IBS is no BS

Millions of people are diagnosed with irritable bowel syndrome (IBS) every year making it one of the most common gastrointestinal (GI) conditions. Despite its prevalence there remain many misconceptions about IBS among both patients and doctors. Here we review some basic concepts in hopes of demystifying this nebulous syndrome.

What is IBS?

Irritable bowel syndrome is defined by a constellation of symptoms including abdominal pain and altered bowel habits (diarrhea or constipation) that persist for a prolonged period of time. There is no blood test, radiology study or endoscopic procedure that can definitively diagnose IBS. These studies are essentially normal and thus IBS is called a functional GI disorder.

The term “functional” is not intuitive and deserves some explanation. Consider this analogy; your GI tract is like your car’s engine. When the engine is running the pistons are constantly moving, axels are rotating, fluids are flowing, heat is being generated, etc. In order to appreciate the complexities of the engine you would need to watch it run for some time. A photograph, capturing a single moment in time, would not convey the functions of the engine. Similarly, if the engine was sputtering it would be impossible to diagnose the problem by taking a snap shot. The problem is with the “function” of the engine not its “structure”.

Your GI tract is like a car engine. It is constantly moving, expanding and contracting, generating fluids and gasses, interacting with nutrients and bacteria. If there were a problem with one of these functions it would lead to bothersome symptoms (pain, diarrhea, constipation, bloating, gas). However, if we took a snapshot of the GI tract (via a blood test, CAT scan, MRI, or endoscopy) it would likely appear normal because the problem is with the “function” not the “structure” of the intestines. IBS is a sputtering engine in your abdomen and while it may appear structurally normal, its function is somehow disrupted.

What causes IBS?

It is not known what causes irritable bowel syndrome but there are numerous theories with varying degrees of supporting evidence. A common explanation suggests that the two major culprits are bowel dysmotility and gut hypersensitivity. Altered bowel motility may explain the diarrhea (accelerated movement) and constipation (decelerated movement) that are seen in IBS. Gut hypersensitivity refers to the finding that people with IBS have a lower pain threshold when it comes to bowel stretching or contracting. Other theories have implicated several other factors as possible causes of IBS. These include mild bowel inflammation, alterations in the bacteria living in the gut, sensitivity to food and even a genetics.

How is IBS diagnosed?

As stated above IBS is a constellation of various symptoms (abdominal pain, diarrhea, constipation, bloating, etc) which taken together may constitute the syndrome. While there is no definitive test for IBS, a medical evaluation is necessary to exclude other conditions that may cause similar symptoms. In general, it is wise to consult a gastroenterologist to help guide the evaluation and make the diagnosis. Needless to say, making the correct diagnosis is crucial to help guide therapy.

What is the prognosis of IBS?

Here’s the good news: nobody has ever died from IBS. There is no debate that irritable bowel syndrome can lead to symptoms which can interfere with well-being. At times these symptoms may be significant and seem insurmountable. But, ultimately, they can be managed effectively and allow for a normal quality of life. People with IBS are not at increased risk for developing other GI diseases (cancers, inflammation, ulcers, etc) when compared with non-IBS individuals. I repeat, nobody has ever died from IBS.

How is IBS treated?

There are numerous therapies for irritable bowel syndrome and reviewing them is beyond the scope of this article. In general, treatment centers around symptom control via the modification of underlying mechanisms thought to contribute to IBS. Since every person with IBS is different in terms of symptom burden and treatment response there is no single right way to manage IBS. Therapies have to be individualized. Consulting with a gastroenterologist will allow IBS sufferers to review their treatment options and tailor a therapy to meet their specific needs.

To sum up, IBS is a real problem and a major problem in our society. While the diagnosis may at times seem somewhat nebulous there is a real physiologic basis to the disorder. Consulting with a gastroenterologist can help make the correct diagnosis and design a tailored treatment regimen.

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