Irritable bowel syndrome is a very common condition that afflicts 10-15% of Americans. Also known as IBS, this condition is a collection of symptoms that affect the gastrointestinal tract. In general, the symptoms of IBS are mild and easily controlled with diet, lifestyle, and stress management. IBS is a chronic condition that requires long-term care.

So, what is IBS? What causes it? And how is it treated? In this article, we will take a comprehensive look at this widely prevalent but frustrating condition. Want more information? Book a video visit with a primary care provider on Sesame to discuss IBS and what you can do about it.

IBS Causes

There is no singular or common cause of IBS. However, several physiological factors appear to play a role in the triggering of IBS symptoms. These include:

• Muscle Contractions: There is a wall of muscles that line your gastrointestinal tract. These muscles contract as they move food through the digestive tract. If these muscles have a problem contracting, they can cause symptoms of IBS. Weak or short muscle contractions can lead to constipation or hard, dry stools.
  

• Nervous system dysfunction: Miscommunication between the nervous system and the gut can cause digestive problems. Similarly, extra-sensitive nerves in the digestive tract can cause symptoms of IBS.
  

• Stress: People who experience stressful events, especially at an early age, are more likely to develop IBS.
  

This is not a complete list of causes, as the exact causes of some IBS cases are unknown.

• Age: IBS is found more frequently in people under the age of 50.
  

• Gender: Women are almost twice as likely to develop IBS as men. Estrogen therapy, in particular, has been linked to the development of IBS in females.
  

• Genetics: IBS may be passed through family history. If you have an immediate family member with IBS, you are at greater risk of developing the condition yourself.
  

• Mental health: A history of anxiety, stress, or depression has been linked to the development of IBS. In addition, a history of physical or emotional trauma might also be a risk factor for this condition.
  
  

IBS Symptoms

The symptoms of IBS vary in severity from person to person. However, these symptoms are generally chronic and require long-term care.

• Abdominal pain or cramping
  
• Bloating
  
• Excessive gas (flatulence)
  
• Diarrhea
  
• Constipation
  
• Mucus in the stool
  
• Fatigue
  
• Nausea and vomiting
  
• Loss of appetite
  
  

Women may experience these symptoms shortly before, or during, their period. In most cases, IBS symptoms occur during “flare-ups”, or episodes in which the effects listed above are particularly prevalent.

If you have noticed a persistent change in your bowel movements or a recurrence of any of the symptoms listed above, you should speak to a health care provider as soon as possible.

Additional triggers

While there is no singular trigger for the cramping, gas, diarrhea, or constipation symptoms associated with IBS, there are several additional triggers that have been known to cause the symptoms listed above. These include:

• Food: Certain foods or beverages have been linked to a flare-up of IBS symptoms. Dairy, citrus fruits and beverages (like orange juice), beans, whole wheat, cabbage, and carbonated beverages have all been associated with uncomfortable IBS symptoms.
  

• Stress: Stress is a common risk factor for the development of IBS. Additionally, periods of heightened stress levels can cause flare-ups. In general, stress is not known to cause symptoms but it can make them worse.
  
  

IBS Diagnosis

There is no specific diagnostic test for IBS. The condition is usually diagnosed by a primary care provider. During your appointment, your provider will ask you about the symptoms you are experiencing as well as your health and family history. You may be asked to undergo stool and blood testing to rule out other conditions that may cause symptoms similar to IBS.

Signs of a more serious medical condition include:

• Symptoms occurring after the age of 50
  
• Weight loss
  
• Rectal bleeding
  
• Fever
  
• Nausea
  
• Vomiting
  
• Stomach pain
  
• Anemia
  
  

Types of IBS

There are three primary types of IBS: IBS-C (constipation-predominant), IBS-D (diarrhea-predominant), and IBS-M (mixed).

IBS-C is characterized by hard stools that pass through the intestines with difficulty and often occur fewer than three times per week. People who have this type of IBS may also experience bloating and abdominal discomfort. Treatment for IBS-C includes dietary changes such as increasing fiber intake or taking over-the-counter laxatives to help relieve constipation.

