Irritable Bowel Syndrome (IBS) is a highly prevalent gastrointestinal disorder that affects about 10-15% of the US population, with women twice as likely as men to report having IBS symptoms.
While the exact cause of IBS is currently unknown, IBS flare-ups can significantly impact a person’s quality of life, causing them to miss school, work or reduce their social activities.
In this article, we look at the bigger picture behind Irritable Bowel Syndrome, providing you with an ultimate guide on the potential causes, risk factors and general IBS symptoms and potential ways to manage them.
What Causes IBS?
Stress, diet, and lifestyle all play a role in people experiencing IBS symptoms although at present there is no scientific consensus on a definitive cause for developing IBS. Similarly, it isn’t certain why IBS flare-ups are more common in people in their 20s and 30s or why it can manifest differently from person to person. However, factors that seem to play a role include:
- Muscle Contractions in the Intestine. According to the American College of Gastroenterology (ACG), our intestines are lined with layers of muscle which contract to move food through the digestive tract. Strong muscle contractions which last longer than usual can cause gas, bloating and diarrhea. Weak muscle contractions on the other hand can slow the passage of food and can lead to constipation.
- Severe infection. IBS can develop following a bout of gastroenteritis which leads to severe diarrhea caused by a bacterium or a virus. Bacterial overgrowth, which is a surplus of bacteria in the intestines, could also play a role in IBS.
- Psychological and Mental Health Factors. Those with a history of anxiety-depressive behaviors or who’ve experienced stressful events in childhood, could be more susceptible to functional gastrointestinal disorders such as IBS, where there are no explicit physical triggers for the symptoms. The general consensus points to a closely linked relationship between out gut and brain, through what is formally known as the gut-brain axis (GBA). For this reason, in some people IBS can set the stage for episodes of anxiety or depression, while in others, a history of mental health issues can be a risk factor for developing IBS in the future.
- Changes in gut microbes. The various bacteria and microbes residing in our gut play a vital role in an individual’s overall health. Disturbances in the gut microbiota and how it interacts with our nervous system, could be a catalyst for IBS attacks and digestive issues.
- Diet. There’s no disputing the role of diet, and many common foods can trigger IBS flare-ups. Among the biggest category of culprits are FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols). FODMAPs are carbohydrates and sugars that are not easily broken down and absorbed by the small intestine. In turn, undigested FODMAP foods act like a sponge by drawing water into the gut and trapping it there, along with bacteria that can cause gas, bloating, stomach pain, diarrhea, and/or constipation – all the classic IBS symptoms.
- Lifestyle. A sedentary lifestyle and lack of exercise can negatively impact gut health. Sitting too long for instance can lead to an array of health problems (from obesity and poor posture) to potentially impacting gut health through decreased blood flow and increased pressure on the digestive tract. Health professionals generally agree that sluggish digestion is a major culprit of excess bloating and gas, cramps, heartburn, and general discomfort after eating. A sedentary lifestyle can also be a leading cause of constipation, which is one of the symptoms some IBS sufferers experience.
What are the risk factors for developing IBS?
As one of the most common gastrointestinal disorders, approximately 1 in 20 people experience symptoms of IBS. But some people are more likely to experience IBS symptoms, particularly if they are:
- Young. Although IBS does and can affect people of all ages, including children, the most common age for IBS sufferers is between 20-30 years old.
- Female. In the US, IBS is more common among women, with 2 in every 3 people experiencing IBS being female. Existing research points to potential causes linked to the effects of estrogen and progesterone on gut function as well as psychological characteristics such as stress reactivity in women which are likely to be related to bowel function. The link between IBS flare-ups and the menstrual cycle is not set in stone, yet studies have shown that women with IBS commonly report bowel symptoms during their menstruation period.
- Known to have a family history of IBS. In previous studies IBS patients frequently reported a positive family history of IBS. However, it remains unclear whether the clustering of IBS in families is due to shared conditions and environmental risk factors among family members, due to shared genes or a mix of both.
- Experiencing anxiety, depression, or other mental health issues. Traumatic and stressful past experiences can also be a catalyst for IBS attacks. According to recent research this link is bidirectional, meaning the state of our mental health can impact on the well-functioning of our gut microbiota. This refers to the microbial community that reside in our gut and contribute to our overall health and sense of well-being.
What are the symptoms of IBS?
IBS is one of the most common gastrointestinal disorders in western countries with 2.4 to 3.5 million visits to the doctor every year in the US alone. And while IBS affects people of all ages, including children, the symptoms – like the ways to relieve – can vary significantly from individual to individual.
Bloating and Abdominal pain
Talking about intestinal gas is not an ideal conversation starter at the best of times. But the reality is that most people will build up gas in their intestinal track through swallowing, talking, eating, and drinking. This can lead to belching and flatulence. Belching is a regular process associated with air accumulated in the stomach. Normally this can be belched back or as it moves into the small intestine, it can be eventually passed as flatus or rectal gas. Flatulence is one way to refer to the passage of rectal gas, which is normally a combination of ingested air and gas generated by the activity of colon bacteria on undigested carbohydrates.
