Welcome to part three of my frequently asked questions series! We've already covered general questions about IBS and common questions about IBS triggers. This week, we'll discuss frequently asked questions about IBS symptoms. Grab your spectacles, friend. I'm about to get my nerd on!
Why Are My Symptoms So Inconsistent?
There are several reasons your IBS symptoms may seem to strike without warning or reason. First of all, many things can trigger IBS symptoms. These include what we eat, our daily routines, how we cope with stress and anger, as well as the environment in which we live.
First, let's look at food. Many different foods may trigger people with IBS. These can include general gut irritants (like fat, spice, caffeine, etc.), foods containing large amounts of FODMAPs (a specific group of short-chain carbohydrates), resistant starches, foods high in histamine, etc. The kind of foods that trigger symptoms is different from person to person. So, it can be hard to pin them down.
If that isn't tricky enough, it can also take between 6-12 hours for your food to reach the large intestine (colon). This means when you experience symptoms (even if they occur right after eating), you're likely reacting to something you ate hours or even days ago.
On top of that, there are many external factors (like lack of sleep, high levels of stress, little or no physical activity, etc.) that can throw a monkey wrench in your digestive system.
So, how are you supposed to figure out what's going on? The trick is to track as many variables as you can. Try writing down everything that goes in and comes out of your body in a food/symptom journal. Once you have a few weeks of data, you and your healthcare team will be able to spot patterns between specific foods, events, and activities, and your symptoms even if they happen days apart.
You can read more about how to keep a useful food and symptom journal here. I also have a journal template available in my free resource library if you need help getting started. You can access the library here.
Are My Symptoms Normal?
If you're not sure if some of your symptoms are related to IBS, your first stop should be to your doctor. Unlike Dr. Google, your healthcare team knows your medical history and can help you navigate symptoms better than any algorithm.
If you're just curious, because IBS sits differently in each person, there is no “normal.” If you meet the criteria for IBS, you're in the club no matter how many times a day you poop (or how many days in a row you don't).
As a refresher, to meet the criteria for IBS, a person must have abdominal pain related to bowel movements at least once a week for at least three months and two or more of the following symptoms:
- Pain related to bowel movements;
- A change in the frequency of bowel movements; and
- A change in the consistency of bowel movements (as rated on the Bristol Stool Scale)
You can read more about the criteria for IBS and specific IBS-related symptoms here.
How Can I Control My IBS Symptoms
The key to controlling your IBS symptoms is to understand what's happening in your body. There are a few reasons IBS symptoms may occur. You may have an imbalance between good and harmful bacteria in your gut. Some of the foods you eat may pull excess water into your bowel. Or, the movement of your gut muscles may be too fast, too slow, or uncoordinated.
So, how do you know what the problem is? To combat imbalanced gut bacteria, your doctor may suggest trying a probiotic to send in some reinforcements. If a probiotic helps your symptoms stabilize, you know you're on the right track.
If you and your healthcare team suspect your gut pulls in too much water, you can use a food/symptom journal to look for dietary triggers. Or, you can try a program like the Low FODMAP Diet to test foods known to pull excess water into the bowel.
If you and your healthcare team think your muscles move too fast or too slow, you can try making dietary adjustments to help keep food in your gut longer or to give it a gentle nudge.
Uncoordinated muscles, on the other hand, can be a symptom of pelvic floor dysfunction (Pelvic Dyssynergia), among other things. If you and your healthcare team suspect you're suffering from pelvic floor dysfunction, a physiotherapist can help you strengthen and retrain your muscles to work more efficiently.
Why Do I get Sharp Pains in my Abdomen?
For people with IBS, sharp or sudden abdominal pain is often caused by stool or gas building up in the intestine. Traffic jams of the food or wind variety can cause the bowel to swell. As the intestinal wall expands, the nerve endings in the gut report back to the brain on the sensations of pressure, stretch, and pain.
The gut connects to the Autonomic Nervous System (ANS). This system monitors all of the organs in your chest and abdominal cavity. While your gut can feel pain, it can't pinpoint the location. So, while your intestine swells, you may feel a sense of pressure or general discomfort.
