Tags: IBS
Irritable bowel syndrome (IBS) is a disorder affecting the intestine. IBS involves problems with motility (movement of digested food through the intestines) and sensitivity (how the brain interprets signals from the intestinal nerves), leading to abdominal pain, changes in bowel patterns and other symptoms. Although often disruptive, debilitating and embarrassing, it may be some comfort to know that IBS is not life-threatening, nor does it lead to cancer or other more serious illnesses.
Canada has one of the highest rates of IBS in the world, estimated 18% vs 11% globally (Lovell et al. 2012). However, it is thought that IBS often remains under diagnosed. More than 70% indicate that their symptoms interfere with everyday life and 46% report missing work or school due to IBS. (Gastrointestinal Society 2016).
People with IBS frequently report feeling depressed, embarrassed and self-conscious. Their inability to predict symptoms places significant burden on daily living. IBS limits productivity and performance at work, has a negative effect on the quality of relationships, and limits participation in routine social activity (Gastrointestinal Society 2018).
IBS also has a personal financial burden with individuals sometimes trying multiple over-the-counter (OTC) treatments and alternative therapies in their quest to be symptom-free; costs can be significant due to the lack of information about the effectiveness of these purported remedies (Gastrointestinal Society 2018).
The underlying cause of IBS is still unclear and there is no diagnostic disease markers for IBS. Guidelines recommend doctors make a positive diagnosis using criteria that are based on person’s symptoms.
Subtypes of IBS are recognised by the Rome IV criteria based on the person’s reported predominant bowel habit, when not on medications, as follows:
More questions? See our top 10 IBS questions: Answered here.
Irritable bowel syndrome with constipation, also referred to as IBS-C, is a distressing condition that can significantly affect the quality of life of those affected.
Constipation occurs when digested food moves slowly through the digestive tract. As a result, stool remain in the large intestines for prolonged periods of time where the intestines remove excess water causing stool to become hard, dry, lumpy and difficult to pass.
Irritable bowel syndrome with diarrhea is IBS with diarrhea as the primary symptom, also referred to as IBS-D.
People with IBS-D experience frequent abdominal pain and watery bowel movements, and, on occasion, loss of bowel control. In fact, approximately 1 out of every 3 people with IBS-D have loss of bowel control or soiling. This has a strong, negative impact on day-to-day life, however these and other symptoms of IBS-D can be managed.
You should see your physician. The American Gastroenterology Association (AGA) recommends to patients three steps to improve communication with their physician:
If you think you may have IBS, click here to download our handy Infographic.
Citations
Gastrointestinal Society. 2018. IBS Global Impact Report 2018. https://badgut-5q10xayth7t3zjokbv.netdna-ssl.com/wp-content/uploads/IBS-Global-Impact-Report.pdf [accessed 3 September 2018]
Gastrointestinal Society. 2016. 2016 Survey Report: Irritable bowel syndrome. https://badgut-5q10xayth7t3zjokbv.netdna-ssl.com/wp-content/uploads/IBS-Survey-Results-2016.pdf [accessed 3 September 2018]
Lovell RM and Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: A meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-21.e4.
Citations:
Buono JL et al. Economic burden of irritable bowel syndrome with diarrhea: Retrospective analysis of a U.S. commercially insured population. J Manag Care Spec Pharm. 2017 Apr;23(4):453-60.
Fedorak RN et al. Canadian Digestive Health Foundation Public Impact Series 3: Irritable bowel syndrome in Canada. Incidence, prevalence, and direct and indirect economic impact. Can J Gastroenterol. 2012 May;26(5):252-6.
