Frequently Asked Questions

Do you have a question about IBS? Please send your question to us at ibs@iffgd.org. While we cannot provide specific advice, we will try to post questions and answers that generally apply to those with IBS.

What is IBS?

IBS is a long-term or recurrent disorder of gastrointestinal functioning. It usually involves the large (colon) and small intestine with disturbances of intestinal/gut motility (motor function), sensation, and secretion.

What are the symptoms of IBS?

The gut disturbances found in IBS can produce symptoms of abdominal pain or discomfort, bloating or a sense of gaseousness, and altered bowel habits (diarrhea and/or constipation). Abdominal pain and/or discomfort is the key symptom of IBS and is often relieved or reduced with a bowel movement. Symptoms can come and go, and even change, over time.

Is there then a distinction between someone who is constipation-predominant, someone else who might be diarrhea-predominant, and people who alternate between the two bowel habits?

Traditionally there has been that distinction. But we're beginning to see that this is not a condition that causes constipation or diarrhea, but it's a disturbance in the regulation of the bowel function. It's a brain-gut condition, and triggering factors may variously cause symptoms of diarrhea at one time and constipation at another as the predominant bowel habit. We've found that about half of those affected have alternating diarrhea and constipation. About 30% will usually have only the diarrhea, and about 20% usually only the constipation.

How is IBS diagnosed?

The starting point of the diagnosis is a detailed history or interview and a physical examination. Diagnosis of IBS involves identifying certain symptoms typical of the disorder, and excluding other medical conditions that may have a similar clinical presentation. The symptom-based Rome diagnostic criteria for IBS emphasize a “positive diagnosis” rather than exhaustive tests to exclude other diseases.

Are there tests to confirm irritable bowel syndrome?

There are no physical findings or tests that confirm the diagnosis of IBS. Laboratory blood and stool tests, x-rays, and endoscopic procedures (such as colonoscopy) are used not to make the diagnosis, but to rule out other diseases of the bowel, which can present with similar symptoms.

I have been diagnosed with irritable bowel syndrome (IBS), but tests found nothing wrong. Do I need more tests?

The absence of a definitive biological marker to diagnose IBS may result in a tendency for physicians to overdo diagnostic procedures, or for patients to ask for them. The symptom-based Rome diagnostic criteria have been shown to be reliable. In addition, a physical examination and limited diagnostic tests help confirm this diagnosis with a high level of confidence. Extensive testing may be reserved for specific situations.

What is the Rome Criteria?

The Rome Criteria is a classification system that looks at specific symptom patterns to identify the different functional gastrointestinal disorders, such as IBS. <

Is a syndrome a disease, or is it something other than a disease?

It depends on what you mean by disease. Irritable bowel syndrome is in the group of conditions that are called functional gastrointestinal (GI) disorders. By that we mean disorders of dysfunction. These are conditions where you don't see anything on x-ray or endoscopy, unlike diseases where there is visible tissue damage or inflammation such as inflammatory bowel disease. And that's had a negative attribution because when the doctor doesn't find anything he or she may say, "Well, there's nothing wrong." but the symptoms are still very real for the individual.

How common is IBS?

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal (GI) disorder with worldwide prevalence rates ranging from 9–23%.

What are “functional” disorders?

Functional disorders (disorders of functioning) are conditions where there is an absence of visable anatomical or biochemical abnormalities, which could explain symptoms, found on common diagnostic tests. In a functional GI disorder the body's normal activities in terms of the movement of the intestines, the sensitivity of the nerves of the intestines, or the way in which the brain controls some of these functions is impaired. However, there are no structural abnormalities that can be seen by endoscopy, x-ray, or blood tests. Thus a functional GI disorder is identified by the characteristics of the symptoms and infrequently, when needed, limited tests.

What does “irritable” mean?

Irritable means that the nerve endings in the bowel wall, which control muscle function and affect sensation of the gut, are unusually sensitive. The gut becomes over-reactive to even what may be quite normal events such as the passage of gas, food, or stool within the bowel.

What causes IBS?

This is not yet completely understood. In IBS there is an altered pattern of muscle contraction in the colon and increased sensitivity within the gastrointestinal tract, as well as a tendency for the bowel to be overly reactive to various triggers such as eating, emotional arousal, gastrointestinal infections, menstrual period, or gaseous distension. In IBS, normal regulation of the communication between the brain and the gut becomes altered, which leads to changes in normal bowel function.

