IBS (Irritable bowel syndrome) is a catch-all term for a chronic and common condition that causes a constellation of uncomfortable gastrointestinal symptoms. These symptoms include abdominal pain, cramps, gas, bloating, diarrhea, and constipation.

In western countries, like the US, up to 15% of adults have IBS, which makes it the most commonly diagnosed GI disorder we have. Also, for unknown reasons, IBS seems to affect people assigned female at birth twice as often as men.

There really is no soft way around the hard truth: IBS is a cumbersome condition that can impact physical, mental, and emotional health as well as every facet of your life.

Home life. Work life. Social life. And, yes, even your sex life.

The good news is IBS doesn’t cause tissue damage in your GI tract or increase your risk of more serious conditions, like colon cancer. Additionally, most people can effectively manage IBS symptoms with a combination of lifestyle changes, diet adjustments, medications, and even behavioral therapy.

IBS Symptoms

Besides being chronic and cumbersome, IBS can be confusing too. Some people get IBS with constipation; some people get IBS with diarrhea; some people get IBS with a mix of those symptoms. A fourth category, Unsubtyped IBS, describes the condition when its symptoms don’t follow a predictable pattern.

Another confusing and frustrating thing about IBS is this: Symptoms can appear frequently or only during flare-ups. In other words, the condition can wax and wane without any warning, causing lots of discomfort for a stretch of time. While other times, people can experience no symptoms (and normal bowel movements) for another period of time.

When IBS strikes, these are the most common symptoms people tend to experience:

• Abdominal pain and cramps, usually related to having a bowel movement.
• Excess gas and bloating in the body.
• Chronic constipation (IBS-C), diarrhea (IBS-D), or both (IBS-M).
• An urgency to use the bathroom and a sensation of still needing to empty your bowels after having a bowel movement.
• Mucus (a whitish film) in your stool.

People with IBS may also experience symptoms unrelated to the intestines, such as:

• Migraine headaches
• Sleep disturbances
• Anxiety and depression
• Fibromyalgia
• Pelvic pain

Causes and Triggers of IBS

While the definitive cause of IBS is unknown, research shows that IBS may be related to hypersensitivity of nerves found in the walls of the GI tract. Most people associate serotonin, the “feel-good” chemical, with happiness, mood regulation, and mental health. But the gut is loaded with serotonin receptors, and this “happiness hormone” plays a big role in digestive health too. This finding might explain why IBS can have a wide-ranging set of symptoms that are triggered by a variety of factors.

Women with IBS often recognize certain factors that trigger their symptoms. Triggers vary greatly from person to person, but here are some of the most common ones:

• Periods: For some people, IBS worsens predictably according to their menstrual cycle.
• Food: Common culprits include dairy products, food that contain gluten, and food or drinks that cause “gas”.
• Psychosocial Factors: Stress, anxiety, and depression, which have complex interactions with the gut-brain axis, are more commonly reported by women with IBS.

Diagnosing IBS

A healthcare provider diagnoses IBS based on symptoms and medical history. If you have “red flag” symptoms (unexplained weight loss, anemia, GI bleeding), your provider may order additional tests to rule out another condition, like celiac disease or IBD (inflammatory bowel disease).

Additional testing might include:

• Blood tests to check for other digestive diseases
• Stool tests to look for signs of infection and inflammation
• A hydrogen breath test to rule out bacterial overgrowth in your gut
• Lactose intolerance testing to rule out this condition.

If clinical suspicion still exists after further testing, your provider might order an imaging study, like a colonoscopy, endoscopy, or CT scan, to confirm a diagnosis of IBS by process of exclusion.

Managing and Treating IBS

Managing IBS often requires a multifaceted approach, including dietary changes, stress management, medication, and behavioral therapy. Treatment focuses on reducing symptoms so a person with IBS can experience less discomfort less often and be able to predict flare-ups more often. As with many chronic health conditions, time and trial and error are two of the most important factors to keep in mind when seeking a management strategy that works best for you and your unique condition.

