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IBS specialists are experts in irritable bowel syndrome (IBS). The IBS specialist focuses on diagnosing the cause of your irritated bowel, not on evaluating the structural integrity of the digestive tract with a scope. To the IBS specialist, the label of IBS primarily serves as a starting point for further investigation. Rather than focusing on the patient’s symptoms, or simply treating the symptoms, the IBS specialist is devoted to identifying the underlying condition or conditions in the patient that are causing the symptoms.
What is IBS?
Irritable bowel syndrome (IBS) is also known as spastic colon, irritable colon, mucous colitis, and spastic colitis. It is a separate condition from inflammatory bowel disease and isn’t related to other bowel conditions. IBS is a group of intestinal symptoms that typically occur together. The symptoms vary in severity and duration from person to person. Types of IBS are classified based on certain specific symptoms that occur, such as constipation and weight loss.
IBS vs. IBD: What’s the Difference?
Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are very different conditions that share a few symptoms in common, such as belly discomfort and diarrhea. Both are chronic and have no known cure. But IBD is much more serious. The inflammation that it causes can damage your intestines, and the disease raises your risk of colorectal cancer. IBS, on the other hand, does not harm your gut or increase your chances of cancer or other serious health concerns.
What Does an IBS Attack Feel Like?
The main symptoms of IBS are belly pain along with a change in bowel habits. This can include constipation, diarrhea, or both. You may get cramps in your belly or feel like your bowel movement isn’t finished. Many people who have it feel gassy and notice that their abdomen is bloated. Persistent pain and frequent trips to the bathroom can make everyday life harder. In women, the symptoms are more common during their menstrual period.
Is IBS Curable?
IBS is a chronic condition without a cure. However lifestyle changes, like following a low FODMAP eating plan and reducing stress, can significantly reduce symptoms and the frequency of flare-ups. Identifying your triggers is an important step toward symptom relief. A healthcare professional may also recommend medications that may make life more comfortable.
Can Probiotics Help IBS?
These “good” bacteria live in your gut. There are many kinds of probiotics, and the best known is the type found in yogurt -- look for a label that says "active cultures." Some studies show that certain probiotics -- Bifidobacteria and some probiotic combinations -- may help with IBS symptoms.
Is IBS a Disability?
IBS is a chronic illness that varies in its symptoms and severity. For some with severe IBS, the symptoms may be debilitating. If they prevent a person from doing typical activities, certain organizations may consider the condition to be a disability. However, different organizations have different ways of defining disability. The SSA, which provides disability benefits, does not consider IBS a disability. However, a person with the condition could still qualify for SSA benefits if they can prove they cannot perform meaningful work. For those who can work, employers must provide reasonable accommodations under the ADA. Other protections and tools a person with IBS may be able to use include the Restroom Access Act and “I Can’t Wait” cards.
Can IBS Go Away on its Own?
IBS is one of many incurable conditions. Unfortunately, if you have IBS, you will always have IBS. It won’t go away on its own, and there’s yet no treatment that will banish it forever. One of the most important things to learn about IBS is that you have the power to control the frequency and intensity of your symptoms. Although researchers still can pinpoint the root cause of IBS, we know a lot about what triggers flare-ups, and the more you know about what triggers your symptoms, the better off you’ll be.
Is IBS Genetic?
Irritable bowel syndrome (IBS) can affect members of the same family, but this may be due to shared lifestyle and other risk factors. Scientific research has not found a genetic reason for IBS to run in families.
How Common is IBS?
In Western countries, IBS seems to affect women twice as often as men. IBS is very common, occurring in up to 15 percent of the United States population. Most people with IBS develop their first symptoms before the age of 40, with many patients recalling the onset of symptoms during childhood or young adulthood. There appears to be a familial component, as many IBS patients report having a family member with similar symptoms. Less commonly, the symptoms of IBS develop after a severe intestinal infection; this is called post-infectious IBS.
How Much Does IBS Treatment Cost?
Annual out-of-pocket expenses averaged $406 for treatment of IBS symptoms, $294 for diarrhea, $390 for constipation, and $304 for abdominal pain. Lower gastrointestinal costs comprised 9% of total costs for IBS, 9% for diarrhea, 6.5% for constipation, and 9% for abdominal pain. In-patient care accounted for 17.5% of total costs (15.2% IBS). Costs were affected by disease severity (increased), recent exacerbation of bowel symptoms (increased), and whether the patient was consulting for the first time (decreased).
Types of IBS
Researchers categorize IBS based on how your stools (poop) look on the days when you’re having symptom flare-ups. Most people with IBS have normal bowel movements on some days and abnormal ones on others. The abnormal days define the kind of IBS you have.
