Irritable bowel syndrome, or IBS, is the most common diagnosis I encounter in my job as a dietitian in a gastroenterology practice. The condition affects an estimated 7 to 16 percent of the U.S. population, but is surprisingly misunderstood among the general public — and even healthcare practitioners. Here are three facts to help set the record straight:
1. IBS is not a “catch-all” diagnosis.
There’s a common misconception that IBS is a “default” diagnosis that doctors resort to when they can’t find anything “real” wrong. While it’s true that it’s not diagnosable via blood tests, stool tests, X-rays or tissue biopsies, that doesn’t mean it’s diagnosed via process of elimination or that it’s not diagnosable at all. In reality, clinicians diagnose the condition using a defined set of symptoms called the Rome criteria.
In lay terms, the criteria indicate that people with IBS suffer from chronic, but waxing-and-waning, abdominal pain and irregular bathroom patterns that range from very loose, frequent and/or urgent bowel movements to very hard, incomplete and/or infrequent bowel movements. The symptoms need to occur at least once a week for three months for a diagnosis to be considered.
[See: What to Eat, Drink and Do to Relieve Constipation.]
2. IBS is a physical, not psychological, condition.
Once upon a time, many people considered IBS a mostly psychological condition that manifested as physical pain. But this is not the case. Just because there are no convenient lab tests (yet) that can definitively diagnose IBS in the way that clinicians can diagnose a vitamin deficiency or bacterial infection doesn’t mean IBS isn’t associated with true, observable differences in how the body functions. Researchers have identified multiple physiological differences between people with IBS and their healthy peers, including:
— Differences in how the brain and gut communicate to signal pain;
— A common set of differences in the types of microorganisms living in their guts; and
— Differences in the way the gut’s lining and immune cells interact with various stimuli.
While it’s true that some people with IBS find certain types of antidepressant and anti-anxiety medications help treat their symptoms, it’s not because those folks’ IBS is actually depression or anxiety. Rather, these medications mitigate symptoms of IBS by changing nerve function, muscle function or both in the gut and brain. These drugs are often effective for IBS even when prescribed at doses much below those used for psychiatric purposes, and are not intended to address a presumed psychological “root cause.”
Similarly, while stressful situations can most certainly aggravate IBS symptoms, this is likely because of underlying physiological differences that make people with IBS more susceptible to the effect of stress hormones on physical symptoms. This is different than saying that IBS is caused by stress. (After all, if stress “caused” IBS, then all of us would have it, and stress relief measures would cure it!)
[See: 8 Ways to Relax — Now.]
3. You don’t have to just “live with” IBS; there are many treatments that work.
My patients who have been living with IBS for decades often describe encountering very dismissive attitudes from their healthcare providers. “It’s ‘just’ IBS,” many have been told. “There’s nothing you can do about it,” they’ve heard time and again. These patients were left on their own to cobble together a coping strategy, which often involved guessing about over-the-counter anti-diarrheal medications; limiting their travel; waking up several hours before work in order to complete prolonged toileting activities; going entire days without eating so as to avoid triggering debilitating pain or an uncontrollable urgency to defecate; avoiding restaurants and socializing entirely; restricting themselves to a rigid dietary regimen of a dozen or so plain, bland foods; and even changing careers to accommodate their unpredictable bathroom needs.
If this sounds awful to you, then you’re starting to get how infuriating it must feel to a person dealing with this condition to be told it’s “just” IBS. Survey data suggests that people with IBS may miss an average of two workdays per month due to their condition. And, they score significantly lower on quality of life measures than their healthy counterparts and people with diseases that are commonly considered more “serious” — including acid reflux disease, asthma and migraines. The struggle is real, and it’s under-recognized.
In contrast to what my older patients were told decades ago when diagnosed with IBS, there are so many evidence-based treatment options available today. These interventions can be combined in a way to target an individual’s symptoms and improve his or her quality of life. Here are some common remedies:
— Dietary Changes: A soluble fiber-rich diet or a low-FODMAP diet can help.
— Supplements: Patients may benefit from enteric-coated peppermint oil for abdominal pain, soluble fiber supplements for diarrhea or magnesium and high-dose vitamin C for constipation. Specific supplemental probiotic strains such as B. infantis 35624, L. rhamnosusGG, S. boulardii and a few others can also be used to regulate bowel movements.
— Medications: Over-the-counter medications like PEG-3350 (MiraLAX) or other laxatives can work well for patients who tend toward constipation. When these aren’t up to the task, prescription options include lubiprostone, linaclotide, plecanatide and sertraline. For patients who suffer more from diarrhea, medication options may include anti-spasmodics (hyoscyamine and dicyclomine) or medications that slow down the colon’s motility like eluxadoline, tricyclic antidepressant medications like amitriptyline and selective serotonin reuptake inhibitors (SSRIs) like paroxetine hydrochloride. Rifaxamin, an antibiotic often used to treat small intestinal bacterial overgrowth, may also be effective.
[See: Pharmacist-Recommended Stomach and GI Products.]
— Behavioral Treatments: Cognitive behavioral therapy techniques, hypnotherapy and acupuncture can improve quality of life by providing patients with tools to cope with pain. They also help patients break the vicious cycle of anxiety about having an attack that can often precipitate an actual attack and teach them to “sit with” feelings of discomfort and urgency until they pass so that IBS symptoms exert less control over quality of life.
This list is by no means exhaustive. A gastroenterologist or registered dietitian experienced in treating IBS can help you build a multi-pronged strategy that best addresses your individual symptoms and triggers.
Editor’s note: Dr. Eric Goldstein, a New York City-based gastroenterologist and expert in functional bowel disorders, contributed to this article.
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3 Facts About IBS Too Many People Still Don’t Believe originally appeared on usnews.com
