What is Irritable Bowel Syndrome? Causes, Symptoms & Treatment


Irritable bowel syndrome (IBS) affects up to 10–15% of adults.  It has a significant worldwide prevalence.  Although IBS is not associated with an increased risk for life-threatening illness, it is associated with a significant health care and economic burden.  Studies have shown that IBS patients have an increased number of outpatient health care visits, diagnostic tests, and surgeries.  IBS can also severely compromise a person’s quality of life.  IBS is second only to the common cold, as a cause of absenteeism from work.

Irritable bowel syndrome (IBS) is a common, long-term condition of the digestive system.  It can cause bouts of stomach cramps, bloating, diarrhea and/or constipation.  The symptoms vary between individuals and affect some people more severely than others.  They tend to come and go in periods lasting a few days to a few months at a time, often during times of stress or after eating certain foods.

IBS is thought to affect up to 1 in 5 people at some point in their lives, and it usually first develops when a person is between 20 and 30 years of age.  Around twice as many women are affected as men.  The condition is often life long, although it may improve over several years.

IBS is best understood as a long-term or recurrent disorder of gastrointestinal (GI) functioning. It usually involves the large intestine (colon) and small intestine with disturbances of intestinal/bowel (gut) motor function (motility) and sensation.  These gut-related activities are regulated by the brain. The bi-directional interactions between the brain and gut are important in maintaining normal bowel function.  This may also be impaired, which is why IBS is often called a brain-gut disorder. 

There is no specific cause for IBS.  However, it has been proved that when the intestinal contractions are stronger and last longer than normal, they cause gas, bloating, and diarrhea; and when the intestinal contractions are weaker they cause slow food passage leading to hard, dry stools.

Various factors like food allergy, stress (physical and mental), GI infections, emotional arousal, hormones (worse during menstrual periods in women), and genetic factors predispose to the onset of IBS.  

Risk factors:
The risk factors are: 
  1. Being young.
  2. Being a female.
  3. Having a family history of IBS (genetic).
  4. Having a mental problem.
The symptoms of IBS are usually worse after eating and tend to come and go in episodes (flaring up and remission).

Most people have flare-ups of symptoms that last a few days.  After this time, there is remission where the symptoms usually improve, but may not disappear completely. 

Common symptoms of IBS are:
  1. Abdominal pain and cramping, which may be relieved by passing stools and exacerbated by eating.
  2. A change in the bowel habits – such as diarrhea, constipation, or sometimes both.
  3. Bloating sensation of the abdomen. 
  4. Excessive wind or gas (flatulence).
  5. An urgent need to go to the toilet.
  6. A feeling that you have not fully emptied your bowels after going to the toilet.
  7. Passing mucus in stool.
Alarm signs or “red flags” include:
  1. Rectal bleeding.
  2. Abdominal pain that progresses or occurs at night.
  3. Weight loss.
Additional symptoms are:

In addition to the main symptoms described above, some people with IBS experience additional symptoms like:
  1. A lack of energy.
  2. Feeling sick.
  3. Backache.
  4. Bladder problems (such as needing to wake up to urinate at night, experiencing an urgent need to urinate and difficulty fully emptying the bladder).
  5. Pain during sex.
  1. Aggravation of hemorrhoids.
  2. Malnourishment.
  3. Depression, etc.

The starting point of the diagnosis is a detailed history to identify the characteristic symptoms of IBS and a physical examination.  Laboratory blood and stool tests, x-rays, and endoscopic procedures (e.g., colonoscopy) are used not to make the diagnosis but to rule out other diseases of the bowel, which can present with similar symptoms. These tests are usually normal in patients with IBS.  IBS is best determined by the use of the Rome Criteria, which is a collection of the most common symptoms that typify the disorder.

The first line of treatment for IBS includes general measures such as:
  1. Establishing an effective patient-physician relationship.
  2. Obtaining education about IBS.
  3. Implementing lifestyle changes, which may be associated with symptoms.  If certain foods set off or worsen symptoms, reduce or avoid them.  If the abdominal discomfort or pain occurs after eating, it may be helpful to eat smaller and more frequent meals.
A number of medications may be helpful:
  1. Antispasmodics:  Relieve abdominal pain or discomfort.
  2. Anti-diarrheal agents:  Prevents diarrhea.
  3. Laxatives:  Treat constipation.
  4. Anti-anxiety medications: Help in psychological distress.

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