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Diet is very important in irritable bowel syndrome. We recommend a Low-FODMAP diet. Foods that are low in dairy, gluten, certain highly fermentable foods and vegetables, artificial sweeteners, and we ask patients to avoid those types of foods. It has a tremendous impact on their symptoms.
Exercise seems to play a very important role in the management of irritable bowel syndrome. Patients who engage in regular physical activity tend to have improvement in their IBS symptoms. Other things such as meditation, yoga, Tai-chi, mindful-type stuff seems to help very much with the symptoms as well.
One of the mainstays of preventing irritable bowel syndrome is preventing gastroenteritis. So good hand hygiene and watching what you’re eating is very important. There have been some studies that show that early antibiotic use in gastroenteritis and traveler’s diarrhea has been associated with decreased risk of post infectious irritable bowel syndrome. There is a lot of research being done right now looking at early interventions to prevent irritable bowel syndrome. However, a specific medication or drug has not been identified. Physical activity, a balanced diet, and management of underlying psychiatric conditions and stress are very, very important.
Irritable bowel syndrome can be cured (in a sense) and there are people who have irritable bowel syndrome for a period throughout their life and they get better and it never comes back. But the majority of people tend to have some flares from time to time, but if they’re on the right medications, they’re on the right diet, and they understand how to control their triggers (whether it be lifestyle or dietary) they’re able to manage their symptoms very, very well.
IBS is a clinical diagnosis, meaning: if you have the typical symptoms of irritable bowel syndrome (abdominal pain, a change in bowel habits, whether it be diarrhea or constipation and improvement in symptoms with bowel movements are the typical symptoms), so if a person has those and there are no alarming symptoms or clinical signs such as weight loss, bleeding, anemia, and a number of other concerning features – one can make a diagnosis of irritable bowel syndrome. You don’t necessarily need to have blood tests or an endoscopy or cat scans or MRIs. Before, it used to be a diagnosis of exclusion, meaning you go to your doctor and he would run the whole gamut of tests and then when nothing was found, they would say it’s probably IBS. Now we know that if you meet the symptoms and there are no alarm symptoms, then one can make a diagnosis of irritable bowel syndrome on clinical grounds.
I think it’s really important that people who are diagnosed with irritable bowel syndrome make sure that the physician isn’t labeling them with irritable bowel syndrome because they don’t know what else is wrong with them. Oftentimes patients go to the doctor and they complain of bloating or gas and they have no abdominal pain and their bowel habits are normal – that’s not IBS. If you just have abdominal pain but your bowel movements are okay – that’s not irritable bowel syndrome. If you’re really constipated or you have a lot of diarrhea but you don’t have much abdominal pain – that’s not IBS. It’s really, really important to understand that IBS is a constellation of symptoms and you really need all of those symptoms to be diagnosed as irritable bowel syndrome. If you just come in with abdominal pain, there’s so many other things that one could have and it would be inappropriate to diagnose and categorize you as having irritable bowel syndrome. Very important to make sure that your doctor has thoroughly looked at your symptoms and made sure that he’s not just labeling you as a patient with irritable bowel syndrome, but rather, in fact, that there’s nothing more serious going on.
Patients with IBS can often have a number of other functional disorders such as: Fibromyalgia, chronic fatigue, and also symptoms of anxiety, depression. Fibromyalgia is a disorder where patients develop pain throughout different parts of their body, so it’s really important to address the whole patient when managing irritable bowel syndrome because a lot of those other associated conditions can have an impact on the symptomatology of IBS.
Because IBS is a constellation of symptoms, it is very important to make sure that a thorough history and physical examination is performed to make sure that patients don’t have any alarm symptoms or any other signs of other conditions such as inflammatory bowel disease, celiac disease, microscopic colitis, thyroid diseases. All of those conditions can mimic symptoms of irritable bowel syndrome, so it’s important for your physician to ask all the necessary questions to exclude these other conditions. Sometimes it’s not so clear. They may require blood work. They may require stool tests to rule out infections. They may even require an endoscopy or a colonoscopy if the symptoms are not clear-cut and you have risk factors for some of these other conditions.
Prognosis for IBS is very good. Patients can have a short duration of symptoms and then be fine for many, many years. Then, there are those patients who have mild symptoms and then they’re better for a long time and then they get symptoms again. It’s really, really variable. Untreated irritable bowel syndrome can affect quality of life in many people and it can be one of the main causes of missed work. So it’s very important that if you have irritable bowel syndrome – find a doctor, find a specialist, get treated because you can lead a very, very normal life with irritable bowel syndrome with all the new advances in the field.
