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Apr 19

Irritable Bowel Syndrome

Happy Monday, and welcome to Medical Mondays! …In addition to being Alcohol Awareness Month and Sexual Assault Awareness Month, April also happens to be IBS Awareness Month! (D-damn, April! You got a lot goin’ on! :O )

What is IBS, you ask?

Well, it’s right in the title of the post–IBS is Irritable Bowel Syndrome. IBS is very often confused with IBD (Inflammatory Bowel Disease, which encompasses Crohn’s Disease + Ulcerative Colitis)–I’ll get to the latter in May.

IBSAwarenessMonth

Irritable Bowel Syndrome (IBS) is a benign idiopathic disorder that’s characterized by abnormal activity of the GI tract while at rest, and is often associated with depression and anxiety.

It is not caused by stress, but is often associated with it due to the connection between the brain + the gut.

IBS affects ~10-15% of the U.S. population, and can range from mild inconvenience to severe debilitation. Individuals with moderate to severe IBS often struggle with symptoms that impair their physical, emotional, and social well-being.

Symptoms

  • Include a combination of diarrhea, constipation, abdominal pain, and/or abdominal bloating
  • Notably relieved by defecation

“Red-flag” symptoms that might suggest a more serious condition include:

  • Anemia
  • Bleeding
  • Weight loss
  • Early satiety

Classification

IBS can be split into 4 different classifications:

  • Constipation-predominant
  • Diarrhea-predominant
  • Alternating
  • Post-infectious

Diagnosis

For the diagnosis of IBS, a patient must have the following:

  • Recurrent abdominal pain/discomfort for >3 days/month in the past 3 months AND 2+ of the following:
    • Improvement with defecation
    • Onset associated with change in stool frequency
    • Onset associated with change in stool appearance

IBS is a diagnosis of exclusion, meaning that other causes must be ruled out first with lab tests + stool exams, and clinical suspicion for IBS is needed.

Tests may range from a colonoscopy (especially with patients > 50 year olds who’ve never had one, to rule out colorectal cancer) to biopsies to lactose breath tests (to rule out lactose intolerance) or blood tests for celiac disease.

Treatment

The best treatment is stress management, although dietary* + lifestyle modifications for symptomatic relief may be beneficial. This includes:

  • Fiber supplementation
  • Increased water intake (for predominant constipation)
  • Lactose-free diet
  • Exclusion of gas-producing foods (e.g. beans, broccoli, cabbage, cauliflower, carbonated drinks)
  • Avoidance of caffeine to limit anxiety/symptom exacerbation

*Carbohydrates that are poorly absorbable and highly gas-forming can exacerbate IBS symptoms. These are known as “FODMAPS” (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, Polyols), and include:

  • Fruits with fructose in excess of glucose (e.g. apples + pears)
  • Raffinose-containing foods (lentils, cabbage)
  • Sorbitol-containing foods (e.g. plums + artificial sweeteners)
  • Fructan-containing foods (e.g. onions, asparagus, large amounts of wheat)

If medications are indicated, options include:

  • Diarrhea-predominant
    • Anti-diarrheals (e.g. loperamide, diphenoxylate hydrochloride + atropine sulfate)
    • Antibiotics (e.g. rifaximin) for severe IBS w/o constipation that does not respond to other treatments
    • TCA’s (tricyclic antidepressants, e.g. amitriptyline, imipramine)
    • Anti-spasmodic agents (e.g. dicyclomine hydrochloride, hysocyamine sulfate)
    • Serotonin receptor antagonists (e.g. alosetron)
  • Constipation-predominant
    • Laxatives (e.g. lubiprostone, methylcellulose, linaclotide)
    • Chloride channel activators
    • Guanylate cyclase C agonists

For a great post on someone’s personal experience with IBS medications, check out Amber’s post on IBS medication options! (She also has a great one for possible natural remedy options that may help!)

Probiotics may also help to improve IBS symptoms, and psychological + behavioral therapies (e.g. cognitive behavioral therapy, hypnosis, relaxation training) may be effective in certain individuals.

For a great post by someone who’s a registered dietitian and thus actually licensed to talk about nutrition, check out The Spicy RD’s post on simple diet + nutrition tips for IBS!

There’s apparently a free mobile app that includes topics related to IBS and constipation, so if you’re interested in gaining a better understanding of either (or both), go check out the app! (Note: I haven’t actually downloaded it, but I came across it whilst doing research for this post, so there you go. :O )


I came up with this design ages ago for our class t-shirt contest! :]
Disclaimer: This is where I reiterate that I am merely a medical student struggling through the world that is her clinical rotations. The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)

Permanent link to this article: http://www.fairyburger.com/irritable-bowel-syndrome/

22 comments

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  1. Ricardo

    Seriously April, do you need to talk? Because that’s a lot of awareness.

    This post is all the more interesting because I’ve had it back in 2011-2012 almost daily. I never though to check it out at the time because I thought it was just normal, and then it’s almost entirely gone ever since I started getting in shape. Stupid depression.