The abdominal wall, on the other hand, connects to the Somatic Nervous System (SNS). This system monitors your skin, muscles, and joints and is far more precise about where it feels pain. When the intestine swells enough to tap the abdominal wall, which can pinpoint location, the brain attributes the pain in the entire digestive system to the spot it can identify.
The pain can happen anywhere in the abdominal cavity (from the bottom of the ribs to the hips). It might come and go, only occur when you're sitting or bending over, or it might be consistent. What you feel may also vary. For example, you may experience a sharp pain in a specific place, a cramp or stitch, of a feeling of fullness or pressure.
While this is a common symptom of IBS, there are a lot of reasons you may experience pain in your abdomen, some of which require medical attention. So, if this is a new symptom for you, always double check with your doctor. And, if you ever experience the pain combined with a fever, or if the pain is more intense than usual, head on over to your local ER. Safety first, friend!
Can IBS Cause Pain in the Shoulders, Back, or Neck?
Yes, it can! This phenomenon is called “referred pain,” and it's very common in the IBS community.
You already know your intestines send and receive information through the Autonomic Nervous System (ANS). This nervous system has two pathways. Think of them as two sides of the highway. But, instead of traveling north and south, they go to and from the organs and the brain.
When your intestines collect information, they send it to the brain via the “visceral afferent” pathway. Once the brain receives the information, it makes a decision and sends instructions back through the “visceral efferent” pathway. Heads up! Your Somatic Nervous System (SNS) uses the same method of communication to and from the brain.
The way your ANS and SNS integrate with your spinal cord is pretty complicated. What you need to know to understand referred pain, is that your ANS and SNS travel side by side through spinal roots that create a bridge between your body and your spinal cord.
This happens through 31 pairs of nerves, each of which serves specific muscles and organs in your body. When they’re working correctly, these nerves branch out to connect every inch of your body to your Central Nervous System (CNS) which houses your spinal cord and brain.
Along with serving specific muscles and organs, each pair of nerves also serves a particular region of your skin. These regions are called “dermatomes.” Each pair of nerves serves a specific dermatome (though, most regions overlap a little). Each dermatome creates a particular pattern of sensory nerves underneath your skin. Check out this dermatome map for an idea of what each region looks like.
When you experience gut pain, the pain message from your gut is collected by sensory receptors in your intestines. This message heads to your Central Nervous System (CNS) along the sensory (visceral afferent) pathway.
When the message reaches the roots of the spinal cord, it enters the CNS like any other message. But, in the case of referred pain, something unexpected happens and part of the message is turned around and sent back out of the spinal cord along the somatic efferent pathway.
Since the Somatic Nervous System (SNS) carries messages about the body, not the organs, the signal travels to the dermatome that enters and exits the spinal cord in the same place in the spine. The message “I’m in pain” registers in that region of the skin.
For IBS patients, this looks like a pain in the neck, shoulders, or lower back. Weird right? You can read my full article on referred pain here.
Don't forget, just like abdominal pain, there are a lot of reasons you may experience pain in your lower back, shoulders, or neck! So, always speak to your doctor when you encounter a new symptom to make sure it's related to your IBS. And, if you experience extreme pain or develop pain combined with a fever, head to your local ER.
What Do I Do If I Have Blood In My Stool?
Heads up! Unexplained blood in your stool always means doctor. It could be something simple like wiping your bum with a little too much enthusiasm. Or, it could be something that needs your attention like a wart, hemorrhoid, anal fissure, or something more serious.
Even if the source of blood is something minor, you need to know how to manage the problem. If the source is something more serious, you'll want to know sooner than later.
Side Note: If you see large amounts of blood, black tarry stools, or particles that look like coffee grounds, head on over to your local ER. These are red flags that something is bleeding higher up in your digestive tract and needs your attention.
Will I Ever Eat Normally Again?
Because there is such a wide range of foods that may trigger symptoms, it can feel impossible to find your food triggers! So, the search for safe foods can often leave people with IBS living on air.
If you've already tried cutting out general gut irritants, speak to your healthcare team about starting the Low FODMAP Diet.
The low FODMAP program is a short-term diagnostic tool used to help people with IBS find common food triggers. By using a systematic program to test several food groups at once, you'll save time and come away with lots of valuable information. The program is successful for 3 out of 4 people, so it's definitely worth investigating.
