Irritable bowel syndrome (IBS) is estimated to impact the lives of 10 to 15 percent of adults in the U.S., but according to the American College of Gastroenterology, only 5 to 7 percent of adults are actually diagnosed with the disease. Some people just never seek treatment for IBS symptoms.
Meanwhile, recent research has shown that stress and anxiety felt amid the ongoing COVID-19 pandemic may have caused an increase in people who felt or reported symptoms of IBS. That includes patients who sought treatment for the first time or those with exacerbated symptoms.
“The pandemic has brought a tremendous amount of anxiety, depression and loneliness,” says Dr. Ramon Reyes III, MD, a gastroenterologist at The Iowa Clinic’s West Des Moines campus. “Because of this, symptoms of IBS have been magnified, causing people to seek care. We’ve remained quite active, even during the pandemic, through personal visits or telehealth.”
While doctors still don’t know the true cause of IBS, there is a lot they have learned in recent years about treating the condition and helping patients find relief and live their best lives. In this blog post, we’ll examine what irritable bowel syndrome is and available treatment options.
What is irritable bowel syndrome?
IBS is the most common disease diagnosed by gastroenterologists and one of the most common disorders seen by primary care physicians. Despite this, no one truly knows what causes IBS.
Quick Facts About IBS
There are plenty of things doctors do know about IBS.
- It is a functional gastrointestinal problem.
- It manifests with abdominal pain and changes in bowel habits.
- Common changes in bowel habits include diarrhea, constipation or both.
- It is a chronic condition, meaning that it requires ongoing attention.
“I tell patients that IBS is a complex disorder, meaning that it has several aspects to consider,” Dr. Reyes says. “We’ve learned that the gut of people with IBS is quite sensitive to stimuli. The gut is either hyperactive, resulting in diarrhea, or it is hypoactive, resulting in constipation. IBS also is a ‘gut-brain disorder’ or vice versa. There is a psychosocial component of the disease, as well.”
The psychosocial component of IBS is what explains why patients with anxiety or depression often report intensified symptoms of IBS. There is a link between the conditions.
“Anxiety and depression make symptoms worse, but they are not the cause of IBS,” Dr. Reyes says. “IBS is a disease on its own. Anxiety is a disease on its own. So is depression. They make each other worse. Some patients go into a spiral. It’s a vicious cycle that needs to be broken.”
“We, as partners, are well aware of that,” Dr. Reyes adds. “We don’t just focus on IBS symptoms. We focus on the patient’s holistic health. That includes addressing anxiety or depression.”
Common Symptoms of IBS
There are four common symptoms felt by those experiencing irritable bowel syndrome that allow doctors to diagnose the condition, often without too much testing or lab work.
Common symptoms of IBS include:
- Abdominal pain
- Diarrhea
- Constipation
- Bloating
Depending on bowel habits, there are three different types of IBS:
- IBS with constipation (ISB-C)
- IBS with diarrhea (IBS-D)
- IBS with mixed bowel habits (IBS-M)
Symptoms of abdominal discomfort or pain associated with altered bowel habits must be present in patients for at least three days per month in the previous three months, for an IBS diagnosis.
What causes or triggers IBS?
As previously mentioned, the specific cause of irritable bowel syndrome is unknown. However, ongoing research continues to help doctors better understand and treat the condition.
“We know there are a lot of players involved,” Dr. Reyes says. “People with IBS do have some sort of visceral hypersensitivity — meaning that people with the condition perceive painful stimuli a great deal more than someone without it. Their nerve fibers fire more often. This affects the gut and results in decreased (constipation) or increased (diarrhea) motility. Gut-brain signaling is also affected. Sometimes IBS is marked by an imbalance in gut bacteria — known as dysbiosis.”
“In addition, there’s psychosocial distress, which explains why anxiety and depression tend to exacerbate symptoms of irritable bowel syndrome in patients,” Dr. Reyes says. “All of these things have to be addressed in any patient we see. Severe cases of IBS can be challenging to treat.”
Dr. Reyes notes that at The Iowa Clinic, primary care physicians are very capable of diagnosing standard cases of IBS. However, if a primary care physician has any trouble making a diagnosis or encounters a more complex case, then they are encouraged to refer patients to a specialist.
Do other gastrointestinal conditions have similar symptoms?
Inflammatory bowel disease (IBD), such as Crohn's disease and ulcerative colitis, and diverticulitis are all gastrointestinal conditions that have an overlap in symptoms with IBS. However, these are more serious conditions that also involve inflammation or irritation in the gastrointestinal tract.
Celiac disease is another culprit doctors often test for when ruling out conditions besides IBS. There are also specific parasitic diseases that can cause abdominal pain, bloating and diarrhea, though this is fairly uncommon outside of those living in or returning from a developing country.