    1. Farrah

      For serious, April! :[ Fun fact–it’s also STD Awareness Month, but I figured I’d spring that stuff on people next year, hahaha.

      I’m glad that exercise/getting in shape helped to kick it for you! 😮

  2. Susie @ SuzLyfe

    IBS is such an interesting condition–the psychological aspect of it plays such a huge role–it truly is one where you have to have your mind in tune with your body and your meds, and cognitive behavioral therapy is such an incredibly powerful tool
    Susie @ SuzLyfe recently posted…Caitlin’s Wedding and 40 Hours in South Side PittsburghMy Profile

    1. Farrah

      Agreed! I actually had a practice question (from one of them “high yield” review books) the other day that asked which type of behavioral therapy was most likely to be the right answer, and of course…it was CBT. :O

  3. Elizabeth @ Enjoy Every Bite

    Love that healthy food can be a successful form of treatment! Another great post for Medical Mondays!
    Elizabeth @ Enjoy Every Bite recently posted…Breastfeeding Tips for Working MomsMy Profile

    1. Farrah

      Agreed! I like the ones where just eating healthier can be the “cure!” :]

  4. Linda @ TheFitty

    I wonder why stressing less can help relieve IBS If it’s not caused by stress? I think i am diarrhea predominant.
    Linda @ TheFitty recently posted…5 MOVES FOR FLAT ABS!My Profile

    1. Farrah

      I think it may have to do with the fact that the gut is very much affected by the brain, so stressing more or less is often associated with changes on the severity of symptoms!

  5. Maureen

    I have dealt with IBS a few times the past few years…months on end. For me personally, it seems that when I clean up my eating habits, my IBS goes away. Thanks for this post!
    Maureen recently posted…Rock Your Core April Ab Challenge {Week 4}My Profile

    1. Farrah

      I’m glad to hear that it went away with cleaned-up eating habits! :] I had a couple more cheat days than usual lately, so I need to get back on that!

  6. Sheryl

    Thanks for all the great info. IBS can be a real drag. It is great to see what to avoid!
    Sheryl recently posted…Crustless Breakfast QuicheMy Profile

    1. Farrah

      It definitely doesn’t sound fun to deal with, but I’m glad there are things that can be done to treat it!

  7. EA-The Spicy RD

    Lots of great info, and thanks so much for sharing my post as well=much appreciated! Have a wonderful week 🙂
    EA-The Spicy RD recently posted…Strawberry Arugula Salad with Chicken, Goat Cheese, Almonds, and Creamy Strawberry Lemon VinaigretteMy Profile

    1. Farrah

      Of course! I loved all the information in your post! I don’t get to learn too much about nutrition in med school, so I always appreciate it when I can find out more from people who do know what they’re talking about! ;P

  8. Kristy @Runaway Bridal Planner

    I am really glad I have not had to deal with this!
    But this is good info, incase it ever happens or someone I know has trouble!
    Kristy @Runaway Bridal Planner recently posted…Sometimes You Have to Believe in YourselfMy Profile

    1. Farrah

      I’m glad we don’t have to deal with it, but yes indeed for hopefully being able to help out others!

  9. Rebecca @ Strength and Sunshine

    I feel like IBS is BS! It’s a cop out sometimes. My first ever GI doctor told me I had it when I was really suffering from Celiac. But digestive disorders are SO hard and complex. It’s frustrating 🙁
    Rebecca @ Strength and Sunshine recently posted…Orange Chocolate Chia Buckwheat CerealMy Profile

    1. Farrah

      It’s definitely hard sometimes to distinguish between it and other GI disorders/conditions since all the symptoms can be so very similar to one another!

  10. Jess @hellotofit

    Enjoyed learning today 🙂 love these posts! IBS reminds me of Ben Stiller in the comedy, Along Came Polly, hahaha.
    Jess @hellotofit recently posted…Monday motivation – how will your story end?My Profile

    1. Farrah

      I need to go watch that! :O

  11. Amber

    OMG OMG OMG I LOVE LOVE LOVE THIS POST <3 and am SOO grateful you included ME, and my blog post in it, THANK YOU THANK YOU THANK YOU, I AM BEAMING not only on your sharing but your INCREDIBLE AND ACCURATE information 🙂 You didn't belittle my condition, but made sure to make note that for some, it is very serious! And FINALLY someone who actually notes that "Exclusion of gas-producing foods (e.g. beans, broccoli, cabbage, cauliflower, carbonated drinks)" IS a treatment, most people just say I'm "being picky" when I say I cannot eat those things…..
    Amber recently posted…IBS – Natural Remedy OptionsMy Profile

    1. Farrah

      Of course, Amber! I really liked your post! <3 I'm really sorry on behalf of anyone who's ever belittled your condition! (That's horrible! :[ )

      It sucks that people just write it off as being a picky eater--if you know for a fact that it's going to cause problems, why isn't it perfectly acceptable to others to avoid it? Hoping that raising awareness for it will help! <3

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