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The Basics
- What is IBS?
- What causes IBS?
- What are the different types of IBS?
- IBS and women: the statistics
- How does IBS affect women differently?
Diagnosis and Treatment
Empower Yourself
References
Irritable Bowel Syndrome
Discuss all medical advice, diagnosis, and treatment with your healthcare provider.
IBS Resources
The Basics
What is IBS?
IBS (Irritable Bowel Syndrome) is a disorder that mainly affects the bowels, primarily the large intestine or colon. The colon is the part of the digestive system that stores stools. The colon absorbs fluid and passes the stool to the rectum where it can be evacuated. Because IBS causes several symptoms, it is considered a syndrome. Some of the symptoms of IBS include
- Cramping
- Abdominal pain
- Bloating
- Gas
- Diarrhea
- Constipation
For people with IBS, the nerves and muscles of the bowels are particularly sensitive. As a result, IBS sufferers have problems with bowel motility, and sensation of the bowels. The pain receptors in the gastrointestinal (GI) tract are more sensitive, so IBS can cause a great deal of pain. In addition, when motility of the colon becomes irregular, affected individuals can experience diarrhea, constipation, or both.
The normal movement of the bowels may be affected in people who have IBS. The bowel can experience spasms, which means the muscles contract suddenly and then return to normal. The bowels in people with IBS may also stop working temporarily.
The lining of the colon is called the epithelium. It regulates the flow of fluids into and out of the colon. In people who are suffering from IBS, the epithelium appears to function properly, but when the contents inside the colon move too quickly, the colon loses its ability to absorb fluids. As a result, more fluid enters the stool than is healthy and diarrhea occurs. In other cases, the movement inside the colon is too slow and more fluid is absorbed than usual, causing constipation.
What causes IBS?
A number of factors are thought to increase the likelihood of developing IBS or to increase the symptoms' flares. Researchers believe that people who suffer from IBS have very sensitive colons. The colon is the large bowel.
There are a number of neurotransmitters that are involved in pain perception and sensation and movement of the GI tract (GI motility) and one of these neurotransmitters is serotonin.
The cells that line the bowel carry serotonin and release it into the GI tract or bloodstream, for example, after a meal. People with IBS have diminished receptor activity, which causes abnormal levels of serotonin to exist in the GI tract. When there isn't the right amount of serotonin, the communication between the brain and the bowel is disrupted.
People with IBS will find that their symptoms increase with certain foods and with chronic stress. Although the following factors may not affect some people, they may trigger IBS in people with sensitive bowels.
- Large meals
- Fatty foods
- Wheat, rye, barley, chocolate, milk products, or alcohol
- Drinks with caffeine such as coffee and caffeinated drinks
- Stress
Stress: Stress is one of the leading triggers of IBS. When people are feeling emotionally overwhelmed or tense, these feelings can stimulate spasms in the colon in people with IBS. The colon is partly controlled by the automatic nervous system, which responds to stress. These nerves control the regular contractions of the colon, so when the nervous system is upset, it can disrupt the contractions and cause discomfort. Short-term stress will induce bowel changes in everyone, for example, when people have performance anxiety, they may experience mild diarrhea. However, with long-term or chronic stress people with IBS will experience ongoing problems such as abdominal cramps or pain, diarrhea, and/or constipation.
Comorbidities to IBS and medical conditions with overlapping symptoms
A number of medical conditions can often coexist in people who suffer from IBS. If this is the case, symptoms from IBS and the coexisting illness will often overlap. Some of these conditions include
- Chronic constipation
- Gastrointestinal reflux disease
- Celiac disease
- Fibromyalgia
- Chronic fatigue syndrome
What are the different types of IBS?
There are three different types of IBS, and each affects your bowels in markedly different ways.
