Living Well With Irritable Bowel Syndrome (IBS) Via Diagnosis, Treatment

The National Institutes of Health estimates that as much as 15 percent of the U.S. population experiences symptoms of Irritable Bowel Syndrome, commonly called IBS. Yet, IBS can be challenging to diagnose, since the symptoms mimic those of other gastrointestinal disorders.

Symptoms of Irritable Bowel Syndrome

According to Sol Harari, M.D., a family medicine physician at Baptist Health Primary Care Family Medicine Center at West Kendall Baptist Hospital, symptoms of IBS include:

• Diarrhea
• Constipation
• Abdominal bloating and gas
• Abdominal discomfort or cramping

Dr. Harari says the challenge with diagnosing IBS is that individuals may not recognize the persistence of these symptoms, which can come and go over time and can vary greatly from person to person. Also, he says, people often are embarrassed to seek care, so they live with their symptoms until they impact their quality of life.

Diagnosing IBS

“An IBS diagnosis is one of exclusion,” Dr. Harari said. “We must first rule out other diseases before we can definitively say a patient has IBS.”

When patients come to him with symptoms consistent with those of IBS, and they have experienced them for at least six months, Dr. Harari refers them to a gastroenterologist for a gastrointestinal (GI) evaluation. This often includes a colonoscopy, an endoscopy or both. In these tests, performed under sedation, a long flexible tube with a tiny camera attached allows the gastroenterologist to look inside the gastrointestinal tract for any abnormalities. With IBS, a patient’s colon and esophagus appear normal.

Types of IBS

Depending on whether a patient experiences diarrhea or constipation as the dominant symptom, he or she will be diagnosed as having IBS-D (with diarrhea) or IBS-C (with constipation). In a third type of IBS, IBS-M, patients experience mixed bowel habits, diarrhea and constipation, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

IBS vs. Inflammatory Bowel Disease

Dr. Harari warns not to confuse IBS with the more sinister Inflammatory Bowel Disease, or IBD. The two most common types of IBD are Crohn’s disease and ulcerative colitis, which both cause inflammation in the intestines and long-term damage if not treated, according to the U.S. Centers for Disease Control and Prevention.

IBS, on the other hand, causes no apparent damage to the GI tract. Nevertheless, the chronic disorder should be managed to improve quality of life, Dr. Harari says.

Treating IBS

Once IBS is diagnosed, Dr. Harari says it’s important to determine what triggers symptoms. He recommends keeping a journal to recognize patterns of triggers. He says common triggers include certain foods and situations that cause anxiety or stress.

Diet
Avoiding known food triggers, Dr. Harari says, will help keep symptoms in check. Some patients, especially children, have reported successful management of their IBS with probiotic foods, the National Institutes of Health reports. Probiotics contain live bacteria that presumably help with digesting certain elements in food that may trigger IBS symptoms. Studies are currently underway to determine if there’s enough evidence to suggest probiotic therapy as a treatment option.

Similarly, some patients have reported relief by following a low-FODMAP diet, which reduces or eliminates five types of sugars – lactose, fructose, fructans, galactans and polyols. When these are poorly absorbed, bacteria in the intestines feed on them and can cause gastrointestinal distress, according to the American Gastroenterological Association.

Medications
Minimizing food triggers helps manage IBS, but medications also have proven effective, Dr. Harari says. Often, the first line of treatment, after eliminating triggers, comes in the form of over-the-counter medications that treat diarrhea and constipation and are taken as needed.

Commonly prescribed antidiarrheal medications, which decrease the movement of waste and secretion of fluid in the intestines, help patients with IBS-D. These medications include loperamide, eluxadoline, rifaximin and alosetron, according to the American Gastroenterological Association.

Prescription medications to treat chronic constipation improve symptoms for those with IBS-C. Dr. Harari says the medication lubiprostone (brand name Amitiza) is taken daily to prevent constipation.

Dr. Harari says anti-anxiety medications and antidepressants help with the psychological triggers of IBS. People with anxiety often exhibit symptoms of IBS, he says, and the connection between the two is being studied to determine if anxiety results from IBS or contributes to it.

Treatment Improves Quality of Life

With estimates that nearly 45 million Americans suffer from IBS symptoms, gastroenterologists say it’s the top reason people come to them. While symptoms are embarrassing and can greatly impact quality of life for those living with IBS, Dr. Harari offers this advice:

“People don’t have to suffer with IBS. Talk to your doctor about your symptoms. If it’s determined you have IBS, the treatments available can greatly improve your quality of life.”

Tags: Baptist Health Primary Care, Family Medicine Center at West Kendall Baptist Hospital, irritable bowel syndrome, Sol Harari M.D.