Irritable Bowel Syndrome? IBS?
Irritable Bowel Syndrome (IBS) is the most common chronic health disorder in America, Canada, the UK, Australia, and New Zealand, affecting more people than asthma, diabetes, and depression combined. Irritable Bowel Syndrome is a physical - not psychological - disorder that affects mainly the bowel, which is also called the large intestine. The bowel is the part of the digestive system that makes and stores stool.
IBS is characterized by its symptoms: lower abdominal pain or discomfort, diarrhea, constipation (or alternating diarrhea/constipation), gas, bloating, and nausea. There is no cure for Irritable Bowel Syndrome, but there are many very effective ways of controlling and even eliminating IBS symptoms.
Interestingly, IBS affects far more women than men; seventy-five percent of people diagnosed with Irritable Bowel Syndrome are women. However, IBS symptoms, IBS diagnosis protocols, and IBS treatments are the same for women and men.
Irritable Bowel Syndrome is not a disease. It's a functional disorder, which means that the bowel simply does not work as it should. Irritable Bowel Syndrome is characterized as a brain-gut dysfunction.
Symptoms of Irritable Bowel Syndrome - What Are IBS Symptoms?
It's important to verify that your symptoms match those of IBS before you accept this diagnosis. As noted, Irritable Bowel Syndrome is characterized by its symptoms: continuous or recurrent lower abdominal pain or cramping (from mild to excruciating) in association with altered bowel motility (diarrhea, constipation, or both).
IBS attacks may strike suddenly at any time of day or night, and may occasionally - though not typically - wake you from a sound sleep. Gas and bloating are common, but vomiting isn't, though it can occur due to nausea from the pain. Upper GI symptoms are not a typical part of the syndrome. For women, attacks are often associated with menstruation.
Passing blood, running a fever, swollen extremities, and joint pain are not symptoms of IBS, and point to other disorders. IBS is diagnosed in part by the use of the official diagnostic criteria known as the Rome Guidelines.
Gas and bloating are common IBS symptoms in women, but vomiting isn't, though it can occur due to nausea from the pain. Upper GI symptoms are not a typical part of the syndrome, though women with IBS are statistically more prone to GERD and acid reflux.
Passing blood, running a fever, swollen extremities, and joint pain are never symptoms of IBS in women, and point to other disorders.
What Symptoms and Diseases Need to Be Ruled Out For an IBS Diagnosis?
In essence, the diagnosis of IBS is a process of exclusion. There is no medical test available that will be positive for IBS; instead, your doctor will test you for all other illnesses that can mimic IBS symptoms, and if those tests are negative, and if your symptoms fit the Rome Guidelines for Diagnosis, you'll then be diagnosed with IBS. In particular, it's important that the following diseases are excluded before you accept a diagnosis of IBS:
Colon, carcinoid, and medullary thyroid cancers
Inflammatory bowel diseases (Crohn's and Ulcerative Colitis)
Celiac (a genetic, autoimmune disorder resulting in gluten intolerance)
Diverticulosis / Diverticulitis
Gallstones and Idiopathic Bile Acid Malabsorption
Food allergies, intolerances, and malabsorptions (fructose, lactose, etc.)
Bacterial infections and small intestine bacterial overgrowth (SIBO)
What Tests Does a Diagnosis of Irritable Bowel Syndrome Require?
As a rule, all possible physical, structural, and infectious abnormalities of the GI tract need to be unquestionably eliminated before you agree to an IBS diagnosis. This requires a physical examination, preferably by a board-certified gastroenterologist, and may include the following studies:
Complete blood count, sedimentation rate, and chemistries
Blood tests for gluten intolerance (endomysial antibody and tissue transglutaminase antibody tests)
Blood and/or breath tests for fructose, and lactose intolerances
Breath test for small intestine bacterial overgrowth (SIBO)
Stool for ova, parasites, and blood
Liver function tests
For women, a gynecological exam including CA-125 blood test for ovarian cancer
Other diagnostic studies should be minimal and will depend on the symptom subtype. For example, in patients with diarrhea-predominant symptoms, a small bowel radiograph or lactose/dextrose H2 breath test. For patients with pain as the predominant symptom, a plain abdominal radiograph during an acute episode to exclude bowel obstruction and other abdominal pathology. For patients with indigestion, nausea, and bloating, an abdominal ultrasound to rule out gallstones. For patients with any numbness in association with constipation, Multiple Sclerosis should be excluded. For older patients (age 50 and above), pancreatic cancer may need to be excluded.
In general, the specific medical tests needed to rule out disorders other than IBS will depend upon your age, health history, family health background, and specific symptoms.