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What does “irritable” mean?

When using the term “irritable” bowel, it is important to understand that the bowel is not actually irritated. Patients with symptoms of IBS were originally described as having a spastic or nervous colon, and/or spastic bowel. Over time, researchers and clinicians began to refer to this group of symptoms as irritable bowel syndrome (IBS).

They used the term irritable bowel syndrome to describe that the nerve endings in the bowel wall, which control muscle function and sensation of the gut, are unusually sensitive. When this occurs, even normal conditions that can stimulate the bowel, such as eating a meal, a woman having her period (menses) or feeling pressure at work may lead to a greater response for persons with IBS when compared to others. This can result in the nerves and muscles of the bowel becoming more active producing diarrhea, bloating, or pain and discomfort.

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How common is IBS?

Irritable bowel syndrome (IBS) affects up to 5-10% of individuals worldwide. IBS affects children and adults of both genders.

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Is IBS a “serious illness?”

Although IBS does not shorten a person’s life span, it is associated with a large health care and economic burden. Studies have shown that IBS patients have an increased number of health care visits, diagnostic tests, and surgeries. IBS can also severely impact a person’s quality of life.

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Is IBS forever?

Over time, some people with IBS will no longer have symptoms. It has been established that each year about 10% of IBS patients get better. Persons with IBS that starts after an infection in their digestive system, such as traveler’s diarrhea or food poisoning are more likely to get better over time than persons with IBS that is not related to an infection.

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How do I know if I have IBS?

A knowledgeable physician can diagnose IBS by careful review of your symptoms, an abdominal examination, and selected diagnostic procedures that are often limited to a few basic tests.

The abdominal examination is a physical examination of the abdomen which generally done in four different stages by your healthcare provider

  1. inspection of the visible characteristics of the abdomen;
  2. listening to the abdomen with a stethoscope.
  3. using their hands to inspect the patient’s abdomen.
  4. tapping the patient’s abdomen and abdominal organs.

Find out more about testing for IBS

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I have been diagnosed with irritable bowel syndrome (IBS), but tests found nothing wrong. Do I need more tests?

When a person has typical IBS symptoms, non-worrying findings on physical examination and normal blood and stool tests, studies show they can be confidently diagnosed with IBS. However, there are several situations where additional testing should be considered, particularly in patients with mostly diarrhea or diarrhea mixed with constipation.

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What is the Rome Criteria?

The Rome Criteria is a classification system that uses specific symptom patterns to identify functional GI disorders, such as IBS.

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Can a person have “constipated diarrhea?”

Pain and/or discomfort related to a change in bowel habits are the main symptoms of irritable bowel syndrome (IBS). These changes are described by the terms “diarrhea” and “constipation”. The commonly used terms diarrhea and constipation mean different things to different people and this applies to healthcare providers as well. However, bowel symptoms affect treatment choices. It is important that you and your healthcare provider communicate clearly about your symptoms and how they affect your life

While it may seem strange to have “constipated diarrhea,” it is not that uncommon. If you have loose stools, but also have difficulty having a BM or feel you have trouble completely emptying, then it makes sense.

It is important to note that some people will experience “constipated diarrhea” due solely to constipation. “Loose stool overflow” occurs when hard stool becomes impacted (stuck) in the rectum and is not easily passed. The stool in the higher portion of the colon remains soft and leaks around the hard stool. The person experiences what they recognize as diarrhea since the stools are loose. 

It is also important to remember that your bowel patterns may change over time. One person’s IBS might be different from another individual’s IBS. It is always important to maintain a working relationship with medical and support teams to obtain help when symptoms change.

This question was taken from IFFGD Publication #265 “Constipated Diarrhea” 

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What is a “functional” bowel disorder?

A functional bowel disorder occurs when there is a problem with the way the bowels work, not their structure. The body’s normal activities are impaired.

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Is IBS a risk factor for other serious diseases?

There are no long-term organic complications associated with IBS. Once an adequate evaluation is made to diagnose IBS, people with the disorder have no greater need of preventive checkups than other people.

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Can the menstrual cycle affect IBS symptoms?

The digestive system can be influenced by changes in hormone levels in some women. Symptoms can become worse at certain times of the menstrual cycle, particularly at the time of menstrual periods. Women both with and without IBS report having more abdominal pain and bloating, just prior to and at the time of their menstrual periods. These symptoms are reported as more intense in women with IBS. This occurrence can sometimes make it difficult for the patient, as well as the healthcare provider, to determine whether they are having a gynecological problem (e.g., endometriosis or other pelvic pain condition) or a GI problem.

It is important to note that when the symptoms are severe, both possibilities must be explored.

Learn more about the gynecological aspects of IBS

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What causes bloating and gas?

Bloating is a common symptom in IBS. It is usually described by people as a feeling of fullness or heaviness in the belly. It may be associated with visible distension in which the belly appears swollen.

Bloating may be due to several factors. These include:

      • increased intake of gas-forming foods,
      • slowed motility in the GI tract,
      • increased sensitivity to food, gas, and other bowel contents.

Those with IBS do not necessarily produce more gas than those who do not have IBS, although for some this is the case.

People with IBS may also have an increased relaxation of the muscles in the belly area (abdominal wall). This is an unconscious muscle relaxation response in response to the pain of IBS. However, people with IBS do appear to be more sensitive to the effects of normal amounts of gas in their digestive system and may have difficulties passing the gas.

