Do I have irritable bowel syndrome (IBS)?

Everyone’s dealt with an unpleasant episode of bloating, diarrhea, or constipation. But if you have irritable bowel syndrome (IBS), symptoms like these are constant.

Despite affecting between 13-20% of Canadians at any given time, the causes of IBS aren’t totally clear. Luckily, it’s treatable. Here’s everything you need to know about IBS.

What is IBS?

IBS is a gastrointestinal disorder that affects your lower gastrointestinal tract and how your bowels function. It can begin at any point in your life, and symptoms can sometimes disappear for years at a time. There’s no cure for the disorder, but with proper treatment, patients can experience long periods of relief.

Within the disorder itself, there are four different types of IBS. These are based on the symptoms you experience most frequently, or on whether your disorder has a precipitating event.

IBS-D — individuals with this type of the disorder mostly experience diarrhea and abdominal discomfort
IBS-C — this subtype includes those who experience constipation as their predominant symptom
IBS-M, or IBS-A, stands for IBS mixed, or IBS alternating, and includes those with both diarrhea and constipation
PI-IBS — Post-infectious IBS is a little different from the other three types. It comes on after an acute period of infection — often with salmonella, E. coli, or other food-borne pathogens. PI-IBS most often results in IBS-D, although it can also cause constipation or mixed symptoms. The good news is that PI-IBS is more likely to resolve on its own than other forms.

What are the symptoms of irritable bowel syndrome?

When it comes to symptoms, gastroenterologists often talk about the ABCDs of IBS: abdominal pain, bloating, constipation, and diarrhea. Depending on the subtype you have, you might experience chronic constipation, chronic diarrhea, or cycle between the two.

Other symptoms of IBS include:

Not being able to have a bowel movement (BM) for long periods of time
Feeling of incomplete BMs
Frequent watery BMs
Fecal incontinence
Abdominal discomfort or intense abdominal pain
Gas and bloating
Fatigue

How do doctors diagnose IBS and when should I talk to a doctor?

There’s no test to confirm if you have IBS. Instead, your doctor will diagnose it based on the symptoms you report.

As for knowing when it’s time to see a doctor, if you can’t manage your symptoms or find yourself avoiding activities due to them, it likely means you need professional help.

Additionally, if you find that your BMs contain blood, are dark and tarry, or if you begin experiencing new gastrointestinal symptoms, it’s important to see your healthcare provider.

What causes IBS?

Individuals with IBS have abnormal digestive motility, or movement. This means their digestive muscles either force food through too quickly, or shepherd it along too slowly. Why this happens, however, isn’t fully understood.

Researchers think several factors may be at play, including family history. The disorder often runs in families so there may be a genetic component, but other things also influence the development of the disease.

You have nerve cells throughout your entire body, including your digestive system, which means that your brain and your digestive tract are connected. One theory is that the gut-brain axis lies at the root of the problem.

Researchers think that people with IBS might have altered pain perception in their digestive tract which is why they have more intestinal discomfort. It could also be that the signals between their brain and digestive tract are faulty, resulting in diarrhea, constipation, and other symptoms.

Studies also show that individuals with IBS are more likely to report early childhood trauma, stress, depression, and anxiety. It might be that these mental health issues affect their digestive processes. This gut-brain connection is so strong that antidepressants are sometimes used as treatment — not to treat specific mental health issues, but because they can help digestive problems.

Beyond these theories, it’s possible that those with IBS may have undiagnosed food sensitivities causing intestinal inflammation. Alternatively, changes to gut flora might be a possible cause of the disease. While more research is needed, it seems clear that IBS has more than just one underlying cause.

How long can IBS last?

IBS is usually a life-long condition, however, many people experience long symptom-free periods. While there is no official cure, there are many different and effective treatments for the disorder to help improve discomfort and bowel habits.

The exception to this is PI-IBS, which may resolve spontaneously in some cases, weeks, months, or even years after its onset.

What triggers IBS symptoms?

Stress and anxiety can trigger symptoms, making stress management a crucial part of controlling flare-ups. Getting regular exercise, or practicing meditation or yoga can help to manage these emotions, and may help to decrease the frequency or severity of symptoms.

Antibiotics can also precipitate a flare-up, as can other medications like antidepressants or NSAIDs (non-steroidal anti-inflammatory drugs).

As you might guess with a bowel disease, however, certain foods are a big trigger for IBS. While food triggers are often individual, there are some general guidelines when it comes to which ones to avoid. Raw fruits and vegetables — especially gas-producing ones like broccoli, brussels sprouts, and cabbage — will likely add to any bloating and gas you’re already experiencing.

It’s also a good idea to limit alcohol and fried foods which cause discomfort in many. And, while it might seem harmless, avoid chewing gum at all costs. It causes your body to take in air, which promotes both bloating and gas.

