If you're suffering from chronic digestive issues, your internet travels may have led you to Irritable Bowel Syndrome. So what is IBS? And, more importantly, do you have it? The answer to both questions is complicated.
In this article, I'll talk about what you need to know about Irritable Bowel Syndrome; including common symptoms, diagnostic criteria, and ways IBS community members manage symptoms. Be forewarned, you're about to get the scoop on poop!
What Is IBS?
Irritable Bowel Syndrome is a chronic Functional Gastrointestinal Disorder (FGID) of the large intestine (colon). That is a lot of words, and not a lot of help, so let's start from the beginning.
Irritable Bowel Syndrome is a chronic illness because a patient's symptoms linger over long periods of time. While the flu can last several days, IBS symptoms last months or years. In fact, patients with IBS need a 3-month history of consistent symptoms before they can be diagnosed.
Currently, there is no cure for IBS. Don't worry, though. We'll discuss ways community members manage their symptoms in a minute.
Like other disorders under the FGID umbrella, IBS symptoms are caused by the way the smooth muscles in your gut behave. This means there won't be any evidence of physical damage or chemical imbalances to explain your symptoms. Because of this, there currently isn't a test to confirm IBS.* As a result, your doctor will diagnose you based on your symptoms.
Since there's no official test, it may be tempting to diagnose yourself. This is a bad plan! Many serious illnesses begin with IBS-like symptoms, so it's important to see your doctor. They can screen for warning signs of more sinister problems like celiac disease, chrons, ulcerative colitis, bowel cancer, etc. These illnesses damage your body and should be diagnosed as soon as possible.
It's worth mentioning that even if your doctor thinks you have IBS, they may send you for additional testing. These tests rule out structural issues like inflammation, obstructions (like impacted poop), or tumors, and biochemical causes like acid or hormonal imbalances. Your doctor normally orders these tests “just in case.” They aren't required for an IBS diagnosis.
But, because doctors often don't tell patients they're being overly cautious, Irritable Bowel Syndrome has developed a reputation as a “diagnosis of exclusion.” IBS patients often feel they receive their diagnosis because their doctor ran out of tests; not because they meet the diagnostic criteria.
Feeling like we're stuck with a catch-all diagnosis combined with limited resources for treating IBS symptoms has created a deep sense of abandonment within the IBS community. However, despite this feeling, IBS is a legitimate and recognized disorder. It also has a specific list of diagnostic criteria.
Common IBS Symptoms
One of the most frustrating things about Irritable Bowel Syndrome is how it affects everyone differently. What triggers me may not bother you, and what affects both of us may be fine for someone else. The same holds true for how we react to triggers.
Though there are many symptoms associated with Irritable Bowel Syndrome, the cornerstone of IBS is abdominal pain. This pain can appear anywhere in your abdominal cavity (from the bottom of your ribs to your hips) and can be relieved by bowel movements or stay constant.
More common symptoms include abdominal bloating and distention, cramping, gas, constipation or diarrhea, a feeling of incomplete evacuation or urgency, and mucus in the stool. Both the severity and combination of symptoms are unique to each patient. One of the great mysteries of IBS is why asparagus gives me cramps, you diarrhea, and Bob can eat it by the bunch.
Secondary GI Symptoms
Many IBS patients experience digestive symptoms outside of their intestines. For example, 25-50% of IBS patients report symptoms like heartburn, feeling overly full, or feeling nauseated. If you experience symptoms like these, let your doctor know. 50% of IBS patients report a second FGIDs, so you need to know if your symptoms are caused by IBS or something else. This will help you adjust your symptom management plan to suit your personal needs.
Secondary Non-GI Symptoms
As if that wasn't complicated enough, some IBS symptoms have nothing to do with your gut. The ROME IV lists fatigue, chronic pain, and poor sleep quality as recognized non-GI symptoms. You may also experience generalized muscle pain, sexual dysfunction, or headaches.
Co-Occurring Functional Disorders
As if three paragraphs of possible symptoms weren't enough, Irritable Bowel Syndrome has also been linked to other Functional Gastrointestinal Disorders. These include chronic spinal pain (specifically affecting the neck and lower back), fibromyalgia, chronic fatigue syndrome, chronic migraines, chronic pelvic pain (occurring in both men and women), chronic urinary symptoms (including painful bladder syndrome or interstitial cystitis), dysmenorrhea, and prostatitis.
Do I Have IBS?
So, now that you know IBS is a long-term case of angry guts without a cause, do you have it? I can't tell you one way or another, but we can talk about the specific criteria your doctor is looking for.
The diagnostic criteria for IBS were developed by The ROME Foundation in 1990. This criterion is a checklist used by doctors to decide whether or not you have IBS. If you don't meet the criteria, other options include Functional Diarrhea (FD), Functional Constipation (FC), Functional Abdominal Bloating/Distension (FAB/D), and Unspecified Functional Bowel Disorder (U-FBD).
According to the ROME IV, a patient with IBS must report abdominal pain at least once a week for 3 months or more. This must be combined with two or more of the following criteria:
- Pain related to bowel movements;
- Change in the frequency of stool; and
- Change in the appearance of stool based on the Bristol Stool Scale – This symptom must be present for 6 months to fulfill the criteria.
If you feel you meet this criterion, you may have IBS. However, a diagnosis should always be provided by a medical professional.
