Everything You Need to Know About IBS

Think you might have irritable bowel syndrome? If so, you’re not alone. An estimated 1 in 5 people in the U.S. suffers from irritable bowel syndrome (IBS), which affects more women than men. It is the most common disorder diagnosed by gastroenterologists and one of the most common seen by primary care physicians. Yet, despite affecting so many, the condition is widely misunderstood.

Health Matters turned to Dr. Daniela Jodorkovsky, director of Gastrointestinal Motility & Physiology in the Division of Digestive and Liver Diseases at NewYork-Presbyterian/Columbia University Irving Medical Center, to explain what causes IBS, treatment options, and how to cope without a cure.

What is IBS and what causes it?
IBS is a common disorder that affects the intestine. It is defined clinically by abdominal pain, plus change in bowel habits such as constipation, diarrhea, or both. We don’t know what causes IBS, but it’s likely due to a variety of factors, including genetics. A history of anxiety or depression has been linked to IBS, but not all patients with IBS have these risk factors. Another possible contributor is a change in the gut’s microbiota — or micro-organisms that live in or on the human body — and there are some patients who develop IBS after an infection like food poisoning or a stomach virus. We call this post-infectious IBS.

What are the symptoms?
The hallmark symptoms are changes in bowel habits (constipation, diarrhea, or both) and abdominal pain, which can include gas, bloating, nausea, and stomach cramps. Some patients have pain that improves with defecation, and others have pain irrespective of bowel movements. Symptoms vary from person to person.

Is there a cure for IBS?
Unfortunately, there is no “cure” for IBS, but with the right combination of lifestyle, dietary, cognitive, and pharmacologic therapies, most symptoms can be managed. If you have any alarming symptoms like weight loss or blood in the stool, you should see a doctor immediately. Otherwise, if IBS symptoms are affecting your quality of life, seeing a doctor may provide you with therapeutic options.

Why is IBS more common in women?
The difference may partially be explained by sex differences such as hormones, but healthcare-seeking behavior, access to healthcare, and cultural differences also factor in. For example, in Asia, IBS is equally prevalent in men and women, whereas in the U.S., studies show women are twice as likely as men to have IBS.

Is IBS the same as inflammatory bowel disease?
No. Inflammatory bowel disease, or IBD, is a disease involving the immune system, and there is overt inflammation of the intestine. In an IBS case, if you were to perform an endoscopy or colonoscopy, it would look normal, but the symptoms are driven by changes in the way the bowel is functioning. For example, the pain from IBS can be from “visceral hypersensitivity,” which means the nerves of the gut are extremely sensitive to normal things like gas, movement, contraction, and secretion. These normal functions of the gut can trigger pain in someone with IBS but might not trigger pain in someone without IBS.

Are there foods that can trigger IBS symptoms?
Any food that can lead to gas, bloating, or diarrhea can be harder for some patients with IBS to tolerate. Common culprits are dairy products containing lactose and cruciferous vegetables like broccoli and cauliflower. Every patient has a different experience, so keeping a food diary where you record what you eat and how it affects you will help identify foods that may trigger symptoms.

Is fiber helpful or harmful?
Fiber has long been proven to be beneficial in IBS, particularly foods rich in soluble fiber like oatmeal, berries, kiwi, and nuts. However, some patients experience symptoms when eating too much fiber. Tracking the fiber content of the food you eat with a food tracker or food diary can help you figure out how much works for you. Another way to add fiber slowly and in a steady amount is by using an over-the-counter fiber supplement like psyllium husk.

Can celiac disease, lactose intolerance, and other food allergies and sensitivities make IBS worse?
The presence of lactose intolerance and celiac disease doesn’t make the IBS “worse” per se, but it can make the symptoms more amplified. For example, while someone with lactose intolerance can develop symptoms like bloating, gas, and diarrhea when eating dairy, someone with IBS may get the same symptoms but have heightened pain.

Can IBS lead to other diseases such as ulcerative colitis, Crohn’s, or cancer?
No. While IBS can at best be a nuisance and at worst impact a patient’s quality of life, thankfully it does not lead to any form of malignancy or inflammatory bowel disease.

How can IBS be treated?
There are many ways to treat IBS, from diet and medication to lifestyle changes. The most studied and validated dietary treatment of IBS is the low-FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet. This involves an elimination phase of foods with high FODMAPs, or chains of carbohydrates that can lead to gas, and a reintroduction phase of food items over time. This is meant to identify trigger foods to avoid.

Since stress and anxiety also play a role in IBS, it’s a good idea to get plenty of rest and reduce stress whenever possible through breathing techniques, meditation, and regular exercise. Overall, eating a well-balanced diet, eating slowly and chewing foods well, not overeating, and keeping a food journal to pinpoint trigger foods can help provide relief.

Do probiotics help?
In some studies, probiotics have been found to be beneficial for IBS symptoms; however, it is important to note that not every patient responds to them.

Is there any truth that intermittent fasting helps with IBS?
There are no scientific studies looking at fasting for IBS. More research would be needed.

Are there any medications that may help relieve IBS symptoms?
Several FDA-approved medications exist for IBS; the medications that are prescribed vary based on your symptoms. For IBS with constipation, lubiprostone, linaclotide, and plecanatide can be useful. For IBS with diarrhea, rifaximin and eluxadoline are both approved. Other medications that are sometimes used are antispasmodics and certain types of antidepressants to treat pain.

Are there more natural remedies?
Some patients report some relief with natural remedies like peppermint, acupuncture, aloe vera, ginger, and fennel seed, and for some of these there are a few scientific studies examining the benefit. It is important to discuss these options with your provider as these supplements are not regulated by the FDA.

Daniela Jodorkovsky, M.D., is the director of Gastrointestinal Motility & Physiology and program director in the Division of Digestive and Liver Diseases at NewYork-Presbyterian/Columbia University Irving Medical Center and assistant professor of medicine at Columbia University Vagelos College of Physicians and Surgeons. Dr. Jodorkovsky’s clinical interests include diagnosing and treating conditions such as gastroesophageal reflux disease, swallowing disorders, IBS, and other functional GI disorders.