritable Bowel Syndrome causes pain in the lower lumbar area. The most common complaint from patients who have IBS regarding back pain is that they experience acute lower back pain with a predominance in the left side. Some patients also experience chronic lower back pain that can generate a hernia between the fifth lumbar vertebra and the sacrum to the left side. IBS patients also frequently complain of pain in the left side of the hip bone due to spasms of the colon, which generate an increase in muscle tension of the left psoas-iliacus muscle.

10) Urinary Symptoms

Irritable Bowel Syndrome can generate a variety of bladder and urinary symptoms, especially in female patients. IBS patients frequently experience an increased frequency of urination and an inability to fully empty the bladder. Additionally, there is a risk to develop coexisting urinary disorders such as interstitial cystitis. Interstitial cystitis, also known as painful bladder syndrome, is a chronic condition characterized by painful bladder pressure and pelvic pain, which can vary from mild to severe. Urinary symptoms of IBS are extremely impactful because the pain and frequent urination can hinder the patient’s ability to participate in social and work-related activities.

11) Fecal Incontinence

Another frequent, although poorly recognized symptom of IBS is dreaded fecal incontinence. Fecal incontinence, also called anal or intestinal incontinence, is an impaired ability to control the passage of feces. Symptoms may vary from mild to severe. In severe cases, patients will be completely unable to control the sphincter muscles that regulate defecation. Patients with IBS suffering from fecal incontinence regularly soil themselves. In case of bleeding in conjunction with a lack of bowel control, it is possible that other more serious conditions are present such as ulcerative colitis, Crohn’s disease, or cancer.

12) Food intolerance

Food intolerance is the existence of adverse reactions in the body as a direct result of ingesting certain foods. Food intolerance can occur due to poor digestion, metabolization, or assimilation of food. Food intolerance can be hereditary; it can occur at any age and can be characterized by a gradually increasing severity. Food intolerance carries a special relationship to Irritable Bowel Syndrome because they cause similar symptomatology. For example, patients with food intolerance suffer from constant and excessive flatulence, chronic diarrhea, constipation, nausea, gastroesophageal reflux, bloating, and abdominal pain.

13) Rectal Tenesmus

Rectal Tenesmus is a symptom of Irritable Bowel Syndrome that can be best described as the sensation of having the urge to defecate, and which remains even after defecation has been achieved. In other words, patients with rectal Tenesmus always feel that their bowel movements are incomplete. The sensation of Tenesmus is not always congruent with the actual presence of fecal matter remaining in the rectum. Rectal Tenesmus is typically associated with constipation. As a symptom, it can develop in cases of gastroenteritis, ulcerative colitis, parasitosis, IBS, and rectal cancer.

14) Sleep Disorders

Sleep disorders, those that impair a person’s ability to rest at night, have far-reaching implications in daily life. For example, patients suffering from regular sleeping disorders often also suffer from physical exhaustion, poor cognitive performance, memory loss, inability to concentrate, and difficulty fulfilling professional, familial, or social obligations.The most common sleep disorders are insomnia, narcolepsy, and sleep apnea. Sleepwalking and restless leg syndrome can also be considered sleep disorders. In cases of IBS, no direct correlation has been established with sleeping disorders. However, patients with IBS are statistically more likely to suffer from a sleep disorder and vice versa.

15) Depression

Even perfectly healthy individuals occasionally go through periods of sadness, unhappiness, or loneliness. However, when these feelings are sustained over extended periods of time and generate an adverse effect on your daily function, a depressive state is likely present. Depression is a mood disorder in which the patient experiences disproportionate sadness and an inability to experience pleasure from any activity. Depression is often accompanied by feelings of guilt, fatigue, worthlessness, and despair. Because of the chronic nature of IBS and the impactfulness of most of its symptoms, strong comorbidity has been observed between it and depression. Patients with IBS are often depressed and suffer from low self-esteem.

16) Reduced Libido

A significant percentage of patients who suffer from Irritable Bowel Syndrome are affected to such a degree that even their sexual relationships begin to suffer. Many patients with IBS report experiencing a drop in their libido due to recurrent abdominal pain and, in many cases, the urge to defecate constantly.

17) Migraines

Patients with Irritable Bowel Syndrome suffer from migraines at a greater rate of incidence than the rest of the population. Just like IBS, migraines are considered a functional disorder, meaning that they are diagnosed by their symptoms, but the mechanisms behind their appearance remain unidentified.