1. IBS with constipation (IBS-C): Most of your poop is hard and lumpy.
2. IBS with diarrhea (IBS-D): Most of your poop is loose and watery.
3. IBS with mixed bowel habits (IBS-M): You have both hard and lumpy bowel movements and loose and watery movements.
The differences are important. Certain treatments only work for specific types of IBS.
- Diarrhea (often described as violent episodes of diarrhea)
- Constipation
- Constipation alternating with diarrhea
- Belly pains or cramps, usually in the lower half of the belly, that get worse after meals and feel better after a bowel movement
- A lot of gas or bloating
- Harder or looser stools than normal (pellets or flat ribbon stools)
- A belly that sticks out
- Mucus in your poop
- Feeling like you still need to poop after you just did
- Food intolerance
- Tiredness
- Anxiety
- Depression
- Heartburn and indigestion
- Headaches
- Needing to pee a lot
Causes of IBS
The exact cause of IBS isn't known. Factors that appear to play a role include:
1. 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 usual can cause gas, bloating, and diarrhea. Weak contractions can slow food passage and lead to hard, dry stools.
2. Nervous system. Issues with the nerves in your digestive system may cause 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 typically occur in the digestive process. This can result in pain, diarrhea, or constipation.
3. Severe infection. IBS can develop after a severe bout of diarrhea caused by bacteria or a virus. This is called gastroenteritis. IBS might also be associated with a surplus of bacteria in the intestines (bacterial overgrowth).
4. Early life stress. People exposed to stressful events, especially in childhood, tend to have more symptoms of IBS.
5. Changes in gut microbes. Examples include changes in bacteria, fungi, and viruses, which typically reside in the intestines and play a key role in health. Research indicates that the microbes in people with IBS might differ from those in people who don't have IBS.
Risk Factors for Irritable Bowel Syndrome
IBS affects between 25 million and 45 million Americans. Some things seem to make people more likely to have it than others:
Being assigned female at birth. About twice as many people AFAB as those assigned male at birth (AMAB) have the condition. It’s not clear why, but some researchers think the changing hormones in the menstrual cycle may have something to do with it. So far, studies haven’t borne this out.
1. Age. IBS can affect people of all ages, but it's more likely to happen in people in their teens through their 40s.
2. Family history. The condition seems to run in families. Some studies have shown that your genes may play a role.
3. Emotional trouble. Some people with IBS seem to have trouble with stress, have a mental disorder, or have been through a traumatic event in their lives, such as sexual abuse or domestic violence. It's not clear what comes first – the stress or the IBS. However, there's evidence that stress management and behavioral therapy can help relieve symptoms in some people with the condition.
4. Food sensitivities. Some people may have digestive systems that rumble angrily when they eat dairy, wheat, a sugar in fruits called fructose, or the sugar substitute sorbitol. Fatty foods, carbonated drinks, and alcohol can also upset digestion. There's no proof any of these foods cause IBS, but they may trigger symptoms.
5. Medications. Studies have shown a link between IBS symptoms and antibiotics, antidepressants, and drugs made with sorbitol.
6. Other digestive problems, like stomach flu, traveler's diarrhea, or food poisoning. A small study published in January 2021 suggests that a GI tract infection can change the immune system so that it responds to certain foods as if they're a threat, like germs or viruses. Researchers are looking into these early findings.
7. Chronic pain conditions. Several disorders that cause pain have been linked to irritable bowel syndrome, including:
- Fibromyalgia
- Chronic pelvic pain
- Interstitial cystitis, which causes bladder pain
- Migraine
- Temporomandibular syndrome, which causes pain when chewing
- Chronic fatigue syndrome
How IBS is Diagnosed
Your healthcare provider will look at your past health and give you a physical exam. You may not need any specific testing. Your provider will decide how much testing you need depending on your age and symptoms. They will also do lab tests to check for infection redness and swelling (inflammation). There are usually no physical signs to tell for sure that you have IBS. There are also no exact tests for IBS. Your healthcare provider will do lab tests and imaging tests to make sure that you don’t have other diseases. These tests may include the following:
1. Blood tests. These are done to see if you are lacking healthy red blood cells (anemia), have an infection, or have an illness caused by inflammation or irritation.
2. Urinalysis and urine culture. These help to see if you have an infection in any part of your urinary system (urinary tract infection or UTI). This includes your kidneys, the tubes that send urine from the kidneys to the bladder (ureters), your bladder, and the urethra, where urine leaves your body.
3. Stool culture. This test checks for any abnormal bacteria or parasites in your digestive tract that may cause diarrhea and other problems. To do this, a small stool sample is taken and sent to a lab. Other infections can also be evaluated by a stool sample.
4. Stool testing for blood (fecal occult blood test). This test checks for hidden blood in your stool that can only be seen with a microscope. A small amount of stool is tested in a lab. If blood is found, it may mean you have redness and swelling (inflammation) in your GI (gastrointestinal) tract.