Learn more about controlling intestinal gas

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Do certain foods affect IBS symptoms?

This varies from person to person. Certain foods stimulate the GI tract in general, and in those with IBS eating too much of these might worsen symptoms. Your doctor or a registered dietitian can help you identify foods that are a problem for you.

Also, at times altered muscle and nerve function in IBS can cause the bowel to over-respond so that even the normal digestive process may bring on symptoms.

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Does lactose intolerance cause IBS?

Lactose (milk sugar) intolerance can cause similar symptoms to IBS. Lactose intolerance and IBS can occur at the same time in a person, but they are separate conditions which are treated differently.

Learn more about lactose intolerance

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Can bacteria affect IBS symptoms?

There are trillions of bacteria in the gastrointestinal (GI) tract. These bacteria help break down the food we eat and regulate bowel function. However, some people diagnosed with IBS have an increased number of bacteria in the small intestine (referred to as small intestinal bacterial overgrowth, or SIBO) and can experience an improvement in their symptoms with antibiotic treatment and removal of the bacterial overgrowth.

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If my doctor prescribed an antidepressant to treat my IBS does that mean I have a psychological disorder?

Not necessarily. In IBS low-dose antidepressants are useful because this class of drugs can help to reduce pain and also overall symptoms. For these purposes, doses are much lower than what is used to treat depression.

Learn more about the use of antidepressants for treatment of IBS.

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How do I find an appropriate health care provider?

There are no rules. In general, your primary care doctor is a good place to start. If that doesn’t lead to relief, seeing a GI specialist would be the next step. A good healthcare provider uses good communication and listening skills to work with the patient, which is the foundation for successful management of IBS. 

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How do I best work with my health care provider?

You should have a provider who takes an interest, listens to you, and helps you to identify factors that may be contributing to your IBS symptoms. Most importantly, your provider should give you hope.

If you are interested in being referred to another health care provider, such as a physician with special expertise in IBS, a therapist for psychological treatment, or an alternative medicine provider, you should explain this to your physician and an appropriate referral should be made.

Learn more about working with your physician

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Can Serving in the Military Cause IBS?

IBS and other functional GI disorders disproportionately impact veterans and active-duty military personnel. Soldiers deployed to combat areas face a heightened chance of developing a functional GI disorder like IBS due to their exposure to risk factors such as GI infections and severe stress. For this reason, the Department of Veterans Affairs (VA) has determined that functional gastrointestinal (GI) disorders, including IBS, dyspepsia and functional abdominal pain syndrome are designated as one of four Medically Unexplained Illnesses in Gulf War Veterans.

On August 15, 2011, the Department of Veterans Affairs (VA) implemented a “presumptive service connection” when assessing disability benefits in soldiers affected by functional GI disorders (such as IBS) who served in Southwest Asia during the Persian Gulf War.

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Is IBS Considered a Disability?

Depending on the circumstances it is up to each employer, insurer, or governing authority to determine individual disability.

The U.S. Social Security Administration (SSA) defines disability as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. (SSA Pub. No. 64-039, May 2002) However, the SSA does not recognize irritable bowel syndrome on its Listing of Impairments — Adults, Section 5, Digestive System.

The Veterans Affairs Dept. first recognized IBS in the Veterans Education and Benefits Expansion Act of 2001, Public Law 107-103 signed by President Bush on December 27, 2001.Section 202 — Payment of Compensation for Persian Gulf War Veterans with Certain Chronic Disabilities — includes this provision: (2) For purposes of this subsection, the term “qualifying chronic disability” means a chronic disability resulting from any of the following (or any combination of any of the following): (B) A medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms. The law authorizes funding to expand and increase educational, housing, burial and disability benefits for chronic multi-symptom illnesses to the list of service-connected conditions for Gulf War veterans.

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So overall, how do I deal with IBS?

Here are some guidelines to help find what works for you.

      • Try to take an active role in your own health care. Obtain educational materials from your doctor and an organization such as IFFGD to learn more about IBS and how to best manage your symptoms.
      • Try to identify factors that may make your symptoms worse. Keep a daily diary for at least a week or two. Talk to your healthcare provider to help figure this out.
      • Use medications to relieve or avoid onset of symptoms. Talk to your healthcare provider about which medication may be appropriate for you. Keep a list of the supplements and medications you have tried and if they worked or not.
      • Consider non-drug treatment options to help decrease symptoms. These options range from
        dietary changes, mindfulness, or relaxation training approaches to hypnosis to yoga, all of which may be helpful for you.
      • Look for and address any sources of stress in your life that may impact your symptoms.
      • Work together with your health care provider to design and apply a plan to manage your  symptoms and improve your quality of life.

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Adapted primarily from IFFGD Publication #104 by Lin Chan g MD, Professor of Medicine at the David Geffen School of Medicine at UCLA, Los Angeles, CA; adapted from article by Douglas A. Drossman MD, Drossman Gastroenterology PLLC, Chapel Hill, NC; edited by William D. Chey MD, Nostrant Collegiate Professor, University of Michigan, Ann Arbor, MI

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IFFGD is a nonprofit education and research organization. Our mission is to inform, assist, and support people affected by gastrointestinal disorders.

Our original content is authored specifically for IFFGD readers, in response to your questions and concerns.

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