An endoscopy is basically a procedure where a camera at the end of a tube is placed through the mouth down into the esophagus, stomach, and in the beginning portions of the small intestine to look for abnormalities. A colonoscopy is when it’s done through the large intestine.
Irritable bowel syndrome typically affects women more than it does men and it typically affects younger individuals more than older individuals. However, anyone really can develop irritable bowel syndrome.
IBS is a very common condition. In fact, I read somewhere that it is the most common cause of missed work due to a chronic condition in the United States. If you’re in a room with a number of people, it’s very likely that you’re not the only one with irritable bowel syndrome.
There are a number of risk factors for irritable bowel syndrome. Being female seems to be a very important risk factor. Having an underlying psychiatric condition such as depression or anxiety is also very, very important. Thirdly, a prior episode of gastroenteritis. What that means is a prior episode of either food poisoning or a GI flu bug – something of that sort. The more severe the episode of gastroenteritis, the more likely one is to develop irritable bowel syndrome.
The treatment of IBS has really come a long way. Initially, IBS was a symptom-based treatment, meaning if you had abdominal pain, you get pain medications, anti spasm medications. If you had diarrhea, you can get antidiarrheals such as Imodium or Lomotil. If you had constipation, you would get laxatives. It was very much a symptom-driven treatment. In recent years, we have learned a lot about irritable bowel syndrome and we have some very, very exciting new treatments. One in particular is antibiotics – Rifaximin, which is a very specific type of antibiotic that is not absorbed in the digestive track, seems to help patients with irritable bowel syndrome – specifically those with overgrowth of bacteria in their small intestine. The term for that is small intestinal bacterial overgrowth, abbreviated as SIBO. You may have seen this online and it is a very common cause of bacterial overgrowth and is treated with antibiotics and the results are really remarkable in those patients that respond. Other treatments for irritable bowel syndrome include SSRIs or Selective Serotonin Reuptake Inhibitors. It’s a fancy term for basically antidepressants, but you’ll learn that you don’t have to be depressed. These medications seem to work on the digestive tract (the nerves of the digestive tract) and they help reduce the pain and the cramping and the bloating. Essentially what these medications do is they balance the nervous system of the digestive track and they have been shown to be very, very effective. Now you may go to your doctor and they may recommend these medications. If you’re a good doctor, don’t worry – they don’t think you’re nuts or crazy. It’s just that these medications tend to help balance and restore the balance of the nervous system of the gut and they’re tremendously helpful.
There are a number of treatments for irritable bowel syndrome. There’s a symptom-based treatments, which is if you have abdominal pain, we use pain medications and anti-spasm medications – those are very helpful. There are medications for diarrhea such as antidiarrheals. Constipation medications such as the over the counter ones, but now we have very effective IBS-C, meaning constipation predominant irritable bowel syndrome medications that not only help you have a bowel movement, but target the underlying causes of why people get pain and bloating and cramping and those are very effective. Then, antibiotics have been shown to be very helpful in a large subset of patients with irritable bowel syndrome. In particular, those who have small intestinal bacterial overgrowth, namely overgrowth of bacteria in their intestines. Medications such as Rifaximin have been very effective in treating patients with irritable bowel syndrome. The last category of medications are antidepressants or anti-anxiety medications in the subset of patients who tend to have a very much stress and anxiety driven nature to their symptoms. In the right population, those medications can be extremely helpful.
In irritable bowel syndrome (because it is a syndrome of symptoms) you typically don’t get the serious complications one sees in other digestive disorders. However, it can be very frustrating. It can have significant effects on your quality of life and have significant impact on your relationships. It can affect people in many different ways from the quality of life, from their social interactions, from work-related limitations. From that standpoint, yes – if you call them complications, it can definitely have an impact on one’s life. But it typically does not lead to hospitalization. It typically does not lead to a requirement for surgery, strong medications. Irritable bowel syndrome can have a significant impact on people’s quality of life – their social interactions, their performance at school or at work – however, it doesn’t typically lead to serious health complications. Because it is a constellation of symptoms, patients typically are not hospitalized for this and they don’t require surgery or very strong medications for irritable bowel syndrome.
The whole concept of small intestinal bacterial overgrowth is a very exciting one. For the first time, we have a specific target in irritable bowel syndrome that we can test and treat. I would highly encourage patients with irritable bowel syndrome to ask their doctors about small intestinal bacterial overgrowth – SIBO. I encourage their doctors to test for it and to treat them for it if they have it because I’ve seen tremendous, tremendous improvement in people’s irritable bowel syndrome after treatment of SIBO.
