Share ThisIrritable bowel syndrome (IBS) is a chronic, often debilitating, gastrointestinal disease that affects as many as 45 million Americans. According to some estimates, up to 40% of all visits to gastroenterologists are due to IBS symptoms. When direct medical expenses and loss of productivity from missing work are combined, IBS can cost an estimated $21 billion annually.
Unfortunately, there are some misunderstandings around IBS, and many people who could be helped never seek treatment. As part of IBS Awareness Month in April, I would like to shed light on IBS with some fact-checking and explanation. For more information, you can also read this recently reviewed and updated “Ask a Doc” interview I did on IBS.
IBS is most certainly not a “wastebasket diagnosis” or “diagnosis of exclusion” that is just given to patients because they have unexplained gastrointestinal symptoms. Many researchers have spent most of their careers trying to unravel the cause of IBS and find treatments for the millions of sufferers.
IBS is a real digestive disorder characterized by chronic abdominal pain and altered bowel habits in the absence of structural or anatomical causes. The Rome Foundation — a multinational group of scientists and clinicians — defines the criteria for IBS diagnosis as recurrent abdominal pain at least one day a week in the last three months that is linked to defecation, or change in the frequency or appearance of bowel movements. This diagnostic framework has not only opened doors for more research but also helped remove stigma and streamline how care providers approach IBS.
If you have ever been told that your symptoms are “just IBS” or “it’s all in your head,” you may be forgiven for believing that you do not have a “real” medical condition. But this could not be further from the truth. IBS has very definite diagnostic criteria and treatment guidelines.
Invalidating patients’ chronic symptoms can sometimes lead to delays in providing care. One study showed that it can take an average of more than 6 years (of seeing physicians and undergoing tests) to reach a definitive diagnosis of IBS from the onset of symptoms. Your condition warrants an honest dialogue with your care team. Your concerns need to be heard and understood, not dismissed. Having a clinician who understands your symptoms and provides an appropriate diagnosis is the first step toward effective treatment.
While, despite extensive research, a unifying cause for IBS may not be evident, it is now established that the brain and digestive system are closely linked — more so than any other organ system. Understanding “brain-gut axis dysregulation” as a driving force of many symptoms of IBS (as well as other conditions), has led to a paradigm shift in managing the condition.
There are several possible causes that can be implicated. Some symptoms may be precipitated by abnormal motility or spasms — uncontrolled contractions in the muscles of the gut. This may explain why certain IBS treatment approaches, such as antispasmodic medications and fiber (both of which help regulate the contractions of the colon), can relieve symptoms.
Many recent studies have revealed that a major component could be visceral hyperalgesia or hypersensitivity, which is heightened sensitivity of the nerves supplying the intestines. The thinking is that nerve-endings in the gut perceive and relay excessive and painful signals to otherwise normal stimuli like gas or stool in the gut. That is why some patients with severe IBS feel better when treated with neuromodulators — medications that decrease pain perception in the intestine. Some people with predominantly diarrheal or bloating symptoms may also have a condition called small intestinal bacterial overgrowth (SIBO), where there’s a surplus of bacteria in the small intestines. While it’s unclear whether SIBO can be a cause of IBS, those with IBS are more likely than others to test positive for SIBO. This means that in some patients, IBS symptoms may respond after antibiotic treatment that focuses on bacteria in the small intestine.
Anxiety, sleep problems and phobias have also been shown to be independent risk factors for the development of IBS. Additionally, food intolerances, recent infections or inflammatory processes in the wall of the gut, and genetics have all been implicated in the genesis of IBS.
You may find ads or “influencers” using marketing phrases like “miracle pill for IBS” or “cure your gut” or “what your doctor isn’t telling you.” Do not fall for these. When it comes to IBS, there is no quick fix. The key to achieving relief is to embrace the understanding that IBS is a condition in which multiple factors can contribute to its development and can trigger the symptoms.
Every patient is unique and warrants a compassionate, individualized strategy. Finding a plan that works can take time, patience and experimentation. IBS management is not one-size-fits-all — and the path to feeling your best will often involve a coordinated, multidisciplinary approach. That’s the value of integrated medical centers that typically combine the expertise of registered dieticians, therapists and gastroenterologists to provide you with a variety of evidence-based treatments.
Given the intertwined roles of the brain and the gut, several behavioral therapies have emerged as being effective to help treat symptoms that arise from this complex pathway. Cognitive behavioral therapy (CBT) addresses stress, negative emotions and co-occurring depression and anxiety. This allows IBS patients to unlearn the negative thoughts and behavior patterns that may have evolved due to their digestive symptoms. Recently, gut-directed hypnotherapy’s (GDH) role in restoring the brain-gut function has been studied and validated. Similarly, mindfulness-based stress reduction (MBSR) engages in regular practice of emotional and physical relaxation skills which in turn decreases awareness of abdominal symptoms.
In addition, diaphragmatic breathing, abdominal massages and pelvic floor biofeedback may also be viable options to explore.
There are several drivers of how food can trigger digestive symptoms in IBS. What you are eating can affect the intestinal motility, modulate visceral sensation, unfavorably change the gut microbiome, or activate an immune response within your GI tract.
A diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) — carbohydrates that are poorly absorbed in the intestines — has been shown to be effective in alleviating abdominal distress in as many as 86% of patients with IBS, leading to improvements in symptoms like abdominal pain, bloating, constipation, diarrhea, and flatulence. Since this diet can be challenging during the initial (most restrictive) phase, it is vital to work with a gastroenterologist or dietitian, who can ensure you are following the diet correctly — which is crucial to success — while maintaining proper nutrition.
We hear from so many patients about their sense of despair in the face of their chronic illness experiences. It seems to them that no one understands their illness, treatments are fickle and sometimes unreliable; and hence their recovery from IBS is unachievable.
However, establishing a fruitful patient-doctor partnership and exploring various options really can result in symptoms that are less frequent and less severe. While IBS is chronic, your struggle and pain does not need to be so. Our knowledge and understanding of this condition is rapidly evolving. Hopefully, studies emerging over the next few years can reveal interventions that can help enhance our patients’ quality of life, sense of well-being and capacity to engage and succeed in everyday activities.
Saad Javed, MD, is a gastroenterologist with AHN Medicine Institute, specializing in the diagnosis and treatment of diseases and problems of the gastrointestinal tract. His clinical interests center on functional and motility disorders of the GI tract, including chronic abdominal pain and IBS.
He went to medical school at King Edward Medical University in Lahore, Pakistan. He did his residency in internal medicine and his fellowship in gastroenterology at Lahey Clinic in Burlington, Massachusetts. Dr. Javed completed his advanced fellowship in neurogastroenterology and motility at the University of Pennsylvania in Philadelphia, Pennsylvania.
Dr. Javed is certified by the American Board of Internal Medicine. He is affiliated with the American College of Gastroenterology, the American Neurogastroenterology and Motility Society, and the American Gastroenterological Association. Dr. Javed speaks English, Urdu, Punjabi, and Hindi and sees patients ages 18 and older.
Dr. Javed strives to provide compassionate and conscientious care to each patient; all the while working together, with the patients and colleagues from different specialties, in a collaborative and communicative spirit. Outside of the office, you can find Dr. Javed hiking, baking, reading to his young son and volunteering at the local animal shelter.
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