IBS-D: IBS with mostly loose and watery stools (diarrhea)
IBS-C: IBS with mostly hard, lumpy stools (constipation)
IBS-M: IBS with mixed diarrhea and constipation
IBS-A: IBS in which an individual transitions between types over weeks to months
IBS and women: the statistics
- IBS affects 1 in 10 adults in the US, making it one of the most common ailments diagnosed by doctors. Women are more frequently affected than men.
- Between 60% and 75% of IBS sufferers are women.
- IBS accounts for nearly 3.5 million physician visits in the US annually, and it is the most common diagnosis by gastroenterologists.
- About 70% of IBS patients may suffer from their IBS symptoms more than once a week.
- Treatment (direct and indirect healthcare burden) of IBS costs the US healthcare system up to an estimated $30 billion annually.
- Generally, IBS sufferers take up to 3 years before actually getting help for their symptoms and receiving a proper diagnosis. This may, in part, be due to the fact that often the patients' symptoms are not considered a serious medical condition, patients are not comfortable discussing their symptoms, or they are not confident that a treatment exists for their symptoms.
- Symptoms of IBS typically occur in women between the ages of 30 and 50. In a GI sufferer study conducted by the Society for Women's Health Research, the average age at which symptoms appeared was 29. The prevalence of IBS is reported to decrease after the age of 60.
How does IBS affect women differently?
Although the symptoms of IBS are not different in women than in men, IBS presents in women up to three to four times as frequently as men (in the healthcare-seeking population). Women are more likely to suffer mixed symptoms (consitipation and diarrhea), and it is more common for women to have visible bloating, urinary symptoms, and other associated symptoms such as fatigue, myalgia, and sexual disturbance.
Some general reasons that IBS may affect women differently include differences in reproductive hormones, pain perception, stress responses, and gastrointestinal function.
One study showed that for women with IBS, sleep is very important. A poor night's sleep led to even more severe symptoms the following day for a woman with IBS who experiences associated symptoms described above, it is very important to consult your healthcare professional to exclude other illnesses that may account for these symptoms. For example, urinary symptoms may be a sign of a urinary tract infection.
Diagnosis and Treatment
Diagnosis
IBS is a heterogenous disease with a wide range of associated symptoms associated. Therefore, it is difficult to create a single definition of the syndrome and somewhat difficult to identify and diagnose IBS in patients. However, in 1999, a group of experts met in Rome to develop a set of criteria for symptoms to be used in the diagnosis of IBS.
The Rome III Criteria state that to be diagnosed with IBS, a patient should
- Have suffered from abdominal pain or discomfort commencing 6 months before diagnosis and active currently for the past 3 months (and for at least 3 or more days per month) and have at least two of the following characteristics:
—The pain is relieved with defecation and/or
—The pain's onset is associated with a change in the frequency of the stool and/or
—The pain's onset is associated with a change in the form of the stool
Note: Discomfort means an uncomfortable sensation not described as pain.
Other symptoms that may support a diagnosis of IBS, but aren't delineated in the Rome III Criteria, include
- Abnormal frequency of stools: more than 3/day or less than 3/week
- Abnormal stool form: lumpy and hard or loose and watery
- Abnormal stool passage: straining, urgency, or feeling of incomplete evacuation
- Passage of mucus
- Bloating: feeling of or visible abdominal enlargement
If you think you might have IBS, you need to see your healthcare professional. He or she will analyze your medical history and will take note of your specific symptoms. You will also undergo a physical examination. Other tests may include stool samples, blood tests to exclude thyroid and celiac disease, X-rays, and a colonoscopy. Blood tests may be done.
A colonoscopy may be necessary to exclude other causes of your bowel symptoms. This is done by inserting a flexible tube with a camera on the end of it through the anus. The camera documents what's going on inside the colon and transfers these images onto a large screen.
If the diagnosis from these tests is negative, you still may be diagnosed with IBS depending on your reported symptoms. How often you have experienced abdominal pain, when the pain stops and starts in relation to your bowel function, and bowel frequency and stool consistency are the factors to be considered in making a diagnosis.
