Irritable Bowel Syndrome (IBS)
Tests and Treatment
Testing for irritable bowel syndrome (IBS)
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 Criteria) has been developed to help physicians diagnose IBS. According to these criteria, IBS is suspected based on the symptoms shown to the right. In a young person, the diagnosis can be confidently made based on symptom criteria, absence of any “red flags” in the history or physical exam (e.g. blood in the stools, symptoms awakening patients from their sleep, a strong family history of colon cancer, unexplained weight loss). There is no laboratory test, X-ray or scope to diagnose IBS, however, your doctor may order tests, particularly if there are red flags. To rule out other infections or underlying medical problems, these tests may include some of those listed below:
- Blood tests: Blood tests can help to rule out anemia, diabetes, abnormal thyroid function, changes in the calcium level that can affect the gastrointestinal tract, and celiac disease.
- Stool sample tests:A stool analysis can detect blood in the stool and rule out bacterial infection, malabsorption, parasites and other digestive problems.
Your doctor may order tests to see inside your lower digestive organs. This is done to rule out potential, more serious health problems.
These safe tests can help to identify problems such as ulcers, polyps (growths on the lining of the intestines), colon cancer or inflammatory bowel disease (IBD) and include:
- Colonoscopy: A slim flexible tube equipped with a light and a tiny camera is guided through the rectum into the large intestine (colon). The colonoscope allows your doctor to examine the lining of both the upper and lower sections of the colon.
- Flexible sigmoidoscopy: In a procedure similar to a colonoscopy, a flexible scope allows your doctor to view the lining of lower part of the colon only.
- CT (computed tomography) colonography: In most centres, barium enemas have been replaced by CT colonography. This scan takes cross-sectional pictures of the abdomen and uses special computer software to create a 3D image of the entire colon. It is very accurate at detecting larger polyps and cancers.
- Lactose intolerance: Lactose intolerance (an inability to digest the sugar in milk) can cause gastrointestinal symptoms similar to IBS. Your doctor can rule out lactose intolerance by performing a hydrogen breath test or by asking you to eliminate lactose from your diet for 2 weeks, and then reintroducing lactose and recording your symptoms.
- Celiac Disease: Celiac disease (a condition where the immune system reacts against gluten, a protein found in wheat) causes damage to the lining of the small intestine and may also cause symptoms similar to IBS. Celiac disease can be ruled out with a simple blood test performed at the doctor’s office or with a home kit that you can purchase at the pharmacy. You must be eating gluten at the time of the test in order for the results to be accurate. If the blood test is positive, a biopsy is needed to confirm a diagnosis of celiac disease.
Testing for irritable bowel syndrome with constipation (IBS-C)
There are two sets of diagnostic criteria for IBS-C which are used after other conditions have been ruled out. These are the Rome and Manning criteria.
To fit this criteria, patients must have experienced abdominal pain and discomfort that lasts for at least three days in a month in the last three months, and experiences two or more of following:
- symptom improvement after a bowel movement
- change in frequency of stool
- change in stool consistency
To fit the Manning criteria, patients are asked if they experience:
- pain linked to frequent bowel movements
- looser stools associated with pain
- pain is relieved by a bowel movement
- significant abdominal bloating
- when having a bowel movement, feeling the bowel movement is unfinished or incomplete more than a quarter of the time
- diarrhea with mucus more than a quarter of the time
The more symptoms the individual has, the greater the likelihood that IBS-C will be diagnosed. The hallmark symptom of IBS-C is abdominal pain.
Testing for irritable bowel syndrome with diarrhea (IBS-D)
Your physician will first conduct a careful review your medical history and a physical examination. Utilizing IBS diagnostic algorithms, such as the Rome Foundation’s Diagnostic Criteria for Functional Gastrointestinal Disorders, and excluding any “red flags” suggesting other disorders your physician will then establish a diagnosis of IBS based on your symptoms. If diarrhea is predominant, then it is determined that you have IBS-D.
Few tests are typically required, especially in young people as doctors can make the diagnosis with a high degree of certainty. A measure of your blood cell counts (CBC) and a blood test to exclude celiac disease (tissue transglutaminase) are recommended. If the onset is relatively recent, your doctor may order stool cultures to exclude an ongoing infection. If you are suspected of being lactose intolerant, your doctor may order testing to exclude this (breath test or blood test). In addition, if you have a family history of diseases such as Celiac Disease, Crohn’s Disease, Ulcerative Colitis or colon cancer, or if your symptoms onset after the age of 45 – 50 years old, your physician may order further tests. They may include blood, stool, and imaging (colonoscopy with biopsies, sigmoidoscopy with biopsies.
Treating irritable bowel syndrome (IBS)
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.
