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Understanding irritable bowel syndrome

Last Modified: February 21, 2020

Diseases & Disorders

Irritable Bowel Syndrome

This post was written by Reshi Kanuru, MD, PPG – Gastroenterology.

While sitting at a restaurant eating a delicious meal, you notice a growing pressure in your belly. Your stomach starts serenading your friends with loud rumblings. You know what this means. You rush to the bathroom in the nick of time. Many of those with irritable bowel syndrome (IBS) deal with this situation on a frequent basis. IBS can severely impact someone's quality of life and be very frustrating to deal with, but the condition should be taken seriously, as these symptoms are also associated with several serious diseases.

What is irritable bowel syndrome?

IBS is when someone experiences abdominal pain that is associated with having bowel movements, changes in the frequency of bowel movements or changes in relation to bowel movements. IBS is divided into three main categories. IBS type diarrhea is when someone has abdominal pain that is associated with diarrhea or frequent bowel movements. IBS type constipation is abdominal pain that is associated with constipation or too few bowel movements. IBS mixed is abdominal pain that is associated with both diarrhea and constipation.

Each of these forms require very different treatments. It’s important to understand that IBS is a diagnosis of exclusion, meaning all symptoms of IBS need to be evaluated to rule out other diseases before providing a diagnosis of irritable bowel syndrome.

What causes irritable bowel syndrome?

IBS is a complicated syndrome that can involve many different symptoms. While we don’t know what causes IBS in everyone, there are a few known causes. One of the most common forms of IBS is called post-infectious irritable bowel syndrome, which results after someone goes through an infection and subsequently develops abdominal symptoms even though the infection has resolved. The infection may not even affect the bowels but for unclear reasons can lead to severe IBS symptoms. Post-infectious IBS symptoms of bloating, abdominal pain, constipation and/or diarrhea can last for weeks to months to even years.

Alternate causes of IBS are diet related. What we eat is very important not only for our health, but maintaining the health of our gut. Our gut is lined by trillions of bacteria. These bacteria help with digestion, strengthen our immunity and keep the lining of our gut healthy. For example, an autoimmune disease called ulcerative colitis leads to inflammation in the colon. Ulcerative colitis is believed to be caused by a change in the bacteria that line the colon, resulting in the immune system attacking the colon. The diet we eat influences the type of bacteria found in our gut. Eating more processed and fried foods may promote more bad bacteria that can cause excess gas production, bloating and abdominal pain. Eating healthy foods like those in the Mediterranean diet have been shown to improve belly symptoms and positively alter the bacteria that line our gut.

The last common cause of IBS has to do with how we feel. A unique aspect of our GI tract is that many symptoms of stress can present as belly symptoms. This is why when someone gives a public speech they might describe “butterflies in their stomach”. The stress of public speaking presents as belly discomfort. When we are under a great deal of stress or are feeling depressed, our feelings can be expressed in how our belly feels. In addition, stress can change the types of bacteria that line our gut through the hormones we release under stressful conditions. Controlling stress and focusing on our mental health are equally important in maintaining a healthy gut and possibly preventing irritable bowel symptoms.  

How do I know if I have irritable bowel syndrome?

If you have symptoms like bloating, abdominal pain, constipation and/or diarrhea, it’s important that you seek help from your family doctor or a gastroenterologist to look for causes for your symptoms. An evaluation may include blood work, imaging, stool studies and endoscopies. If after an evaluation you are diagnosed with IBS, remember there are many treatment options available to control your symptoms and improve your quality of life.


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