IBS-D is marked by frequent loose stools that come on quickly and urgently, sometimes resulting in accidents before reaching the restroom. People who have this type of IBS may also feel an urgency to use the bathroom after eating certain foods or drinking certain beverages. Treatment for IBS-D includes dietary changes such as avoiding food triggers, taking probiotics, and using anti-diarrheal medications as needed.

IBS-M is a combination of both constipation and diarrhea that usually fluctuates over time with periods of both constipation and diarrhea occurring at different times throughout the month or year. People who have this type of IBS may also experience abdominal pain or discomfort along with their bowel movements. Treatment for IBS-M typically combines dietary modifications, stress management techniques, and medication to help reduce symptoms and achieve symptom relief.

Treatment for IBS

IBS is a chronic condition, meaning that it requires long-term management to reduce symptoms. Once diagnosed, IBS cannot be cured, but the treatment options available are used to help patients live as symptom-free as possible.

Treatment for IBS will vary depending on the severity of your symptoms. Mild IBS can be treated with dietary adjustments and lifestyle changes.

Lifestyle changes: A healthy, low-stress lifestyle has been shown to reduce symptoms associated with IBS. Your health care provider may direct you to take steps such as:

• Avoiding meals that make symptoms worse
  
• Consuming foods that are high in fiber
  
• Drinking plenty of fluids
  
• Exercising regularly
  
• Getting enough sleep
  
• Practicing stress management techniques
  
  

Dietary adjustments: In addition to the practices listed above, your provider may recommend that you avoid certain foods or cut certain foods out of your diet entirely. These adjustments include avoiding:

• Foods that cause gas: If you have bloating or gas, you may want to avoid carbonated and alcoholic beverages, as well as some foods that cause gas.
  

• Gluten: Even if you don't have celiac disease, some patients with IBS experience improvement in diarrhea symptoms when they quit consuming gluten (wheat, barley, and rye).
  

• FODMAPS: FODMAPS are a group of carbohydrates that include fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These carbohydrates are found in certain fruits, vegetables, grains and dairy products. A low-FODMAP diet has been shown to help some people relieve symptoms of IBS.
  

You may be referred to a dietician to help you with this diet change.

If you experience moderate to severe IBS symptoms, you may be prescribed medication to adequately reduce symptoms.

Medications indicated as a treatment for IBS include:

• Anti-Diarrheal Medication: Loperamide, an over-the-counter medicine, can help reduce diarrhea. A bile acid binder, such as cholestyramine, colestipol, or colesevelam, may also be prescribed by your doctor.
  

• Anticholinergic medications: Anticholinergic drugs are used to treat a variety of conditions. Painful bowel spasms can be relieved with medications like dicyclomine.
  

• Pain medications: Pregabalin and gabapentin are two drugs that can help with pain and bloating caused by IBS.
  

• Fiber supplements: Constipation can be controlled by taking a psyllium supplement with water.
  

• Laxatives: If fiber supplementation isn’t enough to control constipation, your doctor may prescribe an over-the-counter laxative such as Milk of Magnesia or polyethylene glycol (Miralax) to aid bowel movements.
  

• Tricyclic antidepressants: Commonly prescribed for the treatment of depression, these medications can also inhibit the activity of neurons in the brain that control intestinal function. This can help with painful symptoms caused by IBS. You may be prescribed a lower-than-normal dose of tricyclic antidepressants such as imipramine, desipramine or nortriptyline to relieve diarrhea and abdominal pain.
  
  

This is not a complete list of medications used to treat IBS, although they are among the most common. If you do not notice symptoms getting better within a few days of taking medication, talk to your health care provider. They may adjust your treatment or order follow-up testing to adequately treat your condition.

While IBS is a chronic condition that requires long-term care, the treatment options above can significantly reduce symptoms and improve your quality of life. IBS is not life-threatening and is generally manageable with care. If you are experiencing the warning signs of IBS, talk to a health care provider on Sesame right away to start treatment. Sesame offers convenient and affordable in-person and video IBS vistis so you can get the care you need without the hassle of waiting rooms and insurance networks.

• Patel N, Shackelford K. Irritable Bowel Syndrome. https://www.nih.gov
  
• Saha L. Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. https://www.nih.gov
  
• Weaver, K. R., Melkus, G. D., & Henderson, W. A. Irritable Bowel Syndrome. https://www.nih.gov