So What Is IBS, How Do I Know If I Have It, and How Do I Get Help for Diarrhea AND Constipation?

Irritable Bowel Syndrome, which causes recurring diarrhea and/or constipation in association with abdominal pain, is not a finitely defined medical diagnosis with a clearly understood cause. Although there has been much desperately-needed research into Irritable Bowel Syndrome in recent years, the term "IBS" was pretty much coined by the medical establishment to mean "I don't know what's wrong with you. There are no physical findings that point to a recognizable problem I can treat and cure."

Good doctors will freely admit this, and typically suggest their patients try a combination of dietary changes, stress management techniques,(1) and prescription anti-spasmodic (anti-cholinergic) drugs to try and control their diarrhea and/or constipation and pain.(2) There is also a new class of drug, serotonin-antagonists, that shows promise in controlling selective IBS symptoms (diarrhea-only, constipation-only, etc.).(3)

Irritable Bowel Syndrome is a chronic, functional disorder of the gastrointestinal (GI) tract characterized by recurrent abdominal pain and discomfort accompanied by alterations in bowel function, diarrhea, constipation, or a combination of both, typically over months or years. It is not caused by structural, biochemical, or infectious abnormalities, but is instead classified as a "dysregulation" of brain-bowel inter-function.

Although there is clearly still much research to be done on IBS, the most recent findings suggest that IBS sufferers have, in sum, colons that are too easily stimulated. There is an "altered regulation of bowel motor and sensory function; a disturbance in the interaction between the gut, the brain, and the autonomic nervous system which regulates involuntary reactions of internal organs".(4) In other words, people with IBS have colons that react to stimuli that do not affect normal colons, and their reactions are far more severe, often producing extreme diarrhea and or constipation.. The result is heightened pain sensitivity and abnormal gut motility (irregular or increased GI muscle contractions resulting in pain, diarrhea, and/or constipation).

This overreaction and hypersensitivity cause the standard symptoms of Irritable Bowel Syndrome: lower abdominal pain and cramping (frequently severe, and can be to the point of losing consciousness),(5) in association with diarrhea (often sudden and explosive), and/or constipation (often chronic), gas, and bloating.

An estimated 15-20% of all Americans suffer from IBS, more than have asthma or diabetes, and a 60-70% majority of these people are women.(6) In fact, IBS is the single most common gastrointestinal diagnosis among gastroenterology practices in the U.S., and it is one of the top ten most frequently diagnosed conditions among all U.S. physicians.(7) The average age of IBS onset is late teens to early twenties, but people can be afflicted in childhood. There is no known "cure", as this problem is a syndrome, not a disease. As such, if you can control the symptoms, you effectively eliminate the problem. I have found that diet alone can alleviate more than 90% of the misery of IBS - pain, diarrhea, and constipation. .

My favorite analogy is that having Irritable Bowel Syndrome is rather like having very sensitive skin, only the problem is internal. You cannot visit a dermatologist to cure sensitive skin, as there is nothing physically wrong that can be fixed. No surgery or drug can eliminate the problem. It is simply a condition that must be controlled on a daily basis by avoiding those things that trigger the symptoms. IBS requires the same type of precautions.

Please note that a diagnosis of IBS is acceptable ONLY if the patient has the hallmark symptoms (abdominal pain in association with diarrhea and/or constipation) in combination with a lack of physical abnormalities as determined by diagnostic tests.(8) Although published diagnostic guidelines do exist for IBS, almost 80 percent of U.S. physicians say they don't follow them, and less than 20% say they are even somewhat familiar with these guidelines.(9)

Food allergies, gluten intolerance disorders such as celiac sprue,(10) inflammatory bowel diseases such as Crohn's and Ulcerative Colitis,(11) colon cancer, endometriosis, and even ovarian cancer can all mimic the symptoms of IBS and must be conclusively ruled out.(12) Removal of the gallbladder or ileum (the last portion of the small intestine) can also result in chronic diarrhea that may be misdiagnosed as IBS. This diarrhea results from the malabsorption of bile acids secreted by the liver – these acids irritate the colon and cause severe diarrhea. The prescription drug Questran, which binds the bile acids in the intestines and prevents them from reaching the colon, can help this problem. On a related note, gallstones can cause daily indigestion, nausea, and bloating, which may also be misdiagnosed as IBS. What tests are required for a diagnosis of IBS?

If your GI symptoms do not match those of IBS but you are given this diagnosis anyway simply because your doctor cannot find anything structurally wrong with you, find a new doctor. It is unacceptable for all patients with unexplainable diarrhea, constipation and abdominal symptoms symptoms to be lumped into the IBS category and summarily dismissed, but unfortunately this is a common occurrence.

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