- Antispasmodic medications may help reduce muscle spasms, abdominal pain and cramping.
- Antidepressant medications, in low doses, act on the chemical messengers in the digestive tract and can help relieve diarrhea, pain and cramping. In higher doses, these medications help to relieve depression and anxiety that may accompany IBS.
- Antidiarrheal medications, such as Loperamide, can help control diarrhea by reducing stool frequency and slowing the movement of the intestines.
- Laxatives speed up the motion of stool through the intestines and may be prescribed for people who have IBS with constipation. Laxatives are available in prescription or over-the-counter formulations. Speak to your doctor about which one is best for you.
- Prosecretory and analgesic agents, which increase the amount of fluid in the digestive tract as well as reduce the sensitivity of pain nerves in the intestines. They have been shown to soften bowel movements and make them occur more often, reduce the amount of bloating and to decrease abdominal pain in patients with IBS.
Treating irritable bowel syndrome with constipation (IBS-C)
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.
OTC therapies for IBS-C:
- Osmotic laxatives: are non-stimulant laxatives that draw water into the colon, increase bowel movements and allow stool to pass through the colon more easily.
- Bulk-forming laxatives are non-stimulants containing fibre. Fibre brings water into the colon, softens and increases the bulk of stool, and softens stool. Psyllium or methylcellulose are the most common bulking laxatives used.
- Stool softeners are non-stimulants, which soften the stool by reducing surface tension and allowing intestinal fluids to penetrate the stool to make it softer and easier to pass. Stimulant laxatives stimulate the nerves and muscles of the intestine to trigger a bowel movement by increasing contractions of muscles in the intestine. This helps stool pass through the colon more quickly.
Prescription Medications for IBS-C
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:
- Prokinetic agents which stimulate movement and contractions of the bowel. This increases the speed with which stool travel through the digestive system, increases frequency of bowel movements, and reduces IBS-C symptoms.
- Prosecretory and analgesic agents increase the amount of fluid in the digestive tract as well as reduce the sensitivity of pain nerves in the intestines. They have been shown to soften bowel movements and make them occur more often, reduce the amount of bloating and to decrease abdominal pain in patients with IBS-C.
- Identify food triggers – Tracking foods you eat and logging the times you experienced symptoms/distress may help reveal connections between food and IBS-D. You should take detailed notes that should include the types and amounts of foods eaten and the time of consumption. It’s important to also record the time and description of distressing bowel events or related pain and discomfort. Below are some dietary considerations which you may want to discuss with your doctor and/or registered dietitian.
- High-fat foods may worsen symptoms of IBS-D
- Dairy products – lactose free products may be better tolerated
- Avoid alcohol
- A reduction of caffeine may be beneficial. This includes caffeinated drinks, such as coffee, tea, colas and energy drinks
- Sorbitol sweeteners (found in some chewing gum) may be problematic
- Drink plenty of water
- Probiotic supplements such as lactobacillus acidophilus may help alleviate IBS symptoms including abdominal pain, bloating, and bowel movement irregularity. Ask your health care professional for more information.
- A diet low in FODMAPs (fermentable oligo-saccharides, di-saccharides, mono-saccharides, and polyols), a group of short-chain carbohydrates, may help relieve symptoms. The diet is used in the short-term followed by re-introduction to assess tolerance to individual foods. Consult your health-care professional for more information.
- Eating large meals also may trigger abdominal cramping and diarrhea. It’s best to eat smaller meals.
- Fibre may be helpful in reducing symptoms of IBS-D. If a trial of a fiber supplement such as psyllium is used, fiber should be added gradually, because it initially may worsen bloating and gassiness. If you have IBS-D, look for foods with more soluble fiber, the type that takes longer to digest (such as that found in oats).
- Stress is considered one of the triggers of IBS symptoms. Here are some healthy habits that may also help reduce IBS symptoms.
- Exercise may improve and could reduce stress.
- Get enough rest. This allows your body to maintain basic function, repair and manage stress.
- Use relaxation techniques: deep breathing, visualization, Yoga.
- Consult a professional trained in Cognitive Behavioral Therapy or Gut Directed Hypnotherapy.
Medications for IBS-D
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.
OTC therapies for IBS-D
- Peppermint oil
- alpha galactosidase enzymes (e.g. Beano), simethicone, although efficacy with many products is not proven.
Prescription Drugs for IBS-D
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:
- reduce abdominal pain by blocking the pain signals to the brain
- relax the muscles in the gut to reduce diarrhea and the urgent, uncontrollable need to use the washroom (urgency)
- reduce both abdominal and bowel symptoms including pain, bloating, urgency and diarrhea Your doctor can determine if a combination or a single treatment is right for you.