IBS: A real disease with real treatment options

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Irritable bowel syndrome is a real disease. Too often I’ve had patients tell me they had debilitating abdominal pain with a change in bowel habits, had a couple tests done, and then were dismissed by their doctor since no obvious source was found. Don't let that happen to you!  IBS is a complex, multifactorial disorder that confuses people and doctors.. Factors that increase the risk of developing IBS include genetic, environmental, and psychosocial factors. Factors that trigger the onset or exacerbation of IBS include a previous GI infection, food intolerances, chronic stress, diverticulitis, and surgery. This results in altered GI motility, increased response in your gut to pain, increased intestinal permeability, immune activation, altered microbiome and disturbances in brain gut function.

Here is what needs to happen in the workup and management of IBS:

1. Make sure it is IBS and not anything else

First, go see your doctor and don't try to manage this on your own. You need to make sure that there is no other disease contributing to abdominal pain and altered bowel habits such as Inflammatory Bowel Disease (Crohn's disease; ulcerative colitis), Celiac disease, lactose and fructose intolerance, and microscopic colitis to name a few. You will need a GI doc to evaluate the need for an endoscopy/colonoscopy.

Once other diseases are ruled out, then IBS is made by fulfilling the following: IBS is an functional bowel disorder with recurrent abdominal pain at least 1 day per week in the last 3 months associated with 2 or more of the following criteria:

1. Related to bowel habits (constipation, diarrhea or both)

2. Associated with a change in stool frequency

3. Associated with a change in stool form/appearance (Bristol stool scale)

 

2. Determine the types of IBS you have

   The Bristol Stool Form Scale. Type 1 &2 = slow transit, constipation. Type 6&7= fast transit, diarrhea      Adapted from Lacy et al. Gastro 2016

The Bristol Stool Form Scale. Type 1 &2 = slow transit, constipation. Type 6&7= fast transit, diarrhea

Adapted from Lacy et al. Gastro 2016

IBS-C: mostly constipation: > 25% bowel movements are Bristol types 1 or 2 and < 25% are Bristol types 6 or 7.

IBS-D: mostly diarrhea: > 25% bowel movements are Bristol types 6 or 7 and <25% bowel movements are Bristol types 1 or 2.

IBS-M: mixed bowel habits: > 25% bowel movements are Bristol types 1 or 2 and > 25% bowel movements are Bristol types 6 or 7

IBS-U: unclassified: if you meet diagnostic criteria for IBS but cant categorize your bowel habits into 1 of the 3 groups

 

3. Treatment for all types of IBS

- increase exercise!

- reduce stress! Cognitive behavioral therapy, hypnosis, and various relaxation methods reduce muscle tension and autonomic arousal that are involved in IBS symptoms

- improve your sleep habits

- increase/supplement dietary fiber (specifically SOLUBLE fiber)

- DIET! eat a low gluten, low FODMAP diet (FODMAPS are highly fermented, gas-producing foods) see the #feedyourgutdiet page! 

 

4. Specific treatment for IBS subtypes

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Many patients don’t like the idea of starting an antidepressant for IBS and believe that they are getting labeled as having a psychologic issue instead. The truth is, antidepressants are extremely effective medications for chronic abdominal pain in IBS. Although antidepressants were developed for depression, at lower doses they were found to be great pain relievers (also used in migraines, neuropathy, fibromyalgia). They work at the level of the brain and spinal cord to block pain messages between the GI tract and the brain, thereby reducing visceral hypersensitivity and normalizing the brain-gut function.

The jury is still out on probiotics, folks.

#gutlove: Feed it, clean it, inspect it, respect it.