Gastrointestinal Society. 2018. IBS Global Impact Report 2018. https://badgut-5q10xayth7t3zjokbv.netdna-ssl.com/wp-content/uploads/IBS-Global-Impact-Report.pdf [accessed 3 September 2018]
Gastrointestinal Society. 2016. 2016 Survey Report: Irritable bowel syndrome. https://badgut-5q10xayth7t3zjokbv.netdna-ssl.com/wp-content/uploads/IBS-Survey-Results-2016.pdf [accessed 3 September 2018]
Han CJ and Yang GS. Fatigue in irritable bowel syndrome: A systematic review and meta-analysis of pooled frequency and severity of fatigue. Asian Nurs Res (Korean Soc Nurs Sci). 2016 Mar;10(1):1-10.
Lovell RM and Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: A meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-21.e4.
IBS is not a single entity. It’s a collection of abdominal and bowel-related symptoms. Symptoms common in IBS that support a diagnosis are:
While most people experience digestive troubles once in a while, what sets IBS apart is abdominal pain and diarrhea or constipation that comes back again and again. At times, the pain and discomfort of IBS symptoms may be severe and debilitating, and at other times, they may improve or even disappear completely.
When living with IBS-C, symptoms may suddenly worsen (flare) and then improve for no apparent reason. When symptoms flare, they may be severe, debilitating and last for days or months. Possible signs and symptoms of IBS-C are:
The exact cause of IBS is unknown, however, it is believed that IBS may be caused by one of several factors. In some patients, it may be linked to a prior infection or event which disrupts the normal functioning of the intestines. It is common for people to develop IBS following a gastrointestinal infection, food poisoning, traveller’s diarrhea, surgery, a change in diet or the use of antibiotics or new medications. In others, an imbalance of intestinal bacteria or a change in the body’s level of hormones, immune signaling in the bowel wall or neurotransmitters (brain chemicals) may also lead to the development of IBS. Currently, there is a great deal of interest in possible alterations in the number or type of bacteria within the intestine, but the exact role this may play in IBS is not yet known. In people with IBS, bowel function can be altered in several ways:
The cause of IBS-C is not yet known; however, there are a variety of factors that may contribute to the disorder. These include:
If left untreated, IBS-C can potentially lead to additional health complications. These include:
Although the exact cause of IBS-D is unknown, it is believed that IBS-D may be caused by one of several factors:
If left untreated, IBS-D can potentially lead to additional health complications. These include:
Often, symptoms alone can provide doctors with the information they need to diagnose IBS. Your doctor will perform a physical examination and take a complete medical history that includes a careful review of your symptoms. For this reason, it is important to be candid and specific with your doctor about the problems you are having. A set of specific symptom criteria (referred to by physicians as the Rome IV Criteria) has been developed to help physicians diagnose IBS.
In May 2016, the Rome Foundation released the new Rome IV criteria for diagnosing IBS. All around the world, physicians follow this organization’s lead when diagnosing IBS.
According to the Rome IV diagnostic criteria, IBS is characterised by recurrent abdominal pain for, on average, at least one day per week in the last three months, associated with two or more of the following:
Take comfort in knowing that IBS is an extremely common problem, and in many cases, simple changes in your lifestyle and diet can provide symptom relief. However, no one treatment works for everyone and treatment will depend on the types of symptoms you have, their severity and how they affect your daily life.
Your doctor may recommend prescription or over the counter products if your IBS symptoms are severe and if lifestyle and dietary strategies have not helped. Typically, medications are targeted at the dominant symptom – diarrhea, constipation or pain.
It is important to find a solution that works best for you so you can find relief and enjoy the best quality of life possible despite IBS-C. Your healthcare provider will try to help you manage your symptoms. Recommendations generally begin with changes to lifestyle and diet. If those changes do not bring relief, over-the-counter (OTC) products or prescription medications may be prescribed.
While lifestyle and dietary changes can play a role in helping manage mild IBS-C symptoms, if your symptoms do not improve or even worsen, you may require further intervention. Over the Counter (OTC) and prescription therapies are available for treating IBS-C. OTC medications are recommended for short term/occasional use. If you symptoms are still unresolved, you should consult with your health care provider. With the right medication, you should find relief and prevent IBS-C from inhibiting your everyday activities and quality of life.
