So what is IBS? IBS stands for irritable bowel syndrome and is considered a “functional” disorder of the gastrointestinal system. Studies estimate that perhaps 15% of the US population suffer from IBS. Functional means that the intestines are not working correctly, but this is not due to any visible problem.
In IBS, the lab work should be normal, X-rays normal, endoscopy normal. In IBS there is no intestinal inflammation, no ulcers, blockages, no infections or cancers. Essentially, we must prove that there are absolutely no other causes for the individual’s symptoms before a diagnosis of IBS can be made. IBS is defined as group of symptoms lasting several months and include abdominal pain, a change in bowel habits and stool consistency. Stool consistency means loose or hard stools and often with increased mucus production.
In addition, individuals with IBS often have other symptoms like chronic pain and fibromyalgia, heartburn, non-cardiac chest pain, high stress, anxiety and depression. They are more likely to miss work or not participate in social activities.
There are official criteria used to define IBS – most medical providers apply the ROME IV criteria which was developed by a group of experts in IBS who provide regular updates in correctly diagnosing and managing IBS.
Not all IBS is the same. There are different group classifications for IBS.
- Diarrhea predominant – this individual has abdominal pain and attacks of diarrhea, urgency
- Constipation predominant – this individual has abdominal pain but may go a few days without a bowel movement, or has lots of straining and hard stools
- Mixed – these individuals go back and forth – sometimes diarrhea and urgency other time straining and constipation
- Unspecified – these individuals have an unusual pattern – sometimes abdominal pain, sometimes diarrhea, sometimes constipation
So when an individual comes to our clinic with complaints of diarrhea, constipation, intermittent pain, and symptoms occurring on a weekly basis, we start to consider IBS as the diagnosis. And as we know, there a different categories for IBS so we will try to determine where you fit – abdominal pain with diarrhea predominance or constipation predominance, mixed or indeterminate.
Our typical work up will begin with taking a detailed history, a physical examination, basic blood tests, possibly a few X-rays and then an assessment and plan. Based on our results, we might consider endoscopy which can be very useful to rule out gut inflammation, celiac disease, Crohn’s disease, ulcerative colitis, ulcers, cancers, and blockages. Endoscopy allows us to directly visualize the intestinal lining and helps us confirm that there are no other potential causes of the patient’s symptoms prior to giving the diagnosis of IBS.
Fortunately, IBS is very treatable and we can eliminate or greatly reduce these symptoms with good medical management.