Get Some Facts About IBS

Irritable bowel syndrome (IBS) is a common disorder of the digestive system, specifically the large intestine. In general, people with the condition display symptoms such as abdominal pain, bloating and unprompted changes in their toilet habits. IBS sufferers can experience constipation or diarrhea—or both in the span of a single day.

The exact cause of IBS is unknown. One potential cause is an overactive colon, meaning an increase in the contractions of the muscles that surround the large intestine. These contractions tend to occur more frequently in IBS patients and lead to increased bowel movements, pain and cramps along the abdomen.

However, many other factors can contribute to the development of irritable bowel syndrome. These can include the following, according to a 2019 study:

• Dysregulation of the brain-gut axis: Problems arise when communication between the brain and the gastrointestinal system breaks down. An example of this is dysbiosis, which refers to an imbalance in the gut bacteria/microorganisms that help regulate the digestive process.
• Genetics: People with a family history of IBS are more likely to develop the condition. Women are also more likely to develop the condition than men.
• Psychological factors: Mental health plays a role. Can depression cause IBS? Can anxiety cause IBS? Yes. Stress, anxiety and other emotional issues might worsen the symptoms of IBS.

"IBS is often associated with mental health conditions such as depression or anxiety due to the link between the gut and the brain," said Anna Mapson, a registered nutritionist in Bristol, England, who specializes in IBS. "People who've had previous trauma or a difficult childhood are more at risk for digestive conditions such as IBS. And if it runs the family, you might also find you're more likely to experience that dodgy tummy your parent also has. This could be genetic or linked family mental health or family eating habits that get passed down."

What are the causes of IBS?

Can stress cause irritable bowel syndrome? Possibly.

It's true that the specific cause of IBS is unknown, but it can be linked to having a high level of stress and a family history of IBS, according to Reema Patel, M.Sc., a registered dietitian with Dietitian Fit in Surrey, England. In addition, an overly sensitive stomach is a factor, as food passes too quickly or too slowly through the gut.

"IBS can also develop after an infection such as gastroenteritis or where certain antibiotics are taken," Patel said. "This is because these infections and/or medications can have an influence on our gut health, increasing the risk of symptoms and development of IBS."

What are some of the other factors associated with IBS? Molly Warner, an accredited practicing dietitian and certified intuitive eating counselor in Queensland, Australia, listed several:

• Genetics/family history of IBS
• Inflammation or food poisoning
• Medications
• Stress/anxiety/poor sleep
• Hypersensitive gut nerves
• Menstruation/hormone changes
• Altered gut microbiome
• Altered gut motility
• Too little/much physical activity
• Not enough dietary fiber
• Dehydration
• Too much caffeine/alcohol
• Fatty/sugary/spicy foods
• Concentrated tomato products
• FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols)

What are the types of IBS?

IBS is categorized as a biopsychosocial disorder, according to experts. That means it involves a combination of biological, psychological and environmental factors that interact with one another.

Each factor contributes to the development and maintenance of the IBS symptoms being experienced. As a result, IBS diagnosis is symptom-based, because its exact causes are complex and not fully understood.

Healthcare experts recognize four subtypes of IBS, categorized based on the person's bowel movements. The four types, according to Amanda Sauceda, a registered dietitian nutritionist and the founder of The Mindful Gut in Long Beach, California, are the following.

• IBS-C. Describes people who are constipation-prone
• IBS-D. Describes people who are diarrhea-prone
• IBS-M. Describes people who have a mix of constipation and diarrhea
• IBS-U. Describes people who have IBS but don't fall under the above categories

IBS doesn't advance in defined stages and can occur either in a flare state or not, according to Erin Judge, a registered dietitian nutritionist who specializes in digestive disorders in Nashville.

"A flare state will mean that symptoms are more present and the gut may be even more vulnerable to triggers," said Judge, who is the founder of Gutivate, a virtual nutrition counseling practice. "This can vary in duration and severity between individuals. When someone is not in a flare state, triggers may be better tolerated."

One of the most difficult things about living with IBS, she added, is it doesn't always progress in one direction. It can fluctuate without much reason.

"Symptom patterns can completely change throughout one's life, which can lead to confusion," Judge said. "It is known to be chronic without a known cure, so it is something individuals must learn to manage over time."

What does the research say about IBS?

The prevalence of IBS in society is difficult to establish for a couple of different reasons. The first is due to the lack of a clear cause explaining its emergence. Another is the reliance on symptom-based diagnosis, which may differ based on the stringency of the diagnostic criteria being used. Plus, not all studies use the same criteria when onboarding IBS patients to conduct their research.

Additionally, some people with moderate IBS may not seek medical treatment for their symptoms. And the definition and diagnostic criteria for IBS have evolved over time, which also makes it challenging to compare prevalence data from different studies.

Nevertheless, one large-scale study suggested that the worldwide prevalence of IBS is between 3.8 percent and 9.2 percent depending on the specific criteria used to make a diagnosis. Other experts believe IBS is much more common. They place the worldwide prevalence between 9 percent and 23 percent.

Another study conducted on students found irritable bowel syndrome in nearly 30.2 percent of the participants, suggesting the condition is much more prevalent in young people and adolescents.

"Most people with IBS are diagnosed before age 50 years. It affects women more often than men," Warner said. "People with a family history of IBS are more susceptible. There is likely a role of the gut microbiome in IBS, so a previous bout of food poisoning can increase the risk of having IBS."

In fact, experts suggest that IBS symptoms found in patients who are over the age of 50 may indicate a potential red flag. Why? IBS is a functional gastrointestinal disorder, which means that while it is characterized by abnormal function of the digestive system, it does not actually cause any physical abnormalities in the gastrointestinal tract.

When healthcare providers observe IBS symptoms in older patients, they should think about whether there could be an underlying physical health issue behind them and do tests to rule out more dangerous conditions such as inflammatory bowel disease (IBD).

People should consult their primary healthcare physician if IBS is suspected, regardless of age. This allows your doctor to draft an effective treatment plan for your specific needs or symptoms. Irritable bowel syndrome is not a dangerous condition and can be effectively managed so it has minimal impact on one's overall quality of life.

Follow-up stories on this topic will discuss the diagnosis and treatment of IBS and how to manage and live with the condition.