Irritable Bowel Syndrome FAQ
PART 1: Background
1a: What is Irritable Bowel Syndrome?
1b: What is the prevalence of IBS?
1c: What factors contribute to the onset of IBS?
1d: How long does IBS last?
1e: What effect does IBS have on one's lifestyle?
1f: Are my symptoms just "all in my head" or psychosomatic?
1g: What factors contribute to health care utilization?
PART 2: Symptoms
2a: What are the symptoms of IBS?
2b: How severe are these symptoms?
2c: Does everybody get the same symptoms?
PART 3: Medical Facts
3a: What causes IBS?
3b: What is the role of psychological and/or social factors in IBS?
3c: Is IBS life-threatening?
3d: Will IBS lead to colon or rectal cancer?
3e: Will IBS lead to IBD (Crohn's, ulcerative colitis)?
3f: Will my IBS eventually go away, or will I have it for the rest of my life?
PART 4: Diagnosis
4a: How do I know for sure if I have IBS?
4b: Is IBS a legitimate diagnosis? Should I seek a second opinion?
PART 5: Related Maladies
5a: How does IBS differ from Crohn's disease or ulcerative colitis?
5b: How does IBS differ from gluten enteropathy/celiac disease?
5c: How does IBS relate to other broad-spectrum symdromes, such as Fibromylagia, Chronic Fatigue Syndrome (CFS), Myofascial Pain Syndrome (MPS), Multiple Chemical Sensitivity Syndrome (MCSS), and others?
Part 1: BackGround
1a: What is Irritable Bowel Syndrome?
Irritable Bowel Syndrome (IBS) is part of a spectrum of diseases known as Functional Gastrointestinal Disorders which include diseases such as noncardiac chest pain, nonulcer dyspepsia, and chronic constipation or diarrhea. These diseases are all characterized by chronic or recurrent gastrointestinal symptoms for which no structural or biochemical cause can be found.
1b: What is the prevalence of IBS?
IBS affects between 25 and 55 million people in the United States and results in 2.5 to 3.5 million yearly visits to physicians. Approximately 20 to 40 percent of all visits to gastroenterologists are due to IBS symptoms.
IBS symptoms affects men and women of all ages and of all races. The prevalence of IBS in the general population of Western countries varies from 6 to 22%. IBS affects 14-24% of women and 5-19% of men. The prevalence is similar in Caucasians and African Americans, but appears to be lower in Hispanics. Although several studies have reported a lower prevalence of IBS among older people, the present studies do not allow to definitely conclude whether or not an age disparity exists in IBS. In non-Western countries such as Japan, China, India, and Africa, IBS also appears to be very common.
1c: What factors contribute to the onset of IBS?
Many patients with IBS report that their symptoms began during periods of major life stressors such as a divorce, death of a loved one, or school exams. Many patients also report the onset of symptoms during or shortly after recovering from a gastrointestinal infection or abdominal surgeries. Symptoms of IBS have also been known to appear upon the ingestion of a certain food to which the individual is sensitive. The type of food which causes symptoms varies with the individual. (There is no one definite universal food trigger for IBS.) Similarly, a flare of symptoms in a patient with long-standing IBS may be triggered by all of the symptoms listed above, or for no apparent reason.
1d: How long does IBS last?
Almost everything about IBS is totally dependent on the individual patient. For some, IBS may arise during times of stress or crisis, and then subside once the stressful event has passed. For others, IBS strikes seemingly randomly and without warning and never completely goes away. Still others will get IBS for a while, then it will go away for a long period of time, then come back. The duration of IBS is different for everybody.
1e: What effect does IBS have on one's lifestyle?
IBS can be nothing more than a mild annoyance, completely debilitating, or anywhere in between. Again, it depends on the person and how he or she reacts to it and treats it.
1f: Are my symptoms just "all in my head" or psychosomatic?
Several studies have shown that psychological disturbances are more common in IBS patients than patients with other gastrointestinal diagnoses and healthy controls. However, people with IBS who do not seek medical care have a similar psychological profile as the general population. Therefore, IBS is not caused by psychological problems, but a person's outcome and illness behavior is affected by their psychological make-up. Different people respond differently to their IBS and IBS symptoms, depending on a number of psychosocial factors.
1g: What factors contribute to health care utilization?
Although IBS is very common in the general population, only a minority of people ever seek medical care for their symptoms. Cultural factors may affect health care utilization. For example, as opposed to the U.S. and Europe, in India male patients are more likely to seek medical care than women. The presence and severity of abdominal pain, and the number of "Manning Criteria" correlate with health care consultation. Finally, psychological disturbance (e.g. anxiety or depression) also appears to influence health care utilization.
Part 2: Symptoms
2a: What are the symptoms of IBS?