Some IBS-C patients do not find relief with lifestyle and diet changes nor over the counter medications. These individuals need safe and effective long-term therapies. There are currently two classes of prescription medications that may help. These are:
While lifestyle and dietary changes can play a role in helping manage mild IBS-D symptoms, if your symptoms do not improve, you may require further intervention. Over the Counter (OTC) and prescription therapies are available for treating IBS-D.
OTC medications are recommended for short term/occasional use. If your symptoms are still unresolved, you should consult with your health care provider. With the right medication, you may find relief and prevent IBS-D from inhibiting your everyday activities and quality of life.
IBS-D patients suffer from a multitude of symptoms including abdominal pain, bloating, and diarrhea. The commonly used prescription drugs only address a single symptom rather than the constellation of symptoms observed in IBS-D patients. Recent advancements in the treatment of IBS have produced newer medications that not only treat the multiple symptoms but have been specifically studied and approved for use by Health Canada in IBS-D patients.
Physicians may now prescribe one or a combination of drugs that:
Think you may have IBS? Read this article.
What is the cause of excessive flatulence and burping?
This is a common problem! We all pass gas and or experience burping but for some people, these symptoms can be really bothersome. It is important to recognize that everyone has gas in the digestive tract. When there is some gas and fluid in the intestines, movements (contractions) of the intestines to propel the contents onwards may cause rumblings.
There two major causes of excessive gas:
First, subconscious swallowing of air can result in excessive burping. Eating slowly, avoiding gum chewing and smoking, rectifying problems that lead to phlegm accumulation in the back of the throat (such as postnasal drip), and correcting a habit of clearing the throat and swallowing can help minimize air swallowing. Belching often induces instinctive reflex swallowing with further gas accumulation so you need to make a conscious effort not to swallow after each belch.
And second, gas can form as a result of the breakdown of certain dietary items, especially carbohydrates, by bacteria normally present in the large intestine. Foods that cause gas include beans, broccoli, cabbage, fruit drinks, carbonated drinks, and dairy products. Beano (obtainable over-the-counter) may help to reduce gas formation when you have a lot of vegetables and fruits at any meal.
There is no one answer or diagnosis that applies to all people. I suggest that you contact your family doctor and discuss your symptoms and the tests he or she might want to do.
How common is IBS?
IBS is very common. In fact, Canada has one of the highest rates of IBS in the world, estimated 18% vs. 11% globally (Lovell et al. 2012).
What are the most common symptoms?
A: Abdominal Pain, irregular bowl patterns that result in constipation, diarrhea, or alternating periods of both.
How do you know if you have IBS?
A: A set of specific symptom criteria (referred to by physicians as the Rome Criteria)
has been developed to help physicians diagnose IBS.
Can IBS kill you?
A: No. IBS is a chronic (long term), but manageable condition. Over time, the symptoms of IBS typically do not get worse, and with an effective treatment plan, as many as one-third of IBS patients may eventually become symptom-free.
Are there any complications of IBS?
While IBS can cause pain and stress, it does not cause any permanent damage to the bowel or lead to cancer or any other major illness.
Is there an IBS Diet?
A: One of the most common diets recommended by healthcare professionals to alleviate IBS symptoms is the FODMAP diet. Fermentable carbohydrates (also known as FODMAPs), are small carbohydrate (sugar) molecules found in everyday foods that may be poorly absorbed in the small intestine of some people. FODMAPs are fermented (digested) by intestinal bacteria, which can lead to symptoms of abdominal pain, excess gas, constipation and/or diarrhea. Following a low-FODMAP diet may help to reduce gastrointestinal symptoms in 75% of IBS patients.
Learn more about the FODMAP diet here. Check out the other diets here.
Will probiotics help my IBS?