IBS Causes

The exact cause of irritable bowel syndrome (IBS) hasn’t been discovered yet, so we can say that IBS isn’t fully understood. However, there are factors that doctors and studies have determined as main contributors and causes of irritable bowel syndrome. These factors are:

1. Bacterial factors

1. The most typical cause of IBS is an infection, so active bacterial or viral infection may severely affect the gut causing irritation and inflammation as in gastroenteritis.
2. Modulation of the healthy bacteria living in the gut is considered a highly likely cause of irritable bowel syndrome as experts found that the intestinal bacteria of patients suffering from irritable bowel syndrome is different from the bacteria of healthy people.
3. Overgrowth in intestinal bacteria has a noticeable effect on the intestinal homeostasis (internal balance and stability) as it produces gases and toxins, causing bloating, which may lead to IBS.

2. Hormonal factors

It is well known that women suffering from Irritable bowel Syndrome are more than men with a ratio 2:1, and its symptoms strongly appear as menstruation approaches. Thus, it is proposed that changes in hormones may cause IBS.

3. Nervous factors

1. Any slight damage to the enteric nervous system controlling the motility and secretion of the small and large intestine during surgical operation predispose the patient to suffer from irritable bowel syndrome.
2. Abnormal reflexes in the brain-gut axis due to the presence of food in the gut may cause exaggerated or weak response, triggering similar symptoms to those of irritable bowel syndrome.

4. Dietary factors

1. The prevalent dependence on fast food containing too much sauce, spices, salt, and chill is considered the most frequent cause of irritable bowel syndrome, contributing to form inflammatory tissues in the intestines which will lead to most IBS symptoms such as diarrhea alternated with rough constipation and bloating.
2. Specific food causing allergic reflex is a common known cause of irritable bowel syndrome. This one isn’t fully understood, and there are no listed food allergies so far, so keep in mind that any kind of food could cause allergy to anyone at any stage of life. Allergic reflex may cause similar manifestations to those of IBS.
3. Sensitivity to fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) such as those found in apples, apricots and peaches may contribute to causing IBS, as it promotes the sensation of thirst, leads to drinking more water, and this causes fermentation in the large and small intestine forming irritable tissue in the gut and subsequently cause irritable bowel syndrome.

5. Hereditary factors

It is found that people with a family history of irritable bowel syndrome are more likely to suffer from IBS than those with a clear account. According to the previous observation theories, there are prevalent claims that irritable bowel syndrome is mainly passed down genetically and there’s a genetic link playing a significant role in its onset, but none of these claims are well proved.

6. Psychosocial factors

Doctors found that people who suffer from stress, depression, anxiety, mood swings or any overwhelming social emotions could be predisposed to irritable bowel syndrome, and they are more likely to suffer from its symptoms while facing social distress, as in near project deadlines and college exams. Another forgettable minor cause of irritable bowel syndrome is the quality of life because people with a low life quality are more likely to get IBS than those with reasonably better life quality. Statics also shows that 35% of people living in unhealthy environments suffer from irritable bowel syndrome in an early stage of life or young adulthood.

7. Enzymatic factors

There is no doubt that enzymes are indispensable throughout the digestion process, so any deficiency in digesting enzymes whether they are produced in the pancreas, the stomach or intestines will lead to mal-digestion and mal-absorption as food isn’t broken down properly. Accumulation of undigested food in the gut cause irritation of the surrounding tissue which may cause irritable bowel syndrome.

8. Immunity factors

Presence of many immune cells in the intestinal tissues or exaggerated immunologic reflex to intestinal infection could effectively cause similar symptoms to those of irritable bowel syndrome which usually include colic pain and chronic fatigue.

9. Other factors

1. It is believed that certain sorts of drugs and medications could possibly cause irritable bowel syndrome such as iron supplements. High blood pressure drugs, as well as group of antacids, were recorded as a cause of IBS.
2. Some diseases are frequently associated with the same symptoms with irritable bowel Syndrome such as Crohn’s disease and ulcerative colitis, and their link with IBS is researchable.

IBS Diagnosis

Irritable Bowel Syndrome, or simply “IBS,” is one of the most annoying medical conditions a man can be diagnosed with. Despite this fact, luckily, the disease does not affect the lifespan of these patients.

Various tests may be needed before rushing to inform the patient that he or she might be suffering from such a bothering disease. These tests may be as simple as running a basic stool test to search for any bugs that could have infected the bowels. More sophisticated investigations could be used, such as an endoscopy, which uses a flexible wire with a camera attached to its front part to be introduced and visualise the intestines from the inside, and even collecting samples could be to be analyzed afterward. Imaging techniques could be of great help as well to exclude any problems in the walls of the bowels as tumors or even abscesses.

A key point which should be thoroughly investigated is to search for absorption problems. For such an aspect, specific tests could be done. Tests for Lactose intolerance, one of the famous malabsorption diseases, and another test called “Breath test.”