Whether you complete the low FODMAP program or find your triggers using a different method is irrelevant. Once you've identified your food triggers, you can add foods back to your diet with confidence.
Do I Have IBS-M/A?
A person with IBS-M experiences “mixed” symptoms of constipation and diarrhea. In the IBS community, this is also called IBS-A (for alternating symptoms).
So, if you have mixed symptoms do you have IBS-M? Not necessarily. To fit the criteria for IBS-M, a person must have 1/4 (25%) of their problematic bowel movements clearly between 1 and 2 on the Bristol Stool Scale and 1/4 (25%) of their problematic bowel movements between 6 and 7 on the Bristol Stool Scale (you can grab a Bristol Stool Scale in my free resource library HERE).
That means if you have ten problematic bowel movements in a week, at least four of them need to be clearly between 1 and 2 (constipation) and at least four of them have to be clearly between 6 and 7 (diarrhea) on the Bristol Stool Chart to be considered IBS-M.
Heads up, many people with IBS experience mixed symptoms. If you don't fall clearly into the IBS-M criteria, you likely fall under the IBS-U (unspecified) umbrella. For the record, most people fall into this category. So, don't worry, you'll be in good company!
Thanks for checking out part three of my frequently asked question series! Make sure to check out my next post for answers to common questions about the Low FODMAP Diet.
Don’t want to miss it? Sign up for my mailing list below, and you’ll get a roundup of my monthly posts along with exclusive access to bonus content, VIP discounts, and some fabulous freebies! Together we’ll get the low FODMAP Diet down to a science!
© 2019 Amy Agur – The FODMAP Formula
- Agur, A. M., Dalley, A. F., & Grant, J. C. (2017). Grants atlas of anatomy (14th ed.). Wolters Kluwer.
- Barrett, J., Dr. APD. (2016, June 20). Timing of symptoms and FODMAPs. Retrieved from https://www.monashfodmap.com/blog/timing-of-symptoms/
- Drossman, D. A., & Chang, L. (2016). Rome IV multidimensional clinical profile (MDCP) for functional gastrointestinal disorders. Raleigh: Rome Foundation
- Heidelbaugh, J., & Hungin, P. (2016). Rome IV Functional Gastrointestinal Disorders for Primary Care and Non-Gi Clinicians (First ed.). Raleigh, NC: Rome Foundation
- Marieb, E. N. (2004). Human anatomy & physiology (6th ed.). San Francisco, CA: Pearson Benjamin Cummings
- >Martini, F., Ober, W. C., Nath, J. L., Bartholomew, E. F., Garrison, C. W., Welch, K., & Martini, F. (2011). Visual anatomy & physiology. Boston: Benjamin Cummings
- Moore, K. L., Agur, A. M., & Dalley, A. F. (2015). Essential clinical anatomy (5th ed.). Wolters Kluwer
- Moore, K. L., Dalley, A. F., & Agur, A. M. (2017). Moore Clinically oriented anatomy (8th ed.). Wolters Kluwer/Lippincott Williams & Wilkins.
- Neurovascular Supply of the Large Intestine. (n.d.). Retrieved from https://www.kenhub.com/en/library/anatomy/neurovascular-supply-of-the-large-intestin
- Seeley, R. R., Stephens, T. D., & Tate, P. (2006). Anatomy & Physiology (7th ed.). Boston, Mass: McGraw-Hill Higher Education
- Tortora, G. J., & Derrickson, B. (2012). Principles of anatomy & physiology(13th ed.). Hoboken, NJ: John Wiley & Sons
- The Vagus Nerve. (n.d.). Retrieved from https://www.kenhub.com/en/library/anatomy/the-vagus-nerve
You might also like one of these:
The Truth About IBS and Exercise Think you can't work out with IBS? Here's everything you need to know from managing your symptoms to crushing your fitness goals. Ready, set, go!
How to Survive the Holidays with IBS Worried about keeping your IBS symptoms under control this holiday season? Check out these practical tips on preventing and managing common IBS symptoms.
How to Cope with IBS-Related Bloating Sometimes you can do everything right and things will still go wrong. I interviewed the experts for tips on coping with symptoms when our bodies feel out of our control.