5. Upper endoscopy, also called EGD (esophagogastroduodenoscopy). This test looks at the inside or lining of your food pipe (esophagus), stomach, and the top part of your small intestine (duodenum). This test uses a thin, lighted tube called an endoscope. The tube has a camera at one end. The tube is put into your mouth and throat. Then it goes into your esophagus, stomach, and duodenum. Your healthcare provider can see the inside of these organs. They can also take a small tissue sample (biopsy) if needed.
6. Abdominal X-rays. This test makes images of your internal tissues, bones, and organs.
7. Abdominal ultrasound (sonogram). If your symptoms seem like they may be coming from the liver or gallbladder area, an ultrasound can check. It can also check how blood is flowing through different blood vessels.
8. Colonoscopy. This test looks at the full length of your large intestine. It can help check for any abnormal growths, red or swollen tissue (inflammation), sores (ulcers), or bleeding. A long, flexible, lighted tube called a colonoscope is put into your rectum up into the colon. This tube lets your healthcare provider see the lining of your colon and take out a tissue sample (biopsy) to test it. They may also be able to treat some problems that may be found.
9. Breath test. This test may diagnose bacterial overgrowth in the intestines that some believe can lead to IBS.
Foods that Trigger IBS Attack
Each person with IBS has different symptoms that different foods or other factors may trigger. Below are some of the most common ones. Foods that may make IBS diarrhea worse:
- Fried foods
- Fatty foods
- Dairy (especially if you are lactose intolerant)
- Foods containing wheat (if you are gluten-sensitive)
- Too much fiber (especially from fruit/vegetable skin)
- Chocolate
- Carbonated drinks
- Caffeine
- Alcohol
Foods that may make IBS constipation worse:
- Processed foods (cookies, chips)
- Refined grains (white flour)
- Dairy (especially cheese)
- Too much protein
- Carbonated drinks
- Caffeine
- Alcohol
If you’re not sure what foods are triggering your symptoms, try the elimination approach. Make a list of foods you suspect may be causing your symptoms and eliminate one food at a time for 12 weeks to see if it makes a difference in how you feel.
What to Eat for IBS
Food is a powerful tool to have in your toolbox, and a registered dietitian can help guide and support you in creating a long-term strategy and plan that works for you and your lifestyle. This could include helping to foster a positive relationship with food, increasing confidence when making food choices at home and when out, encouraging nourishing foods that won’t worsen gut symptoms, preventing unnecessary food restrictions, and managing potential food fears.
1. Drink at least 8 cups (2 L) of fluid per day (e.g., water, herbal tea, broth) to stay hydrated.
2. Space fruit intake apart by 2-3 hours and stick to no more than one fruit portion per meal or snack.
3. Choose cooked vegetables more often than raw, as cooked vegetables are easier to digest.
4. Choose easier-to-digest proteins, such as eggs, chicken, turkey, fish, extra-firm tofu, and plain lactose-free Greek yogurt. Lower-fat cooking methods, such as baking, roasting, steaming, boiling, and sautéing, can also help you avoid uncomfortable symptoms.
5. Consider adding certain types of fiber if you are constipated, such as flaxseeds, oats, inulin, or psyllium. Avoid wheat bran and prunes, which are highly fermentable fibers that can trigger symptoms such as gas and abdominal pain.
6. Consider a short-term trial of a daily probiotic for at least one month and monitor symptoms. Check out probioticchart.ca for a list of evidence-based probiotics in Canada. Ask your doctor, pharmacist, and/or registered dietitian if there are any reasons why you shouldn’t be taking a probiotic (e.g., immunocompromised).
How to Treat IBS
No specific therapy works for everyone, but most people with IBS can find a treatment plan that works for them. Typical treatment options include changing the foods you eat and your routine. Medications can help, too. Behavioral health therapy may help. Many of these treatments take time to work. They can help your symptoms, but they may not completely disappear.
Activity Changes
Changing daily activities can help, too. Your provider may recommend that you:
1. Exercise regularly. Aim for 150 minutes of moderate exercise weekly. This is about 30 minutes a day, five days a week. “Moderate” means you’re raising your heart rate.
2. Try relaxation techniques. Daily yoga, meditation, and other de-stressing techniques can help calm an overtaxed nervous system and a “nervous gut.” Sometimes, a behavioral therapist can help.
3. Get enough sleep. Aim for seven to nine hours of quality sleep each night. Go to bed at the same time each night. A good night’s rest is one of the most powerful de-stressors available. Reach out to a provider if you’re having trouble sleeping.
