Irritable Bowel Syndrome (IBS) FAQ

[TheTMJAssociation]

The following information was provided by the International Foundation for Functional Gastrointestinal Disorders for use on this forum.

What is IBS?
Irritable bowel syndrome (IBS) is a functional bowel disorder in which abdominal pain or discomfort is associated with defecation or there is a change in bowel habit. A functional disorder has its basis in how a bodily system works.

IBS is a complex motor and sensory disorder that is very common and can overlap with other conditions. A confident diagnosis can be made based primarily on well-defined symptoms. Effective diagnosis and treatment start with the recognition of the validity of symptom complaints. Multiple combinations of factors contribute to the symptoms, and treatments will vary. Setting realistic treatment goals that fit individual needs is an important step. A strong partnership between a knowledgeable patient and an empathetic, knowledgeable healthcare provider can produce significant improvement and control over symptoms for most individuals with IBS.

What is the cause of IBS?
The cause of IBS is not completely understood. Many factors may contribute to symptoms, which vary from person to person. The changes in normal function appear due, in part, to disturbances affecting the normal movement (motility) of muscles in the intestines. The muscle contractions can be influenced by several factors, such as stretching or distention, hormones, and stress. Alterations in the sensitivity of the nerves in the gut and a dysregulation in the way the brain controls these functions are other factors contributing to the pain and other symptoms of IBS.

Major advances in the understanding of IBS have occurred in the last several years, and science is now beginning to reveal underlying biological mechanisms that lead to symptoms. Areas of investigation include brain-gut interactions, motility, inflammation, gut sensitivity, genetics, and the role of bacterial flora.

Who gets IBS?
This chronic condition affects approximately 10 to 20 percent of the global population and is one of the most common disorders seen by primary care physicians. Two-thirds of individuals with IBS are female, and prevalence among women is estimated at 14 to 24 percent. Symptoms of IBS are unpredictable and often embarrassing to talk about. It causes lost time at work or school, interferes with social interactions, and can limit personal potential. IBS is termed a “functional” disorder because no structural abnormalities can be seen by common tests—such as endoscopy, X-ray, or blood tests—that would explain the multiple symptoms. Yet the normal functioning of the bowels is affected so that they don’t work properly. They move too much or too often, or not enough or often enough. Additionally, the nerves and muscles in the bowel are more sensitive to stretch or movement, which can lead to pain. Functional disorders are prevalent in most body systems, and IBS may coexist with any of these disorders. For example, as many as 40 percent or more of patients diagnosed with interstitial cystitis (IC) also have symptoms consistent with IBS.

What are the symptoms of IBS?
The primary symptoms of IBS are abdominal pain or discomfort that is relieved by a bowel movement and/or is associated with a change in consistency or frequency of bowel movements (for example constipation, diarrhea, or alternating constipation and diarrhea). The pain or discomfort is frequently described as primarily crampy or sharp but also as a generalized ache, and it can occur anywhere in the abdomen. The location and intensity of the pain are highly variable, even at different times in one person. Other bowel symptoms may include passage of mucus in the stool, feeling the urgent need to use a restroom, or the feeling of an incomplete bowel movement.

Up to one-half of patients with IBS also report upper gastrointestinal symptoms, such as bloating, heartburn, or nausea. Many report non-gastrointestinal symptoms such as fatigue, muscle pain, sleep disturbances, sexual dysfunction, low back pain, or headache. These may be due to the coexistence of IBS with other conditions. Symptoms of IBS can begin to occur anytime during adolescence or adulthood. The symptoms can range from a mild nuisance to debilitating pain and bowel urgency. They may wax and wane, but they persist over time.

How is IBS diagnosed?
There are no tests or biological markers to identify IBS. A physician bases the diagnosis on a physical examination, a patient history, and a well-defined cluster of the primary symptoms.

Symptom-based criteria emphasize making a positive diagnosis rather than using extensive tests to exclude other diseases. Limited tests are done when “alarm signs” are present, such as blood in the stool, unintentional weight loss, or when symptoms suggest medical conditions other than IBS. Conditions such as inflammatory bowel disease, intestinal infections, lactose intolerance, or celiac sprue have symptoms similar to IBS but with uniquely identifying features.

How is IBS treated?
Most people with IBS have mild symptoms that occur infrequently. But about 30 percent have more severe symptoms that are frequent, intense, and can substantially interfere with daily functioning.

There is no cure for IBS; treatment is aimed at reducing symptoms. Education about the condition is a cornerstone of managing symptoms. Management usually begins with gaining an understanding of what factors may trigger symptom onset. For example, dietary or lifestyle factors may play a role. Common offenders that can overstimulate the bowel are high fat or gas-producing meals, coffee, or alcohol. Non-drug therapies such as hypnosis, biofeedback, cognitive-behavioral therapy, or relaxation training may help to reduce painful discomfort.

Probiotics, living organisms that can alter gut-flora in a beneficial way, may help to reduce symptoms of abdominal pain and bloating.

No drug has been proven effective for all IBS sufferers. Drugs that target single symptoms are used with varying success, such as laxatives, antidiarrheal agents, and antispasmodics. Low doses of antidepressants are prescribed as pain relievers. Two drugs that target multiple symptoms of IBS in women are currently available: one is prescribed where diarrhea is the predominant bowel symptom, and the other where the primary bowel symptom is constipation.

Can non-gastrointestinal functional disorders overlap with IBS?
Functional disorders affect most body systems and can coexist with IBS. The coexistence of multiple conditions often results in a greater impairment of a person’s quality of life. Here is a list of websites for more information on these other conditions.

• Chronic Fatigue Syndrome (CFS) www.cfids.org
• Chronic Pelvic Pain (CPP) www.health.nih.gov/topic/PelvicPain
• Fibromyalgia (FMS) www.health.nih.gov/topic/Fibromyalgia
• Interstitial Cystitis and Dysuria (pain on urination) www.ichelp.org
• Migraine and Tension headaches www.health.nih.gov/topic/HeadacheandMigraine
• Multiple chemical sensitivities www.health.nih.gov/topic/MultipleChemicalSensitivity
• Post-Traumatic Stress Disorder (PTSD) www.health.nih.gov/topic/PostTraumaticStressDisorder
• Temporomandibular Joint Disorder (TMJ) www.tmj.org
• Vulvodynia www.nva.org