Coeliac disease’s investigations could be requested as well, as this disease could produce symptoms typically found in a patient with IBS. The American College of Gastroenterology recommends all people with symptoms of IBS to be tested for coeliac disease to evade making a misdiagnosis.

– Are these measures the only ones we have currently at hands? Luckily, the answer is no.

Typically, to ensure that the diagnostic process of IBS is on the right path, physical examinations and certain evaluations should be done. “Rome Criteria” is used for this purpose. A significant finding is recurrent tummy pain, on average, at least 1 day per week in the last 3 months, associated with two or more of the following criteria:

• • Related to passing stool
  • Associated with a change in frequency of stool
  • Associated with a change in the appearance of stools

With these criteria fulfilled, it will be possible to reach a diagnosis.

Another method is implementing what is called “Manning Criteria,” which focuses on specific findings related to how the patient passes stool and on the appearance of the stool itself.

Despite the fact that IBS itself is not a life-threating disease and does not affect the patient’s quality of life, a group of symptoms should be ruled out or investigated if present. They are as follows:

• • If the patient’s age is more than 50 years old during the onset of any bowel problems
  • Significant weight loss
  • Bleeding while passing stool
  • Fever
  • Any persistent defecation or diarrhea

In the presence of such symptoms, further investigations would be requested as these symptoms can be described as being “red flags” and may indicate a severe underlying medical condition.

In addition to what is stated above, we should expect that we may still have a narrow chance of misdiagnoses. In details, some patients with IBS can be subjected to unnecessary surgical procedures such as appendectomy “removal of appendix,” cholecystectomy “removal of gall bladder” or hysterectomy in female patients “removal of the uterus.” One of the grave mistakes is to miss making a diagnosis of what is called Inflammatory Bowel Disease or simply “IBD,” an aggressive syndrome consisting of a group of symptoms that could be more severe and could direly affect the patient’s quality of life.

In view of the above, it can be concluded that establishing a diagnosis of IBS is not a piece-a-cake issue and it requires more than the usual attention to do so. The reason for saying this is that many more serious diseases could slip thorough the physician’s fingers leading to resulting of complications that could be prevented if correct measures were taken in the first place.

Treatment of IBS

Unfortunately, there is no fixed medication or therapeutic option that would guarantee a 100% effective treatment of IBS. The following three steps course of treatment will ensure you restore your well-being and full state of health.

A) Acceptance

Being diagnosed with irritable bowel syndrome isn’t welcome news to hear. Thus, accepting this fact is an essential step toward treatment. IBS patients should be aware of what kind of symptoms and side effects they should expect and how to deal with them properly. It is best to give patients as much information about IBS as he asks in order to help him cope with it. Always keep in mind that any progress needs time, so setting goals could result in helping the patient get better sooner.

» The following sorts of therapy are well gathered and highly recommended by many doctors, so following one of them will be the easiest way to treat IBS.

B) Medications

IBS medications treat one symptom or more. Thus, the predominant symptom should be taken into consideration to determine what kind of drugs should be taken. It is advisable to consult a physician or GP (general practitioner) before taking OTC (without prescription) drugs. Classifying drugs according to their action:

1. Antispasmodic / anticholinergic drugs, such as:

Dicyclomine (Bentyl)

Dicyclomine (Bentyl) which is a recommendable smooth muscle relaxant which helps reduce colic pain and intestinal spasms.

Hyoscyamine (Levsin)

Hyoscyamine (Levsin) which is also well-known for its extensive uses, including relieving colic pain and enhancing the motility of the gut.

• • Dosage of both differs according to the condition and the age of the patient, so make sure to consult a doctor or healthcare provider before taking them.
  • Side effects of both include dizziness, headache, blurred vision and nervousness. They are commonly reported, but no considered serious complications.

2. Antibiotic drugs such as Xifaxan (Rifaximin):

It is a well-reputed antibiotic that is usually used in IBS-D (irritable bowel syndrome with diarrhea) to alter or kill harmful intestinal bacteria. It is also believed that a two-week course of Rifaximin would help the patient gets better. Rifaximin, like many antibiotics, is relatively expensive, so it isn’t the first medication doctors recommend or prescribe.

• • Dosage: three 550 mg tablets daily is the standard dose of Xifaxan or as prescribed by your physician.
  • Side effects: nausea, vomiting, abdominal pain, and bloating.

3. IBS drugs (for overall symptoms) such as:

Alosetron (Lotronex)

It reduces the severity of the symptoms and relieves pain significantly as it blocks pain signals discharged from the gut to the brain. Although Lotronex efficacy is reported to be higher in IBS-D, it isn’t prescribed for children because of serious complications that may possibly arise.