The most common symptoms that IBS patients complain of are: frequent diarrhea, abdominal pain (usually in the lower abdomen area), gas, bloating, diarrhea alternating with constipation, mucus in the stool, bowel urgency or incontinence, and a feeling of incomplete evacuation after a bowel movement. Since IBS is considered mainly to be a disorder of the lower gastrointestinal tract, the symptoms tend to remain located below the navel. However, several symptoms of the upper gastrointestinal tract have also been shown to be common in those with IBS, including: difficultly swallowing, a sensation of a lump in the throat or a closing of the throat, heartburn or acid indigestion, nausea (with or without vomiting), and chest pain.
A number of expert investigators during a meeting in Rome, Italy, developed a consensus definition and criteria for IBS, known as the "Rome" criteria.
At least 3 months of continuous or recurrent symptoms of:
1. Abdominal pain or discomfort, e.g.:
a. Relieved with defecation and/or
b. Associated with a change in frequency of stool; and/or
c. Associated with a change in consistency of stool; and
2. Two or more of the following, at least on one-fourth of occasions or days:
a. Altered stool frequency
b. Altered stool form (e.g. watery/loose stools or hard stools)
c. Altered stool passage (e.g. sensations of incomplete evacuation after bowel movements, straining, or urgency)
d. Passage of mucus and/or
e. Bloating or feeling of abdominal distention.
In addition, a number of other non-colonic symptoms may be present in patients with IBS. These include: nausea, feeling full after eating only a small meal, sensation of urinary urgency, incomplete emptying after urinating, fatigue, and pain during sexual intercourse.
2b: How severe are these symptoms?
As with just about everything associated with IBS, the severity of symptoms vary greatly from person to person, ranging from barely noticeable to completely debilitating, and can vary for the same person over periods of time.
2c: Does everybody get the same symptoms?
No. Although the symptoms listed in 2a are the most common, each person's experience and presentation will be slightly different. The severity and frequency of abdominal pain or discomfort will also vary from an intermittent abdominal discomfort during stress life events to severe continuous abdominal pain. Likewise, bowel habits can vary. Diarrhea, constipation, or alternating between the two may be the predominant bowel pattern.
Part 3: Medical Facts
3a: What causes IBS?
Recent physiological and psychosocial data have emerged to improve our understanding of IBS. A biopsychosocial model of IBS involving physiological, emotional, cognitive, and behavioral factors is now felt to be involved in symptom generation. Physiological factors implicated in the etiology of IBS symptoms include: visceral hypersensitivity to spontaneous contractions and to balloon distention of the bowel, autonomic dysfunction including exaggerated colonic motility response to stress and alterations in fluid and electrolyte handling by the bowel, and an alteration in the gastrocolonic response. However, alterations in these physiological parameters are generally found in only a subset of patients and frequently do not correlate with bowel symptoms. Behavioral factors such as stressful life events are reported by up to 60% of IBS patients to be associated with the first onset of the disease or with its exacerbation. Laboratory stressors have also been shown to affect gastrointestinal motility and visceral perception. Cognitive factors such as inappropriate coping styles and illness behavior are common in IBS patients and influence healthcare utilization and clinical outcomes. Emotional and psychiatric factors, such as anxiety and depression, are present in 40 to 60% of IBS patients seeking healthcare with increased prevalence in those patients presenting to tertiary referral centers. IBS patients who have sought medical care are more likely to have abnormal psychological profiles, abnormal illness behaviors, and psychiatric diagnoses than patients with other medical illnesses.
3b: What is the role of psychological and/or social factors in IBS?
Psychiatric diagnoses are present in 42-62% of IBS patients who have sought medical consultation. In comparison, psychiatric diagnoses are present in around 20% of patients with other gastrointestinal diagnoses. The majority of these psychiatric diagnoses are cases of anxiety and depression. Other common diagnoses include somatization disorder and hypochondriasis.
Stress can affect the functioning of the gastrointestinal tract of all people, and particularly those with IBS. Several studies have shown that IBS patients are more likely to report that stress changes their stool pattern and leads to abdominal pain than people without bowel problems. In one study 65% of IBS patients reported a severe stressful life event prior to developing IBS. The kinds of psychological stressors often reported by patients with IBS vary considerably, but include: loss of a parent or spouse through death, divorce, or separation, and sometimes is accompanied by feelings of unresolved grief, and also significant life changes which demand many social and personal adjustments such as moving to a new job or a new city.
3c: Is IBS life-threatening?
No, however, IBS is serious. Patients with IBS have a higher rate of hospitalizations, work absenteeism, feelings of poor quality of life, and abdominal surgeries than healthy controls and patients with other gastrointestinal illnesses. In the general population, people with IBS symptoms missed more than 3 times as many work days than did people without bowel symptoms.
3d: Will IBS lead to colon or rectal cancer?
No. IBS has not been linked to any type of cancer. In fact, those with IBS are more likely to be better aware of bowel health and cancer prevention.
3e: Does IBS lead to IBD (Crohn's, ulcerative colitis)?
No. IBS symptoms are often present in patients with IBD, however, there is no evidence to suggest that IBS leads to IBD.
3f: Will my IBS eventually go away, or will I have it for the rest of my life?
IBS symptoms may fluctuate over time. In one study, more than 50% of IBS patient remained symptomatic 5 years after their initial diagnosis.