Treatment
While no cure has yet been found for IBS, there is no need to suffer without seeking treatment. Unfortunately, that is just what most people suffering from IBS do. Up to 70% of IBS sufferers are not receiving medical care for their condition. However, there are treatments for the different symptoms of IBS to help decrease discomfort. The three primary treatments of IBS are diet and dietary changes, stress management, and medication.
Stress management and lifestyle changes
Because chronic stress is a major trigger for IBS, it is important that you control stress. Some ways you can do this are
- stress reduction (relaxation) training and relaxation therapies such as meditation
- psychotherapy, cognitive behavioral therapy, hypnosis
- regular exercise such as walking or yoga
- changes to the stressful situations in your life
- adequate sleep
There are certain lifestyle changes that may be helpful. Sometimes changing your work schedule can help not only reduce stress but assist you in sticking to a healthier diet. Keeping a diary of your symptoms can help you identify diet and lifestyle triggers.
Diet
Certain foods and eating habits that have a tendency to aggravate sensitive colons. While sensitivities vary from person to person, there are common precipitators of IBS symptoms. Before you make changes to your diet, keep a log of what you eat and what reactions you have. Note especially any foods that seem to trigger symptoms. Share these findings with your healthcare professional. You may want to talk to a dietician or nutritionist to help create a diet that is right for you and your personal sensitivities.
Dairy often causes symptoms of IBS, so many sufferers will cut down on dairy products. However, some kinds of dairy are less likely to cause problems than others. For example, yogurt contains the bacteria that supplies the enzyme needed to digest lactose. Thus, for lactose-intolerant people, yogurt may not be a problem. If you do decide to eliminate dairy from your diet, be sure to take a supplement or to find the important nutrients, like calcium, elsewhere.
Fiber is known to lessen constipation symptoms. High fiber diets keep the colon mildly distended, or relaxed, which prevents spasms. Some types of fiber also help the stool to retain water, helping to soften bowel movements. Of course, this is not the problem in people experiencing diarrhea, so adding fiber may not help these IBS sufferers at all. Some foods with fiber include
- Peaches
- Apples
- Broccoli
- Raw cabbage
- Raw carrots
- Raw peas
- Kidney beans
- Lima beans
- Whole-grain bread
- Whole-grain cereal
Large meals can cause diarrhea and cramping and can thus escalate your symptoms. Eating smaller meals more often throughout the day will help. The exclusion of foods that increase flatulence (for example, beans, onions, prunes, cabbage, and brussel sprouts) should be considered if bloating or excess gas is a concern.
Medication
Medication is only useful as an adjunct to dietary changes and stress management. The choice of medication depends on the individual's symptoms.
If your primary symptom is constipation, your healthcare professional may suggest fiber supplements or laxatives. If your symptom is diarrhea, your healthcare professional may suggest medicine such as Lomotil or Loperamide (Immodium). Loperamide should be used only on an as needed basis, when diarrhea is troublesome.
Other commonly prescribed medications for people with IBS are antispasmodic medicines such as mebeverine and dicyclomine. These medicines help relax the muscles in the bowel wall and thereby control spasms and reduce symptoms of abdominal pain and discomfort.
Some patients with abdominal pain are prescribed tricyclic antidepressants. This medicine can also help with symptoms of diarrhea because it slows down the gut transit time.
A medication called lubiprostone is sometimes prescribed for people with constipation-predominant IBS, although this medicine is not actually FDA approved for use in IBS. It is, however, approved for use in people with the condition of chronic constipation (non-IBS-related constipation).
Medications specifically for women with IBS include
- Alosetron hydrochloride (Lotronex): This drug is specifically for women with IBS who have not responded to other forms of therapy, and whose primary symptom is diarrhea. Lotronex has serious restrictions set by the FDA because its side effects include decreased blood flow to the colon and severe constipation.