• • Dosage: twice a day is the standard dose.
  • Side effect: headache, haemorrhoids, nausea and bloating may happen.

Always share with your doctor any other symptoms.

Lubiprostone (Amitiza )

Lubiprostone (Amitiza ) uses are various. It is helpful to treat chronic constipation as it primarily improves intestinal motility and help the intestines contract and relax in harmony with a specific pace. It is thought that Amitiza enhances the secretory function of the intestines and improves the overall condition of the patient. It is mostly prescribed to patients with IBS-C (irritable bowel syndrome with constipation).

• • Dosage: differs according to the severity of symptoms.
  • Side effects: A runny nose, nausea and vomiting.

4. Probiotic products:

Probiotic products containing bifidobacterium or lactobacillus claim to be the ideal solution for irritable bowel syndrome as they reinforce the intestinal healthy bacteria, which will lead to proper digestion and excretion and subsequently reducing bowel bad habits. Align is one of the most well reputed company for probiotics.

5. Laxatives such as:

Polyethylene glycol (MiraLAX)

Polyethylene glycol (MiraLAX) is an osmotic laxative that could relieve constipation as it keeps hydrophilic compounds in the intestine so that water stays in the gut to stimulate the intestinal motility and ease stool passage through the intestines.

• • Dosage: once daily is the standard dose for up to one week. Any further usage should be under a doctor’s supervision.

Lactulose (Enulose)

Lactulose (Enulose) is a well-known laxative which works as well as other as osmotic laxatives.

• • Dosage: 2-3 tablespoons per day is usually enough to soften your stool. If this dose doesn’t help, consult your doctor before increasing it.
  • Side effects of both: nausea, bloating, vomiting and diarrhoea.

Bisacodyl (Dulcolax)

Bisacodyl (Dulcolax) is a stimulant laxative that enhances intestinal motility and improves its secretion which eases the defecation process and relieves constipation. Dulcolax is believed to have active ingredients causing a fast response within 10 -15 minutes.

• • Dosage: twice a day is the frequent dose with no more intake after one week without the supervision of a doctor.
  • Side effects: nausea, vertigo and vomiting.

6. Anti-diarrheal drugs such as:

Loperamide (Imodium)

Loperamide (Imodium) is an OTC drug that enhances intestinal water absorption with remarkable efficiency.

• • Dosage: two (2mg) capsules per day is a typical dosage. It is reported that misuse of Imodium causes severe complications and may lead to death.
  • Side effects: dry mouth, fatigue, dizziness and vomiting.

7. Anti-flatulence drugs such as:

Simethicone (Mylicon)

Simethicone (Mylicon) is made for patients who suffer from bloating and intestinal flatulence as it reduces the gas bubbles in the gut relieving the associated discomfort. Mylicon feedback is promising so it is usually prescribed by physicians and paediatrics.

• • Dosage: 3 times after meals per day is usually enough to eliminate bloating.
  • Side effects: trouble breathing, dizziness and itching.

8. Anti-histamine drugs:

The action of this kind of medications towards irritable bowel syndrome is still under research. Thus, it is not preferable to start IBS treatment with them.

Theoretically, anti-histamines inhibit and block histamine action, which already has formed the inflammatory tissue causing irritable bowel syndrome.

Claritin and Zyrtec

Claritin and Zyrtec are claimed to relieve most of the symptoms in IBS.

• • Their dosage: as told by the doctor.
  • Side effects: blurred vision and abdominal cramps.

9. Antidepressant drugs:

A significant portion of patients who suffer from IBS face emotional distress and anxiety, so sometimes antidepressants should be prescribed to these patients to treat depression. Antidepressants should be taken only if none of the previously mentioned treatments helped the patient get better.

1. IBS-C antidepressants are usually called SSRI (selective serotonin
   Receptor inhibitors) such as Zoloft, Celexa and Paxil.
2. IBS-D antidepressants are often tricyclic which are known for their more possible serious side effects than SSRI such as Imipramine (Tofranil) and Desipramine (Nopramin).

C) Diet

It is believed that a bad diet is the most frequent cause of irritable bowel syndrome, so following a nourishing and healthy diet will contribute significantly to get well sooner.

• • Avoid spicy food, sweets, alcoholic drinks, glutens and FODMAPs as much as possible.
  • Eat foods rich in fibre, such as banana, broccoli and legumes.
  • Cut down on drinking milk and eating dairy products.
  • Eat smaller meals throughout the day.

Read also; What Is The Best Diet For Irritable Bowel Syndrome (IBS)?