Irritable Bowel Syndrome (IBS) (cont)

IBS Triggers

  • Many people report that their symptoms occur following a meal. Eating causes contractions of the colon. Normally, this response may cause an urge to have a bowel movement within 30 to 60 minutes after a meal. In people with IBS, the urge may come sooner and may be associated with pain, cramps and diarrhea. Certain foods may trigger spasms in some people. Sometimes the spasm delays the passage of stool, leading to constipation.
  • Certain food substances, like complex carbohydrates and caffeine, fatty foods, or alcoholic drinks, can cause loose stools in many people, but are more likely to affect those with IBS.
  • Researchers have found that women with IBS may have more symptoms during their menstrual periods, suggesting that reproductive hormones can increase IBS symptoms.
  • Emotional distress, like preparing for a speech, taking an examination or traveling, can produce intestinal symptoms of diarrhea, constipation or pain in everyone, but more so in those with IBS who seem more sensitive to these events.

It is important to realize that normal bowel function varies from person to person. Normal bowel movements range from as many as three stools a day to as few as three a week. A normal movement is one that is formed, but not hard, contains no blood, and is passed without cramps or pain.

People with IBS usually have crampy abdominal pain that is associated with constipation and/or diarrhea or abdominal bloating. In some people, constipation predominates (IBS-C); in others diarrhea is more common (IBS-D). Some people have both (IBS-M for “mixed”) or neither (IBS-U for “unspecified”). Over time, constipation and diarrhea can even alternate (IBS-A). Sometimes, people with IBS pass mucus with their bowel movements.

Bleeding, fever, weight loss and persistent severe pain are not symptoms of IBS and may indicate other problems.

How IBS is Diagnosed
IBS is usually diagnosed after doctors identify certain symptoms that are typical for the condition and are present after excluding other diseases. The doctor will take a complete medical history that includes a careful description of symptoms.

Recently, the use of specific symptom criteria (known as the Rome Criteria)can help make a diagnosis of IBS with confidence. In addition, a physical examination and a laboratory test will be done. A stool sample may be tested for evidence of bleeding or to exclude the possibility of infection.

Certain findings during the evaluation, called “alarm signs,” may lead to further testing because they may signal other medical disorders. These alarm signs can include rectal bleeding, significant weight loss, low blood count or a family history of cancer.
The doctor may order other diagnostic procedures, such as X-rays or colonoscopy (viewing the colon through a flexible tube inserted through the anus), to find out if there is another disease.

Is IBS Linked to More Serious Problems?
IBS does not lead to more serious diseases, such as cancer or inflammatory bowel disease (ulcerative colitis or Crohn’s disease). It is important to have an appropriate initial evaluation to exclude other diseases and then treat the IBS while staying vigilant to any new findings that may arise over time. Some patients have severe IBS, and the pain, diarrhea or constipation and resultant impairment in quality of life may cause them to withdraw from normal activities. In such cases, doctors may recommend behavioral-health coaching.

Start with a Good Diet
For many people, eating a proper diet that also avoids eating large amounts of food items at one time may help lessen IBS symptoms. Before changing your diet, it is a good idea to keep a journal noting which foods seem to cause distress, and discuss your findings with your doctor. For instance, if dairy products cause your symptoms to flare up, you can try eating less of those foods. High fat can stimulate the bowels and produce nausea or cramping.

Sometimes, it is not what you eat, but the amount you eat that activates IBS symptoms. Many find that reducing the amount of food and eating smaller portions more frequently can reduce symptoms. IBS is a condition in which there is an overreaction to stimuli to the bowel, and this can include dietary substances. Some individual may be more sensitive to food items that in larger, quantities can affect everyone. Recent attention has been drawn to the FODMAP (FODMAP = fermentable oligo-, di- and mono-saccharides and oplyols) concept; this relates to avoiding the ingestion of fermentable sugars, such as fructose or lactose, sorbitol, and frutans present in wheat. These food items, if poorly absorbed, are broken down by bacteria to produce symptoms of gaseousness, bloating, abdominal discomfort and diarrhea, which are seen in IBS.

There are many websites that discuss the types of items to be avoided with the FODMAP diet. you also may want to consult a registered dietitian, who can help you make changes in your diet.

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