IBS: Understanding triggers & treatment

Labels and abbreviations are commonplace in our techno-centric society. Think of texting: LOL, BFF, etc. In medicine we are just as guilty of using abbreviations and shorthand to describe diagnoses or conditions. In the field of GI one common example is IBS.

IBS is an acronym for Irritable Bowel Syndrome. IBS is a common disorder involving the intestines that leads to crampy abdominal pain, gassiness, bloating and changes in bowel habits. Some people with IBS have constipation (difficulty passing or infrequent bowel movements) while others have diarrhea (frequent loose stools, often with an urgent need to pass their bowels) and some people experience both.

Although IBS is common it is often difficult to make a definitive diagnosis since the diagnosis is made by excluding other conditions such as Crohn's disease, celiac disease, Ulcerative colitis or even malignancies of the GI tract. Often times patients will undergo testing including lab testing, stool testing, x-rays or other radiologic studies as well as a colonoscopy.

While there are no known causes for IBS, there are definitely triggers for these symptoms to flare up. Emotional stress can lead to increased pain sensation and diarrhea via increased gut hormones such as serotonin. This is the so-called “Brain-Gut” Axis. Imagine situations such as making a public speech, travelling or taking an exam where patients with IBS may have the urge to have diarrhea or difficulty with having a bowel movement.

Meal time can often be an inconvenient trigger for IBS symptoms. The colon is normally stimulated about 30-60 minutes after a meal, but in IBS patients this can be much more sudden and urgent with anxiousness about having an accident, or can be greatly delayed leading to bloating and cramping. Researchers have found that the colon muscle of a person with IBS contracts and can go into spasm after only mild stimulation. This is one reason why medications that are anti-spasmodics have been used for many years for this condition during flare ups. It is also why this disorder was once referred to as “spastic colitis.”

IBS treatments include dietary modifications with trigger avoidance, probiotics and some antibiotics, as well as psychological treatments that target the brain-gut connection.

• Dietary changes: Avoiding high fat foods, keeping a food journal to target triggers, smaller portions and diets higher in fiber. Insoluble fiber such as psylium can draw water into the stool and promote colonic motility. Think of whole-grain breads, cereals and beans as good sources of fiber. (Caution: too much fiber can create more gas and bloating symptoms).
• Probiotics and some antibiotics: This speaks to one of the theories of IBS being a “post infectious” syndrome. Some studies suggest IBS symptoms begin in certain patients after enduring an infectious diarrhea or dysentery that leaves their gut nervous system increasingly sensitive.
• Psychological treatments such as stress management, meditation, and in some cases anti-depressant medications can help lessen the symptoms of IBS.

While IBS is not a life threatening condition, it can significantly impact a patient's life and sense of well- being, and therefore is an ongoing area of research.