Irritable bowel syndrome is a very common condition. It is a syndrome, so it consists of a constellation of symptoms: abdominal pain or discomfort, the change in bowel habits (so either diarrhea or constipation or alternating between the two) and typically patients have improvement in their pain or discomfort after a bowel movement. Other typical symptoms that we see a lot in patients with IBS are bloating and discomfort.
Irritable bowel syndrome can come in many different types: we have IBS-D (or diarrhea predominant irritable bowel syndrome) IBS-C (which is constipation predominant irritable bowel syndrome), and we have the mixed type, where patients alternate back and forth equally.
The common symptoms of IBS are abdominal pain or discomfort, diarrhea or constipation – sometimes both, bloating, gas, distention are all symptoms of irritable bowel syndrome.
The abdominal pain is often in the form of cramping pain and it could be in multiple different parts of the abdomen. One time it’s here, on time it’s there – it moves around. It’s confusing to patients because first they felt it on this side, then it was on this side – but that’s very typical of irritable bowel syndrome. The diarrhea is typically unpredictable and so is the constipation. When you ask a patient with irritable bowel syndrome “do you know what your bowel movements are going to be like tomorrow?” They often say “no” because they could have normal bowel movement, they can have multiple bowel movements in the case of diarrhea predominant irritable bowel syndrome, or they could have no bowel movements in the case of a patient with constipation predominant irritable bowel syndrome. It’s really unpredictable and that’s one of the hallmarks of irritable bowel syndrome that differentiates it from other conditions such as inflammatory bowel disease or Crohn’s Disease, where in those patients it’s very predictable. In addition, typically patients with irritable bowel syndrome don’t have symptoms while they’re asleep. They usually have daytime symptoms but once they’re asleep, they’re not in severe abdominal pain. They’re not having nocturnal bowel movements. That’s really important in terms of differentiating irritable bowel syndrome from other conditions. Also, there are a number of alarm symptoms that we look for to differentiate. If a person has weight loss, if a person is having rectal bleeding, if a person is anemic, and there are other red flags – we need further evaluation in those patients because there may be something more going on.
One of the most common and now well-studied causes of IBS is post-infectious, meaning that a person develops a gastroenteritis and a large percentage of people go on to then develop irritable bowel syndrome. We define that as post-infectious irritable bowel syndrome. When you look at epidemiologic studies of outbreaks of foodborne gastroenteritis, a certain percentage of those people will go on to develop irritable bowel syndrome. So that’s very, very important cause of irritable bowel syndrome. In some studies and in some research articles, it is believed that a majority of irritable bowel syndrome starts off with an actual infection. Sometimes people are on vacation, they’re on a cruise, they specifically remember that “ever since I got sick in this country, on this trip, on that cruise, my bowels haven’t been the same.” Sometimes, however, people can’t remember. They may have had a mild gastroenteritis and they didn’t think much of it and several months later their bowels just weren’t normal and it persisted. Post-infectious irritable bowel syndrome is a very, very important cause. Gastroenteritis is a loose term that we use for inflammation of the digestive tract. Usually it’s due to some form of either foodborne or viral infection. When a person eats out at a restaurant, and eats food that wasn’t so great, and they have nausea, vomiting, abdominal pain, diarrhea – most of the time, that’s a self-limited form of gastroenteritis.
An infection is thought to be the underlying cause of a lot of irritable bowel syndrome nowadays. Think of it like this: a person gets an infection – whether it’s food poisoning or a virus that they caught from a friend or a loved one. They get sick – nausea, vomiting, abdominal pain, diarrhea. That bug does something to the digestive tract and after that, the bowels are never the same. People can have symptoms of IBS (bloating, cramping, diarrhea, constipation) and it’s as a result of that original insult, an original infection that they had. The infection’s gone but the effects on the digestive tract can last months or years.
Another very important cause of irritable bowel syndrome is an imbalance in the brain-gut connection. We know that there is a central nervous system, but there’s also what we call an enteric nervous system, which is a nervous system that’s specific to the digestive tract. If that nervous system of the digestive tract is somehow imbalanced or it doesn’t connect properly with the nervous system of the brain, people can feel a lot of the symptoms of irritable bowel syndrome. Oftentimes people with irritable bowel syndrome may have underlying depression or anxiety or a lot of stress and that all plays a very important role in the symptoms of irritable bowel syndrome.
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