- Tegaserod maleate (Zelnorm): This drug is also designed for women. It has been approved by the FDA for short-term treatment of women whose primary symptom is constipation, and is prescribed for 4 to 6 weeks.
Therapies not yet proven
Therapies such as herbs, acupuncture, or probiotics may be useful for the treatment of IBS symptoms but as yet there is no conclusive scientific evidence to support their effectiveness.
Empower Yourself
Dealing with IBS
It is important to acknowledge that IBS is a serious disorder that can be treated. If you are suffering from IBS, you need to report symptoms to your healthcare professional and take control. Some steps you can take to diminish the severity of your symptoms.
- Reduce stress levels
- Yoga, meditation, consistent exercise
- Eat healthful foods that do not irritate your bowels (see DIET, above)
- Drink at least 6 to 8 glasses of noncarbonated water per day
- Avoid excess caffeine
- Keep a diary so you can identify which foods and activities trigger your IBS symptoms so you can avoid them in the future.
- Identify and treat other illnesses that may be associated with IBS, like depression or anxiety, chronic fatigue syndrome, stress, or fibromyalgia.
Frequently asked questions
What is irritable bowel syndrome (IBS)?
Irritable bowel syndrome is characterized by abdominal discomfort or pain, bloating, and altered bowel symptoms (constipation, diarrhea, or alternating). The term "syndrome" refers to a collection of symptoms that together comprise this medical condition. Some people may suffer one of these symptoms, and other people may suffer a combination of these symptoms.
How common is IBS?
All forms of IBS impact the lives of millions of people. As many as one in five adults in the US, or 20% of the population, suffer from the abdominal discomfort or pain, bloating, and altered bowel symptoms associated with IBS. IBS typically begins early in life. In more than 50% of patients, symptoms begin before age 35. IBS occurs in both men and women. However, the prevalence appears to be greater in women. Approximately seven out of every 10 IBS sufferers are women.
How serious is IBS?
IBS is a medical condition with recurring symptoms that reduces quality of life. IBS requires proper diagnosis and management. However, IBS has not been shown to cause any dangerous or life-threatening consequences such as cancer.
What is the impact of IBS?
- IBS affects up to 20% of the adult American population.
- More than 70% of patients may suffer from their IBS symptoms more often than once a week.
- IBS costs the US healthcare system an estimated $30 billion annually.
- On average it takes up to 3 years before IBS sufferers receive a proper diagnosis from the time they first experience symptoms. This may in part be due to the fact that patients' symptoms were not initially recognized as a serious medical condition.
What is IBS with constipation?
IBS with constipation, or IBS-C, is characterized by abdominal discomfort or pain, bloating, and constipation as the primary bowel symptom. Approximately 6 million women in the US suffer from IBS-C.
What causes IBS with constipation?
Contrary to what many people think, IBS is not caused only by stress or eating habits. Until recently, the cause of IBS has been poorly understood and underappreciated. However, in recent years, new research has yielded a better understanding of the cause of IBS. People who suffer from the abdominal discomfort or pain, bloating, and constipation of IBS may have a digestive system that is more sensitive or works more slowly than it should, possibly because of the way their digestive system reacts to changes in a naturally occurring chemical in their body called serotonin. Serotonin regulates movement in the digestive system and the perception of abdominal discomfort and pain.
Glossary of IBS terms
Abdomen: Area between the chest and the hips that contains the stomach, small and large intestines, liver, gall bladder, pancreas, and spleen.
Achalasia: Failure of the lower esophageal sphincter to relax.
Acute: Sudden onset of symptoms.
Acquired: Developed after birth.
Aerophagia: Ingestion of air.
Antispasmodics: Drugs that inhibit smooth muscle contraction in the gastrointestinal tract.
Anorectal manometry: A test that can be used to measure resting and squeezing anal sphincter pressures, rectal sensation and compliance, and sphincter response.