If a doctor suspects you have IBD or diverticulitis, they may do further testing to check for inflammation. Inflammation can lead to more serious health problems. If a patient reports a loss of sleep, weight loss, or rectal bleeding then they likely have something other than IBS.
A celiac disease antibody test (tTG-IgA) may be used to rule out that condition. Meanwhile, a stool sample may be taken if parasites are suspected to be the culprit of your abdominal pain.
How is IBS different than Inflammatory Bowel Disease?
“IBD, first and foremost, is a much more severe disorder than irritable bowel syndrome,” Dr. Reyes says. “With IBS we do not see damage or irritation in the gastrointestinal tract. Blood tests and biopsies come back negative. There’s no observable disease progress in patients with IBS.”
“IBD is the opposite — it involves a lot of inflammation and irritation,” Dr. Reyes adds. “Patients with IBD may experience rectal bleeding, weight loss and symptoms causing a loss of sleep. Both gastrointestinal conditions are important to treat, but IBD is a more destructive disease than IBS.”
What treatment options are available for IBS?
Even though the cause of IBS is hard to pin down, there are several treatment options available depending on the symptoms that someone is experiencing and their level of discomfort.
“There actually was a dramatic change in treatment about 10 years ago,” Dr. Reyes says. “As gastroenterologists we focus on many things, not just pharmacology, but the whole patient. That includes stressors. We rule out other diseases. Treatment-wise we start with healthy living.”
“We help patients build plans to diet, exercise and lose weight if they need to,” Dr. Reyes adds. “Counseling and education in those areas is available for all patients diagnosed with IBS.”
Dr. Reyes notes there are now several FDA-approved prescription medicine options available for those who have IBS-C or IBS-D. Examples include Linzess (linaclotide) for IBS-C and Lotronex (alosetron) and Xifaxan (rifaximin) for IBS-D. IBgard is an over-the-counter drug meant for temporary relief of abdominal pain. It is only a short-term solution for symptom relief.
Gastroenterologists at The Iowa Clinic follow the American College of Gastroenterology (ACG) clinical guideline on IBS, which is updated every three years, when determining how to best treat patients with irritable bowel syndrome. They also stay up-to-date with current industry research.
“We now have specific drugs that account for the root cause of IBS that have all been FDA approved in the past 10 years,” Dr. Reyes says. “Previously, treatment was mainly symptom control. Now we have specific ACG recommendations for treatment based on evidence.”
Is IBS ever a sign of a more serious medical condition?
The good news is that IBS is not a life-threatening condition. It also is not typically a sign of another more serious medical condition, assuming that you were properly diagnosed.
“IBS never directly killed anybody, but it is a huge burden,” Dr. Reyes says. “The economy pays somewhere in the range of $20 billion for the care of those with IBS. It’s a very expensive chronic disease that alters quality of life. Diarrhea or constipation certainly will change someone’s life.”
People experiencing IBS may be frequently absent from work or school. Decreases in productivity may impact a person’s ability to hold a job or advance in their career.
“People with IBS experience symptoms for months or years,” Dr. Reyes says. “It’s a burden quite similar to migraine headaches or depression or acid reflux. There are flare-ups. It is a big deal. If these things go untreated then it can have a huge impact on quality of life. The symptoms need to be alleviated. The disease needs to be treated. Patients need to see a doctor for this.”
Dr. Reyes recommends that anyone who thinks they might be dealing with a gastrointestinal issue first reach out to their primary care physician. Your regular doctor can diagnose IBS in most instances, but if the situation is particularly complex, they can also refer you to a specialist.
“If at any point, a primary care physician is not comfortable in the diagnosis and treatment of IBS in patients, then they can send the patient to see us and we’re happy to help,” Dr. Reyes says.
Don’t let IBS make you feel hopeless, help is available.
For patients living with irritable bowel syndrome, life can be overwhelming. At best, you are living in a state of recurring discomfort and in other instances, the condition can severely affect every part of your life. That is why it is absolutely necessary for individuals who are experiencing symptoms to see a doctor.
“At The Iowa Clinic, we have a unified team of gastroenterologists,” Dr. Reyes says. “We are modern. We are innovative. We have the right tools at our disposal, including endoscopy imaging and laboratory access. These are all things we can use to expedite the diagnosis of IBS.”
“Our unified goal is to make an earlier diagnosis of IBS, so we can start treatment earlier to make your quality of life better,” Dr. Reyes adds. “We want patients to be able to go back to work, go back to school and get on with their lives. Unfortunately, IBS is a chronic condition. It flares up and then goes into remission. We are proactive with our continuity of care and follow patients over time.”
“I appreciate when a patient calls me 10 weeks later and tells me their symptoms are gone or reduced and they are back to work or school,” Dr. Reyes says. “That brings me great joy.”
You don’t have to suffer through recurring abdominal pain and diarrhea or constipation. Schedule an appointment with a primary care provider today to find relief from your symptoms.