A: If other dietary strategies have not been successful in relieving your symptoms, a trial of a probiotic (in the dose recommended) may be helpful. However, Probiotics are not medicine! They are available to purchase as capsules, tablets or powders, and can also be found in some fortified yogurts and fermented milk products. However, not all probiotics are the same. It is important to choose a product that is proven to be safe and offers benefits for the specific symptoms you want to relieve. Speak to your doctor or pharmacist about which probiotic may be right for YOU.
Are there other ways to manage IBS?
A: There are medications approved in Canada for IBS (over the counter or prescription) that can help your symptoms as well. Peppermint Oil is a relatively new treatment option out there has recently been confirmed in a clinical trial. Peppermint can relax muscle, eases hypersensitivity in the bowels, and modulates pain in IBS.
IBgard is a new clinically tested capsule filled with tiny beads of peppermint oil, using a technology called SST (Site Specific Targeting). It is the only product of its kind on the market that has gone through a clinical trial. It has been proven to be effective and safe in relieving symptoms in patients with moderate to severe IBS-M and IBS-D.
This product is easily attainable and available over the counter. Patients tested saw relief in symptoms over the course of 24 hours and continued relief over a 3-4 week period. You can read the full clinical study here, or, if you’re interested in giving IBgard a try, you can also fill out a survey to get a free trial sample here.
How is IBS different than IBD?
A: Although both illnesses can be seriously debilitating, there are several primary differences between Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS). IBD is an autoimmune disorder that causes swelling and ulcerations (sores) in the bowel. IBS involves problems with motility (how the bowel moves contents through our intestines) and sensitivity (how the brain interprets sensations in the bowel). Symptoms of IBS may wax and wane and possibly disappear altogether whereas IBD is a chronic condition.
In this handy printable resource, CDHF covers the basics of the FODMAP diet.
[flipbook pdf="https://cdhf.ca/wp-content/uploads/2020/03/AS-Edit-2-Understanding-Fodmaps-rebrnd-1.pdf"]
FODMAPs are a group of small carbohydrate (sugar) molecules found in everyday foods. Carbohydrates are made up of carbon, hydrogen, and oxygen and provide an important source of energy for the body. FODMAP carbohydrates that may be poorly absorbed in the small intestine of some people.
FODMAPs move through the digestive tract to the large intestine (colon), where they can draw water into the colon and are rapidly fermented (digested) by naturally-occurring gut bacteria. The fermentation of FODMAPs produces gas and other by-products. It is estimated that 50% of people with IBS may benefit from a low FODMAPs diet, however, the quality of scientific evidence is very low. Of these people, there is a possible benefit for overall symptoms such as abdominal pain, cramping, bloating, excess gas, constipation and/or diarrhea.
Download and print this resource to help you understand the FODMAP diet. Complete with easy to reference cheat sheets of common low FODMAP food options, as well as a list of foods to avoid, this resource is a great opportunity for those who are new to the diet to learn the basics.
This guide is meant to explain the basics only, and CDHF encourages any IBS patients who are thinking about attempting this elimination diet for themselves to do so under the guidance of a registered dietitian.
If you have Irritable Bowel Syndrome (IBS) you’re probably experiencing abdominal pain, bloating, constipation, diarrhea, or any of these:
But how do you get diagnosed? What type do you have? and what are some of the treatment options? We cover all of this and more in our NEW animation:
We are very excited to announce our new #CDHFTalks with Dr. Turbide, gastroenterologist at the University of Calgary – on a digestive condition that you may be familiar with - Irritable Bowel Syndrome, or IBS for short. IBS is a chronic pain disorder, that is very common within the Canadian Population.
In this series of videos, Dr. Turbide goes over all things IBS – what it is, the different types of IBS, if your microbiome can be a cause of your IBS, and tips on managing IBS. He also talks about all of the treatment options available - whether that be prescription medications, over-the-counter medications, or psycho-social interventions.
This is one you definitely don’t want to miss so have a watch here.