Dietary Changes for IBS

Low-FODMAP Diet

According to Dr. Suma Magge, a board-certified gastroenterologist and co-author of “Low-FODMAP Diet for Treatment of Irritable Bowel Syndrome”: Diet is a huge component in patients with IBS.

Dr. Magge and other gastroenterologists often recommend a low-FODMAP diet as the first-line diet of choice for IBS.

A low-FODMAP (fermented oligosaccharides, disaccharides, monosaccharides, and polyols) involves reducing the intake of certain fermentable carbohydrates that bring fluid into the intestines, causing gas, bloating, and diarrhea.

Since a low-FODMAP diet can be restrictive, most experts recommend meeting with a nutritionist before starting this diet.

Go Easy on the Gas

If you don’t have the stomach for going full low-FODMAP, cutting back on foods and beverages that create gas (brussels sprouts, cabbage, carbonated drinks) can make a big difference for some people.

Increase Fiber Intake

Eating more fiber-rich foods or taking a fiber supplement may help, especially if diarrhea (IBS-D) is your dominant symptom.

Limit Lactose

Lactose intolerance is more common in people with IBS, so limiting dairy products is something to consider.

Avoid Gluten

People with IBS tend to be more sensitive to gluten (a protein found in wheat and other grains), so following a gluten-free diet can be a good thing to try.

Drink More Water

Water can work wonders for promoting gut health and preventing constipation, so make sure you’re getting enough.

Lifestyle Changes for IBS

Making a few commonsense lifestyle changes can also provide relief for people with IBS. Some common recommendations include:

Get regular exercise

Even just walking briskly for 30 minutes 3-5 days per week can help improve IBS symptoms and overall health.

Try relaxation techniques

Yoga. Meditation. Tai chi. Breath work. There are numerous de-stressing practices that can help calm down an overtaxed nervous system.

Get enough sleep

What does improved sleep quality not help? Aim for 7-9 hours of quality, restful sleep per night.

Try therapy

oBecause IBS can cause such a disruption in quality of life and lead to mental health issues, many people benefit from seeing a therapist. Cognitive behavioral therapy (CBT), hypnotherapy, and biofeedback are just a few types of therapy that may help, especially if anxiety and depression are also at play.

Medications for IBS

For people who don’t find relief from diet and lifestyle changes alone, medicine may be necessary. Thankfully, there are many options. Your provider will help you choose the best medication (or combination of meds) for your specific symptoms, so make sure you seek care from a clinical expert who welcomes an open and honest conversation and has the patience and perseverance to find a personalized treatment plan that works. That treatment plan might include one or more of the following medications:

• Osmotic laxatives and stool softeners, like Miralax, pull water into the colon and soften stool.
• Antidiarrheal agents, like Loperamide, reduce intestinal transit time and increase water absorption in the gut.
• Antispasmodic medications, like Bentyl, can help relieve abdominal pain and ease bloating and gas.
• Antidepressants, like SSRIs and tricyclic antidepressants, have been shown to relieve pain. This class of medicine can also help with anxiety and depression.
• Rifaximin, the only FDA-approved antibiotic for IBS-D, is thought to work by modifying bacteria in the gut and reducing inflammation.
• Prosecretory agents, like Linzess, increase fluid secretion and gut motility and can improve symptoms related to IBS-C.
• Direct serotonin agonists/antagonists, like Zelnorm and Lotronex, are reserved for severe IBS-C and IBS-D that don’t respond to other treatments.

If you’re struggling with IBS symptoms, keep the faith. Managing and treating IBS is possible, especially with a comprehensive and personalized approach that addresses the unique aspects of this condition. Plus, the medical community has more awareness and understanding of IBS than ever before, and research continues to unveil the intricacies of this condition.

IBS can feel all-powerful, but it’s no match for a positive attitude, persistence, and a provider who will partner with you to find a treatment plan that puts the powerof personal health back in your hands where it belongs.