Can IBS turn into Crohn’s disease or ulcerative colitis?

IBS shares symptoms with both Crohn’s disease and colitis, but it doesn’t evolve into either condition.

Crohn’s disease is an autoimmune condition where your immune system attacks the lining of your digestive tract. This can cause patches of inflammation along your digestive system, anywhere between your mouth and your anus.

Ulcerative colitis (UC) is similar to Crohn’s in that it’s an autoimmune disease that affects your digestion. UC, however, only affects the inner lining of the colon, or large intestine, causing inflammation throughout that area.

IBS vs. IBD – what’s the difference?

They may sound like synonyms, but IBS and IBD (irritable bowel disease) are completely different diagnoses. IBD also affects your digestive tract, but it’s actually an umbrella term for Crohn’s disease and UC.

This means that unlike IBS, IBD is an autoimmune disease which often requires treatment with immunosuppressant medications. And, while both share certain symptoms, IBD is often accompanied by bloody stool and weight loss. Despite their differences, however, it’s possible to have both conditions at the same time.

How do I know if I have IBS or colon cancer?

While IBS and colon cancer share some symptoms, they differ in a few important ways. Colon cancer can cause blood in the stool or bleeding from the rectum, while IBS doesn’t.

Unexplained or sudden weight loss is also a distinguishing symptom — it’s common in IBD and is a marker for colon cancer, but not for IBS. Regardless, it needs to be investigated by your doctor.

Having the disorder doesn’t increase your risk of developing colon cancer, but it’s possible to have both at once. If you’re experiencing any new or sudden changes in your digestive symptoms or any of the above symptoms of colon cancer, speak to your healthcare provider.

Treatment for IBS

While the causes of IBS are unclear, many different factors can bring it on. This means that individualized treatment for irritable bowel syndrome generally works best.

As a baseline, restorative sleep and regular exercise are crucial. Some also find that they benefit from stress management techniques.

Many naturopathic doctors recommend a food sensitivity test to try to pinpoint the cause of your symptoms. They may also prescribe probiotics to increase the beneficial bacteria in your digestive tract and help with gut health.

The Canadian Digestive Health Association recommends taking peppermint in addition, as it may ease symptoms by soothing spasming muscles in the digestive tract. But some only find relief with medications such as laxatives or anti-diarrheals.

The most common way to manage IBS, however, is through diet, and many find that incorporating a soluble fibre supplement such as psyllium can help.

Managing IBS with diet

To begin, make sure you’re drinking eight to ten glasses of water a day and eating small, regular meals. While your symptoms may keep you from wanting to eat, skipping meals actually leads to more air in your digestive system. This in turn increases the likelihood of bloating and gas.

From there, your best bet may be to keep a food journal to track your food reactions. Most people find that they tolerate fish, chicken, rice, and bread fairly well. Cereal, cooked vegetables, and some fruits — often with the skin removed — also work for many. The low FODMAP diet might also be able to help.

What is the low FODMAP diet and does it help with IBS?

The low FODMAP diet is an elimination diet recommended for those with IBS and other gastrointestinal disorders. It stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.

While it sounds complex, so-called FODMAPs are just short-chain carbohydrates — sugars — that are fermented by intestinal bacteria. Since gas is a by-product of fermentation, eating these foods often results in gas and bloating.

Examples of FODMAP foods include:

Baked beans
Lentils
Milk (cow, goat, and sheep)
Yogurt
Soft cheeses
Watermelon
Apples
Mangoes
Onions
Garlic
Rye
Wheat
Sweeteners like sorbitol and xylitol
Fructose and high-fructose corn syrup

Can IBS be prevented?

While it’s unclear if it’s possible to prevent IBS, certain behaviours can help to minimize your symptoms — especially eating a healthy diet. As an added bonus, a diet high in fibre and low in saturated fats can also help to prevent colon cancer.

You already know that smoking is bad for you, but evidence also shows that smoking 20 or more cigarettes a day increases your likelihood of having IBS-D, not to mention colon cancer. Butting out or not starting in the first place may help you avoid both.

Drinking in moderation or not at all may also help to minimize the frequency and severity of flare-ups. Alcohol may not be a trigger for everyone with IBS, but research shows that binge drinking often is. Cutting down on alcohol also reduces your risk of getting colon cancer.

Navigating your diet after an IBS diagnosis can be overwhelming. If you’re having trouble figuring out what to eat, a dietitian can help. Registered dietitians are experts in nutrition and can help you manage your symptoms with custom meal plans. Book an appointment with a registered dietitian today and get started with a personalized dietary treatment plan.

If you haven’t been diagnosed but think you have symptoms of IBS, a general health assessment can be helpful. As part of this checkup, your healthcare provider will take your medical history, and may recommend additional testing to rule out other conditions. Book a general health assessment today to start taking control of your digestive issues.