Condition Basics

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IBS) is a disorder of the intestines. It causes belly pain, cramping or bloating, and diarrhea or constipation. IBS is a long-term problem, but there are things you can do to reduce your symptoms.

Your symptoms may be worse or better from day to day, but your IBS won't get worse over time. IBS doesn't cause more serious diseases, such as inflammatory bowel disease or cancer.

What causes it?

It's not clear what causes IBS. It may be caused by problems with the way the brain communicates with the digestive tract, or problems digesting certain foods. People with IBS may have sensitive intestines or problems with the muscles of the intestines. Hormonal changes, stress, and some antibiotics may trigger symptoms.

What are the symptoms?

The main symptoms of IBS are belly pain with constipation or diarrhea. Other symptoms are bloating, mucus in the stools, and a feeling that the bowels haven't completely emptied. These symptoms are real and not imagined, even though there are no structural problems in the intestines of people with IBS.

How is it diagnosed?

Most of the time, doctors can diagnose IBS from the symptoms. Your doctor will ask you about your symptoms and past health and will do a physical exam. In some cases, you may need other tests, such as stool analysis or blood tests to rule out other problems.

How is IBS treated?

Treatment for IBS involves making changes in your diet and lifestyle. You avoid foods that trigger your symptoms. Being active and managing stress can help. So can physiotherapy and counselling. If these don't help enough, or if your symptoms are severe, your doctor may recommend medicines.

Cause

It isn't clear what causes IBS. The cause may be different for different people. It may be caused by problems with the way signals are sent between the brain and the digestive tract, or problems digesting certain foods. People with IBS may have unusually sensitive intestines. Or they may have problems with the way the muscles of the intestines move.

For some people with IBS, certain foods, stress, hormonal changes, and some antibiotics may trigger pain and other symptoms.

Symptoms

The main symptoms of IBS are belly pain with constipation or diarrhea. Other common symptoms are bloating, mucus in the stools, and a feeling that you haven't completely emptied your bowels.

Many people with IBS go back and forth between having constipation and having diarrhea. Most people have one of these more often than the other.

IBS is quite common, but most people's symptoms are so mild that they never see a doctor for treatment. Some people may have troublesome symptoms, especially stomach cramps, bloating, and diarrhea.

Because there are no structural problems in the intestines of people who have IBS, some people may think this means that the symptoms "are all in their head." This isn't true. The pain, discomfort, and bloating are real.

What Happens

Symptoms of IBS may last for a long time. But IBS doesn't cause cancer or shorten your life.

The pattern of IBS varies from one person to the next and from one bout to the next. Some people have symptoms off and on for many years. You may go months or years without having any symptoms. But most people have symptoms that keep coming back. It is rare for a person to have symptoms constantly. And many people with IBS don't see a doctor about their symptoms.

When to Call

Call your doctor if:

• You have been diagnosed with irritable bowel syndrome (IBS) and your symptoms get worse, begin to disrupt your activities, or don't respond as usual to your home treatment.
• You are more tired than usual.
• Your symptoms wake you from sleep.
• You have unexplained weight loss.
• You have decreased appetite.
• You have belly pain that is not linked with changes in bowel function or that is not relieved when you pass gas or a stool.
• You have belly pain that is now in one area (localized) more than any other area.
• You see blood in your stool.
• You have a fever.

Watchful waiting

Watchful waiting is a wait-and-see approach.

If your symptoms are mild, it might be okay to try home treatment for 1 week or longer. If you think you may have IBS, try to rule out other causes of belly problems, such as eating a new food; eating sugar-rich foods, especially milk products; eating foods containing sorbitol or other sugar substitutes; nervousness; or a stomach infection. If your symptoms don't get better or if they get worse, call your doctor.

Who to see for symptoms of IBS

The following health professionals can diagnose and treat IBS:

If more tests are needed or your symptoms don't respond to treatment, it may be helpful to see a doctor who specializes in treating digestive system problems (gastroenterologist). It can also be helpful to see a psychiatrist or psychologist.

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Examinations and Tests

Most of the time, doctors can diagnose IBS from the symptoms. Your doctor will ask you about your symptoms and past health and will do a physical exam.

In some cases, you may need other tests, such as stool analysis or blood tests. These tests can help your doctor rule out other problems that might be causing your symptoms. People with diarrhea as part of their symptoms usually need testing. What tests you need depend on your symptoms and your age.

Tests may include a blood test for celiac disease and a complete blood count. Other tests can include stool tests for colon inflammation and infection. A colonoscopy is sometimes done.

Treatment Overview

Treatment for IBS depends on your symptoms and how much they affect your daily life. You may need to try a few things before you find what works best for you.

You will monitor your symptoms and work with your doctor to find which foods, activities, and experience make you feel worse. You avoid foods that trigger your symptoms. Some people do well on a diet called a low-FODMAP diet. Being active can help some people. So can managing stress. A type of counselling called cognitive behaviour therapy (CBT) can help with pain. Some people need physiotherapy.

If these things don't help enough, your doctor may recommend medicines. They can help with constipation or diarrhea. Others, like certain antidepressants, can help with pain.

Self-Care

Keep track of foods and symptoms

• Keep a food diary to track what you eat. Also record when you have symptoms and what they are. There are phone apps that can help, or you can just write it down.
• A food diary can help you figure out if certain foods trigger symptoms and if cutting out certain foods helps.
• When you make changes to your diet, plan on it taking about 6 weeks to know if the changes help.

For pain, gas, and bloating

• Try adding soluble fibre every day. This is the kind that dissolves in water. Some foods with soluble fibre are oats and fruit without skin. A supplement you can try is Benefibre.
• Try a low-FODMAP diet. FODMAPs are types of carbohydrates that can make IBS symptoms worse. Your doctor or a registered dietitian can help you with this diet.

For constipation

• Talk to your doctor or a dietitian about whether you should increase how much fibre you eat. If they suggest more fibre:
  • Try soluble fibre first.
  • If they recommend more insoluble fibre, go slow. Add a little bit at a time. Insoluble fibre is in fruits and vegetables with skin, most whole grains, and beans.
• Drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
• Get some exercise every day. Build up slowly to at least 2½ hours of moderate to vigorous exercise a week.
• Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and do not strain when having a bowel movement.

For diarrhea

You may try giving up foods or drinks one at a time to see whether symptoms improve. Limit or avoid the following:

• Alcohol
• Caffeine, which is found in coffee, tea, cola drinks, energy drinks, and chocolate
• Nicotine, from smoking or chewing tobacco
• Gas-producing foods, such as beans, broccoli, cabbage, and apples
• Dairy products that contain lactose (milk sugar), such as ice cream and milk
• Foods and drinks high in sugar, especially fruit juice, soda, candy, and other packaged sweets (such as cookies)
• Foods high in fat, including bacon, sausage, butter, oils, and anything deep-fried
• Sugar alcohols like sorbitol, xylitol, mannitol, and isomalt. These are sugar substitutes found in some sugarless candies and chewing gum.

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