Anus: The opening of the rectum.
Autonomic nervous system:: The part of the nervous system that controls involuntary actions of internal organs, such as the bowel.
Barium enema: (BAR-ee-um EN-uh-muh): An X-ray of the bowel using a liquid called barium to make the bowel show up better. This test is also called a lower GI (for gastrointestinal) series.
Bowel: The part of the digestive system that makes and stores the stool. It is also called the large intestine.
Celiac disease: Inability to digest and absorb the protein gliadin (a component of gluten). Gliadin is found in wheat, rye, barley, and oats. Celiac disease is also called celiac sprue and gluten intolerance.
Cell: The basic unit of any living organism. It is a small, watery, compartment filled with chemicals and a complete copy of the organism's genome.
Chronic: Symptoms occurring over a long period of time.
Chronic fatique syndrome: A disorder characterized by severe fatigue that is not improved by bed rest, may be worsened by physical or mental activity, and tends to have a profound effect on an individual's quality of life. Persons with chronic fatigue syndrome usually function at a much lower activity level, and, if they suddenly increase their activity level, can experience worsening of their fatigue and exhaustion. People can also experience other associated symptoms, including muscle pains, problems concentrating, and sleeping difficulties. There is no cure, and the specific cause of chronic fatigue is not known.
Colon: The large intestine.
Colonic inertia: Delayed colonic action. Symptoms include long delays in the passage of stool accompanied by lack of urgency to move the bowels.
Colonoscopy: Colonoscopy is a fiberoptic (endoscopic) procedure in which a thin, flexible, lighted viewing tube (a colonoscope) is threaded up through the rectum for the purpose of inspecting the entire colon and rectum and, if there is an abnormality, taking a tissue sample of it (biopsy) for examination under a microscope, or removing it.
Colostomy: A surgically created opening of the colon to the abdominal wall, allowing the diversion of fecal waste.
Endoscopy: (en-DAH-skuh-pee): A test to look at the inside of the bowel.
Epithelium: The inner and outer tissue covering digestive tract organs.
Fibromyalgia: A chronic condition characterized by widespread pain and tender spots in the muscles, ligaments, and tendons. It is also associated with severe fatigue.
Functional: Refers to how something works.
Functional abdominal pain: Continuous, nearly continuous, or frequently recurrent pain localized in the abdomen but not related to gut function.
Functional bowel disorder: A functional gastrointestinal disorder with symptoms attributable to the mid or lower gastrointestinal tract.
Functional constipation: A group of functional disorders that present as persistent difficult, infrequent, or seemingly incomplete defecation.
Functional diarrhea: Daily or frequently recurrent passage of loose (mushy) or watery stools without abdominal pain or intervening constipation.
Functional disorder: Refers to a "disorder of functioning" in which the body's normal activities in terms of the movement of the intestines, the sensitivity of the nerves of the intestines, or the way in which the brain controls some of these functions is impaired. However, there are no structural abnormalities that can be seen by endoscopy, X-ray, or blood tests. Thus a functional disorder is identified by the characteristics of the symptoms (for example, Rome Criteria III) and infrequently, when needed, limited tests.
Gastrointestinal (GI) tract: The muscular tube from the mouth to the anus, also called the alimentary canal or digestive tract.
Gastrointestinal reflux disease (GERD): A medical condition in which the liquid content of the stomach regurgitates back into the esophagus (food pipe). Symptoms include an unpleasant taste in the mouth, chest pain, heart burn, and nausea. Over time, continuous reflux of stomach liquid can cause the esophagus to become inflamed and damaged.
Inflammation: Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.
Inflammatory bowel disease (IBD): Long-lasting problems that cause irritation and ulcers in the gastrointestinal tract. The most common disorders are ulcerative colitis and Crohn's disease.
Ingestion: Taking into the body by mouth.
Intestinal permeability: The barrier properties of the lining of the intestines, which prevent harmful substances from passing through into the body.