4. Keep an activity diary. Record the activities that help you manage your IBS and compare notes with your provider.
Therapy
Many people with IBS benefit from seeing a therapist. Therapy can help you get a handle on stress and conditions such as anxiety and depression that contribute to IBS. Some people find relief through:
1. Cognitive behavioral therapy (CBT).
2. Hypnotherapy.
3. Biofeedback.
Medications
Your healthcare provider may prescribe medications to provide symptom relief, including:
1. Antidepressants (if you have depression and anxiety along with significant abdominal pain). Medications include tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).
2. Medications to ease constipation (including fiber supplements and laxatives).
3. Medications to firm stools (anti-diarrheal).
4. Medications to help with intestinal spasms.
Although research into their effectiveness is ongoing, your provider may recommend probiotics. These “good bacteria” may help relieve IBS symptoms.
Medications specifically used to treat IBS include:
Applying warmth to your belly can help soothe your mind and relieve your IBS pain. There are a variety of ways to apply heat to your stomach, and all of them work. You can choose the one that you like best and is most convenient for you:
- Use a heating pad. Be sure to protect your skin with clothing or a towel.
- Try a hot water bottle. This is an excellent choice when you need pain relief as you sleep.
- Apply sports creams that treat pain by creating a warming sensation. Pain reliever creams and ointments are a good method of fast pain relief on the go.
2. Sip a Cup of Tea
Like a heating pad, something is soothing about a nice cup of hot tea. Each of the following types of tea has a reputation for easing digestive distress:
- Peppermint tea is a good choice to soothe your stomach.
- Chamomile tea can also help calm the stomach.
- Anise tea is good for constipation.
- Fennel tea is good for digestion issues.
If you are following a low-FODMAP diet, you may want to avoid chamomile and fennel tea. A low-FODMAP diet restricts certain types of carbohydrates and sugar alcohols that the small intestine can't absorb easily. It is a common treatment for IBS. Keep your kitchen pantry well stocked and bring tea bags with you when you are out and about.
3. Eat Carefully
When your belly hurts because of digestion problems, you won't want to make things worse with food. Try foods that are light, healthy, and easy on the stomach. At the same time, do your best to avoid foods that will cause more stomach discomfort. Once your pain has eased, you can slowly go back to eating your regular diet. If you have IBS and you have frequent stomach pain, you will want to find a long-term way of eating that helps ease IBS symptoms.
4. Try an Over-the-Counter Supplement
There are a few products available without a prescription that may bring IBS pain relief:
- Peppermint oil has been shown by research to be antispasmodic. This means that it reduces muscle spasms and cramping, which can ease pain.
- Gas-relieving products are easily available at stores. If your abdominal pain feels more like trapped gas than cramping, you may find relief by taking a product containing simethicone, a medication that makes gas easier to pass.
5. Calm Your Mind and Body
When we are in pain, we tend to get anxious. Unfortunately, anxiety can make our pain worse. Taking a few minutes to calm down can be very effective. Relaxation exercises are a way to break the cycle of anxiety and pain. They offer a way to "turn off" the anxious feelings. They work better with regular practice, but can still offer some benefits for immediate pain relief.
Three basic types of relaxation exercises are:
- Visualization
- Deep breathing
- Muscle relaxation
With a little experimentation, you can decide which methods work best for you.
6. Use Your Imagination
Believe it or not, you can soothe your body and promote healing through the use of healing imagery. Research shows that using your imagination can lead to positive changes in your body and even decrease the amount of pain you feel from IBS. After you have calmed your body with relaxation exercises, stimulate your imagination and dream up a few soothing pain-relieving images. Here are some possibilities, but feel free to come up with your own:
- Imagine a white healing light coming into your body and swirling all around your belly, healing and soothing your aggravated digestive tract.
- Imagine that the pain is a hard ball of wax that is slowly melting as you envision a warm, healing heat spread through the area.
- Imagine that a soft, healing balm is making its way through your system, serving to cool, soothe, and calm the inflamed tissue.
7. Listen to a Hypnotherapy Recording
Hypnosis has strong research support for easing the symptoms of IBS, including abdominal pain. Ideally, you want to be engaged in an ongoing hypnotherapy treatment program for best results. But when you are in immediate pain, you may be able to benefit from the relaxation of listening to a hypnosis recording that focuses on the gut.
How to Find an IBS Specialist Near Me
The following steps can help you identify an IBS specialist who aligns with your preferences and circumstances.
1. Recommendations: Ask for recommendations from your primary care provider.
Research gastroenterologists: Look for providers with board certifications and experience treating IBS.
2. Location, availability, and insurance: Choose a provider with a convenient location. Check their availability and if they (and the facility where they perform procedures) accept your insurance plan.
3. Read patient reviews: Patient reviews provide insights about the provider's communication style and patient experience in their clinic.
4. Consult multiple providers: Schedule consultations with more than one provider to determine which provider makes you feel comfortable and confident.
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