Part 4: Diagnosis
4a: How do I know for sure if I have IBS?
Since there is no diagnostic marker associated with IBS, the diagnosis is based on symptoms and by excluding other diseases which may have a similar presentation. The extent of the medical evaluation which is necessary prior to making a diagnosis of IBS will vary depending on the duration of symptoms, the patient's age and clinical presentation. For example, recent onset of symptoms in an older patient will require more extensive testing than a younger person with unchanged symptoms for many years. Most patients, however, will be given a thorough physical exam which is performed mainly to rule out other medical illnesses. If further testing is necessary it will usually be directed toward the predominant symptom. For example, patients with significant diarrhea will often undergo stool tests for ova and parasite, and malabsorption if clinically indicated. On the other hand, patients with constipation will often undergo tests such as radiopaque marker studies (Sitzmarker) for colonic functioning and anorectal manometry for pelvic floor functioning. Most patients over the age of 50 years should have a flexible sigmoidoscopy. In addition, if occult blood is found by either rectal exam or on hem-occult testing a colonoscopy may be necessary.
Some commonly performed tests are:
It is important to note that the ONLY way to be absolutely certain you have IBS is through a doctor's diagnosis.
Because there is no diagnostic marker associated with IBS, the diagnosis is one of exclusion and is based on symptoms. Manning and his colleagues were the first to report six symptoms which differentiated IBS from other gastrointestinal diseases. The six 'Manning Criteria' are as follows: 1) relief of abdominal pain with defecation, 2) looser stools with the onset of pain, 3) more frequent bowel movements at onset of pain, 4) abdominal bloating or distention, 5) feelings of incomplete evacuation, and 6) passage of mucus per rectum. In general the more 'Manning Criteria' present the more likely it is that a patient has IBS. While the 'Manning Criteria' are helpful in diagnosing IBS a consensus meeting in Rome, Italy recently further refined these criteria (see 2a). In addition, since many other gastrointestinal diseases can present with similar symptoms, a diagnosis of IBS should only be made in the right clinical setting.
4b: Is IBS a legitimate diagnosis? Should I seek a second opinion?
Many times a person may think that he or she is being "slighted" by being given a diagnosis of IBS. Unfortunately, to some doctors, IBS is not considered a "true" disease, but rather an unimportant minor condition (when in reality it is hardly all that "minor" to those who have to deal with it), and therefore may not be given the medical attention it deserves. Don't despair; there ARE competent doctors out there who are very good at dealing with IBS cases. A good doctor won't just tell you that you have IBS and give up on you. He or she should be willing to go over your questions and concerns, and outline and monitor a program of treatment for your individual case of IBS. If you suspect that you have not had a thorough enough examination for other diseases before the doctor tells you that you have IBS, you should seek a second opinion.
Part 5: Related Maladies
5a: How does IBS differ from Crohn's disease or ulcerative colitis?
The symptoms of IBS differ from the symptoms of Inflammatory Bowel Disease (IBD) in that there is NO trace of blood in the stool, or history of fevers or chills. IBS is a functional disporder, meaning that there is no demonstrable pathology in the colon or small bowel.
5b: How does IBS differ from celiac disease?
People with celiac disease experience marked intestinal symptoms such as diarrhea and gas upon the consumption of foods that contain gluten, such as products made from wheat, oats, rye, and barley. Upon the elimination of gluten-containing foods, the symptoms disappear. Some people with IBS may experience an aggravation of symptoms with the consumption of similar wheat-related products and eliminating these products can help alleviate symptoms.
5c: How does IBS relate to other broad-spectrum symdromes, such as Fibromylagia, Chronic Fatigue Syndrome (CFS), Myofascial Pain Syndrome (MPS), Multiple Chemical Sensitivity Syndrome (MCSS), and others?
An interesting point to note here is that many IBS patients also experience symptoms in non-gastrointestinal systems. Research has been done on the frequent "overlap" of nonspecific broad-spectrum syndromes in a large number of patients. Muhammad Yunus, M.D., of the University of Illinois College of Medicine has studied a group of syndromes as being part of a larger spectrum of conditions, which he calls Dysregulation Spectrum Syndrome or DSS.
The following syndromes are considered to be part of DSS, according to Dr. Yunus:
Fibromylagia Syndrome (FMS)
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Chronic Fatigue Syndrome (CFS)
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Myofascial Pain Syndrome (MPS)
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Irritable Bowel Syndrome (IBS)
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Temporomandibular Joint Disorder (TMJ)
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Restless Leg Syndrome (RLS)
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Periodic Limb Movement (PLMS)
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Multiple Chemical Sensitivity Syndrome (MCSS)
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Tension Headaches
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Irritable Bladder
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Primary Dysmenorrhea
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Migraine Headaches
Other studies are being conducted on the occurrence of overlapping syndromes in patients. The exact cause of such a wide range of syndromes and symptoms in a patient is not yet clear, but it does seem to be the case that a patient with one particular syndrome on the above list is much more likely to have symptoms from one or more other syndromes on the same list.