Intestinal pseudo-obstruction: A motility disorder with symptoms like those of a bowel blockage, but with no physical evidence of blockage or obstruction. Symptoms may include cramps, stomach pain, nausea, vomiting, bloating, fewer bowel movements than usual, and loose stools.
Intestines: Also known as the gut or bowels, the long, tube-like organ in the human body that completes digestion or the breaking down of food. The intestines consist of the small intestine and the large intestine.
Lactose: A sugar found commonly in milk and dairy products.
Lactose intolerance: The inability to digest or absorb lactose.
Laparoscopy: The insertion of a thin, lighted tube (called a laparoscope) through the abdominal wall to inspect the inside of the abdomen and remove tissue samples.
Large intestine: The long, tube-like organ that is connected to the small intestine at one end and the anus at the other. The large intestine has four parts: cecum, colon, rectum, and anal canal. Partly digested food moves through the cecum into the colon, where water and some nutrients and electrolytes are removed. The remaining material, solid waste called stool, moves through the colon, is stored in the rectum, and leaves the body through the anal canal and anus.
Laxative: A compound that increases fecal water content.
Mucus: A clear, sticky discharge that might look white.
Myalgia: Muscle pain that can be a symptom of muscle overuse as well as certain diseases and disorders.
Neurotransmitters: Chemicals in the body that relay signals from nerve cells or neurons to other cells. Serotonin is an example of a neurotransmitter.
Prevalence: The total number of cases of a disease in a population at a given time.
Receptor: A structure in each cell that selectively receives and binds a specific substance such as a neurotransmitter.
Rectum: The lower end of the large intestine, leading to the anus.
Serotonin (5-hydroxytryptamine, or 5-HT): A chemical neurotransmitter (a chemical that acts on the nervous system to help transmit messages along the nervous system). It is found in the intestinal wall and the central nervous system. It is now widely understood that 95% of the serotonin in the body resides in the gut.
Stool: Feces or bowel motion.
Syndrome (SIN-drome): A group of symptoms.
Urinary tract infection: Bacterial infection of the urine usually in the bladder or in the urethra, which is the passage that allows urine to flow from the bladder out of the body.
IBS resources and tools
Government Agencies
*Accepts Spanish calls
NDDIC
2 Information Way
Bethesda, MD 20892-3570
Phone: (800) 891-5389
Fax: (703) 738-4929
www.niddk.nih.gov
*National Center for Complementary and Alternative Medicine, NIH, HHS
PO Box 7923
Gaithersburg, MD 20898
Phone: (888) 644-6226
TTY: (866) 464-3615
Fax: (866) 464-3616
http://nccam.nih.gov
Private Organizations
International Foundation for Functional Gastrointestinal Disorders (IFFGD) Inc.
PO Box 170864
Milwaukee, WI 53217
Phone: (888) 964-2001 or (414) 964-1799
Fax: (414) 964-7176
www.iffgd.org
Newsletters, Magazines, Reports
Healthy Women Today
The National Women's Health Information Center
www.womenshealth.gov/newsletter
Help for IBS
Subscribe to the "Help for IBS" newsletter to receive information on IBS and news and breakthroughs in research.
www.helpforibs.com
Tools
The IBS Support Group
Through daily blogs, chatrooms, and newsletters, you will see on this site that you are not alone.
www.ibsgroup.org
References
1. American College of Gastroenterolgy. Understanding Irritable Bowel Syndrome. A Consumer Education Brochure. Available at http://www.gi.org/patients/ibsrelief/IBS.pdf. Accessed May 15, 2007. [Evidence Level C]
2. Dhaliwal SK, Hunt RH. Eur J Gastroenterol Hepatol. 2004;16:1161-1166. [Evidence Level C]
3. Brandt LJ, et al. Am J Gastroenterol. 2002;97(11suppl);S7-S26. [Evidence Level A]
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