If you've joined an IBS community, you may have noticed members identify themselves as IBS-C, -D or -M/A. If you feel like you're missing something, don't fret.
Once diagnosed, IBS patients are subdivided into one of 4 groups: IBS-C, IBS-D, IBS-M (A), or IBS-U. Each subcategory has another specific set of criteria. These are based on the number of irregular bowel movements that fall within a specific range on the Bristol Stool Scale.
What this means is, when you add up your problematic bowel movements at the end of the month, how many of them were constipation or diarrhea according to the Bristol Stool Scale. The technical breakdown for each subcategory is outlined below.
IBS-C: These patients suffer from constipation. To be assigned to this group, at least 1/4 (25%) of a patient's bowel movements must fall clearly between 1 and 2 on the Bristol Scale.
IBS-D: These patients suffer from diarrhea. To be assigned to this group, at least 1/4 (25%) of a patient's bowel movements must fall clearly between 6 and 7 on the Bristol Scale.
IBS-M: Patients in this category experience both constipation and diarrhea. They are described as “mixed” (M). However, within the IBS community, they are often called “alternating” (A). Either one is generally acceptable.
Patients assigned to this group require at least 1/4 (25%) of their bowel movements to fall between 1 and 2 (C) and an additional 1/4 (25%) or more to fall between 6 and 7 (D) on the Bristol Scale.
IBS-U: Patients who don't fit clearly into the IBS-C, -D, or -M categories are considered “unspecified.” This is where most patients fall. If your doctor didn't give you a category when you were diagnosed, you likely fit in here.
It's worth noting that these subcategories aren't based on how severe your symptoms are. Instead, they're based on the percentage of abnormal bowel movements that fit within a specific range on the Bristol Stool Scale. Being in the unspecified group doesn't mean your symptoms are better or worse than anyone else's. Only that your bowel movements don't meet the criteria for the -C, -D, or M/A subcategories.
Managing Irritable Bowel Syndrome
Because there is no known cure for IBS, patients need to find ways to manage their symptoms. One of the most efficient ways to do this is to find the things that trigger symptoms.
Some people are triggered by stress. These patients can benefit from stress management. This might include meditation, physical activity, setting healthy boundaries, etc. You can also try personal therapy, behavioral modification techniques like Cognitive Behaviour Therapy (CBT) or Dialectical Behaviour Therapy (DBT), etc. Some patients have also reported success with techniques like hypnosis.
Other people are triggered mostly by diet. These patients benefit from removing specific trigger foods from their day-to-day meals. A dietitian can help you track down the foods that are bothering you. These might include general gut irritants like fat, caffeine, alcohol, or sugar. If that doesn't work, you can try programs like the Low FODMAP Diet and/or taking probiotics.
Many people benefit from a combination of stress relief and diet changes. If those don't provide enough relief, you can also use medications like antispasmodics and laxatives to help manage your symptoms.
If you are diagnosed with IBS, the symptom management tools in your toolbox will be specific to you. Remember that while IBS support communities can be helpful, every patient is different. What works for someone else may not be right for you and vice versa. When someone insists there is one treatment method for IBS, remember Bob and his asparagus.
If you came here to understand IBS, this is what I want you to take away:
IBS is a chronic disorder of the large intestines (colon). It has no signs to look for, no tests to confirm your diagnosis, and currently, no cure. However, it does have a specific set of criteria and is a legitimate and recognized disorder. With this in mind, if you are experiencing frequent abdominal pain combined with problematic bowel movements it's time to speak to your doctor.
Finally, I want you to take away hope that there are more avenues to explore, possibilities to consider, and most importantly, that you are not alone.
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* There is currently a blood test for post-infectious IBS-D called IBScheck. I cannot confirm the accuracy of this test as there is not enough research to determine its reliability at this time.
This article was edited by Dr. Anne Agur B.Sc.O.T; M.Sc; Ph.D.
- Drossman, D. A., & Chang, L. (2016). Rome IV multidimensional clinical profile (MDCP) for functional gastrointestinal disorders. Raleigh: Rome Foundation.
- Dugum, M., MD, Barco, K., RD, LS, CNSC, & Garg, S., MD. (2016). Managing irritable bowel syndrome: The low-FODMAP diet. Cleveland Clinic Journal of Medicine, 83(9), 655-662. Retrieved from hhttp://www.mdedge.com/ccjm/article/111918/gastroenterology/managing-irritable-bowel-syndrome-low-fodmap-diet
- Heidelbaugh, J., & Hungin, P. (2016). Rome IV Functional Gastrointestinal Disorders for Primary Care and Non-Gi Clinicians (First ed.). Raleigh, NC: Rome Foundation.
- Mayo Clinic Staff. (2014, July 31). Irritable Bowel Syndrome (IBS) Fact Sheet. Retrieved April 22, 2017, from http://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/basics/definition/con-20024578
- The Monash University low FODMAP diet: reducing poorly absorbed sugars to control gastrointestinal symptoms. (2013). Clayton, Vic.: Monash University.
- Womens Health.Org (2012, July 16). Irritable Bowel Syndrome (IBS) Fact Sheet. Retrieved April 22, 2017, from https://www.womenshealth.gov/publications/our-publications/fact-sheet/irritable-bowel-syndrome.html#a
© 2017 Amy Agur – The FODMAP Formula