For IBS sufferers, the normal processes of releasing surplus intestinal air through belching and flatulence might not be enough. Significant build-up of intestinal gas can lead to abdominal distention and pain that can vary from mild to severe and significantly affect daily life. For those with IBS flare-ups, changes in diet and lifestyle that are more likely to reduce the severity and frequency of cramps and bloating.
Tips to relieve bloating and abdominal pain
- Slow down when eating and do not overeat
- Avoid chewing gum, which can lead to too much air being swallowed
- Ditch sugar substitutes such as fructose as it can lead to digestive issues including more gas, bloating and diarrhea
- Reduce the intake of FODMAP foods. These are short-chain carbohydrates found in many common foods such as beans, onions, garlic, broccoli, brussels sprouts, or cabbage. These can stagnate in the gut where resident bacteria use these small chains as fuel and produce hydrogen gas, causing bloating, flatulence, and stomach cramps. A low FODMAP diet is often recommended by doctors and dietitians to manage digestive symptoms, but it should be followed under the guidance of a healthcare provider
- Take a food sensitivity test. While some IBS sufferers react to FODMAP foods, others might also experience food sensitivities to wheat, dairy products, certain fruit, and a myriad of other ingredients that they might not be aware of and could aggravate their IBS symptoms. Research has shown that people with IBS can have higher levels of food-specific IgG antibodies in their blood which leads to hypersensitivity to certain foods. Whilst some people keep a food diary to try and eliminate ingredients from their diet, this can be challenging process and not always effective. An ingredient that can cause problems for one person could be completely acceptable for another.
In the US, constipation is a common gastrointestinal complaint, with hundreds of millions of dollars spent on laxatives and over 2.5 million visits to the doctor per year. The American College of Gastroenterology defines constipation based on symptoms including unsatisfactory defecation with either infrequent stools, difficulty in passing stool or both. Some IBS sufferers experience constipation as one of their symptoms which can lead to a sense of fullness, bloating and general discomfort.
Tips to relieve constipation
- Stay hydrated and increase the amount of daily intake of water and fluids
- Incorporate more sources of daily fiber such as vegetables, fruit, whole-grain breads, and cereals. Start introducing high-fiber foods gradually and accompany it with plenty of fluids to give your body time to adapt to the new changes. Try avoiding FODMAP foods that may aggravate symptoms
- Exercise more. Increased physical activity is known to help improve bowel movement and frequency
- Check with your health provider whether using over the counter constipation relief medicine such as laxatives and stool softeners is the right way to go if changes in diet and lifestyle aren’t enough
Second only to respiratory infections, diarrhea is the most frequently reported illnesses in the US. While most people will have experienced bouts of diarrhea at some point in their lives, for people experiencing gut hypersensitivity and IBS, diarrhea can happen frequently and suddenly, usually accompanied by persistent abdominal bloating and pain. In the long term, this can impact negatively on a person’s overall quality of life and on their social and professional activities.
According to the ACG, diarrhea can be acute (lasting less than two weeks), persistent (lasting between two and four weeks) and chronic (lasting more than four weeks). IBS sufferers who experience diarrhea as one of their main symptoms can also include abdominal cramps, nausea, fatigue, fever, and a sense of bowel urgency. For 58 year old Dorothy and 26 year old Eleanor, this meant experiencing anxiety when travelling or being away from home or nearby toilet facilities.
Tips to relieve diarrhea
- A fiber supplement such as psyllium powder (Metamucil) or methylcellulose (Citrucel) — can help relieve mild to moderate diarrhea by adding bulk to the stool
- Eat frequent, small meals
- Try to rest for at least 20 minutes after eating
- Avoid foods that may aggravate digestive issues including dried beans, corn, raw vegetables, cabbage, spinach, dried fruits as well as bacon, processed meats and fried foods.
- Avoid drinks such as caffeine, alcohol or carbonated drinks or drinks high in fructose which can aggravate diarrhea
- Pain relievers to help reduce abdominal pain
- Check with your healthcare provider whether trying the BRAT diet which consists of eating bananas, rice, applesauce, and toast
- Talk to your healthcare provider before starting any prescribed or over-the-counter medications for the treatment of diarrhea
Take Action Against Your Irritable Bowel Syndrome Symptoms
While IBS can be an ominous condition that currently doesn’t have concrete testing and treatment protocols, there are many things you can do to better manage symptoms. Document any triggers to your IBS symptoms, including specific foods. Start your journey equipped with the right information with YorkTest’s Premium Food Sensitivity Test which tests your IgG reactivity to 200 food and drink ingredients. It can also be helpful to journal any personal issues or psychological struggles you may be facing, such as major stressors, feelings of anxiety and depression, or recent or significant life changes. Taking inventory and writing down all things that may be influencing your IBS symptoms as well as optimizing your diet and lifestyle is an important first step to taking action.