Does lactose intolerance cause IBS?

Lactose (milk sugar) intolerance can cause similar symptoms to IBS. While lactose intolerance and IBS can occur at the same time in a person, they are separate conditions which are treated differently.

Is IBS a “serious illness”?

For many people, IBS causes symptoms that are mild, which do not interfere with daily activities. For others, IBS may severely compromise their quality of life. Debilitating symptoms can be unpredictable and cause enough discomfort to alter daily activities and performance.

Is IBS a risk factor for other serious disease?

There are no long-term organic complications associated with IBS. People with IBS have no greater need of preventive checkups than other people.

Will my IBS symptoms resolve?

Each year, approximately 10% of IBS patients get better. This suggests that most people with IBS will eventually get better, but this is not true for every person.

Can the menstrual cycle affect irritable bowel symptoms?

Gut function does appear to be influenced by changes in the level of female hormones, and symptoms like looser stools and cramping can become worse at certain times of the cycle, particularly at the time of menses. It is reported as more intense in women with IBS, than in healthy women without IBS. Sometimes it's hard to tell whether it's coming from the pelvic organs or from the GI tract; what might first be considered to be endometriosis, ends up actually being irritable bowel syndrome.

What is the relationship of stress to IBS?

Stress does not cause IBS, but may influence symptoms. Stress is the body’s normal response to stimuli, or stressors. It has been shown to increase motility and sensation of the colon to a greater degree in IBS patients compared to healthy individuals without IBS.
 
One way to understand IBS is that there's a dysregulation in the way the brain and the gut are functioning with each other. Stress may modify signals between the brain and the intestinal tract. Factors that might normally affect the bowel might then affect it more; there's an increased response of the bowel. The stress factors could be physical, dietary, psychologic, or environmental. Women who have their period are going through a cycle where hormonal changes occur and this can have an effect. A person with IBS might eat a regular meal and experience a bowel problem. For them, it's an overreaction of the bowel to the stressors.

What are stressors?

Stressors are factors which provoke a stress-response in the body. There are various types of stressors, which may impact IBS symptoms. They may be physical or psychological, internal or external. Gastrointestinal infection, abdominal surgery, the loss of a job, divorce, or being stuck in traffic while feeling the urgent need to use a restroom, are all examples of stressors. In IBS there is an increased sensitivity of the bowel to internal and external stressors.

Doesn’t everyone experience stress in their life?

Yes, and stressful events can cause a brief change in bowel habits and even abdominal pain for most people. However, this response in people with IBS is more pronounced on a recurrent or chronic basis. Therefore, they are more likely to experience symptoms or experience worse symptoms when they are exposed to a significant stressor.

Does diet cause IBS?

Diet does not cause IBS. Nevertheless, dietary factors may worsen symptoms in some persons. In IBS the bowel may over-react to stimuli. Even the act of eating, and not a particular food, may aggravate symptoms at times.

Do certain foods affect symptoms?

This varies from person to person. Certain foods are known to stimulate the gut in general, and in those with IBS eating too much of these might worsen symptoms. Maintaining a food and symptom diary for a minimum of one to two weeks can help identify triggering foods.

My doctor prescribed an antidepressant to treat my IBS. Does that mean I have a psychological disorder?

One of the agents that is becoming increasingly recognized as being effective for severe pain with IBS is the antidepressants. The dosage is not the same as for treating certain psychiatric conditions – generally only one-half or one-third that amount. Antidepressants are prescribed because they act on the brain to modulate or decrease the pain. They're called central analgesics. Antidepressants may be prescribed for IBS when the symptoms are more frequent, if people have to stay home from work or school, and if it's limiting their life.

How is IBS treated?

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The first line of treatment for IBS includes establishing an effective patient-physician relationship, obtaining education about IBS, and making lifestyle changes which may be associated with symptoms. If these steps do not relieve symptoms, various medications may be helpful. If lifestyle changes and careful use of medications are not enough, consider seeing a doctor who specializes in motility and stress-related gastrointestinal disorders. A strong partnership between a knowledgeable patient and an empathetic, knowledgeable health care provider can produce significant improvement and control over symptoms for individuals with IBS.

Is IBS a Disability?

Depending on the circumstances, it is up to each employer, insurer, or governing authority to determine individual disability.

The U.S. Social Security Administration (SSA) defines disability as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. (SSA Pub. No. 64-039, May 2002) However, the SSA does not recognize irritable bowel syndrome on its Listing of Impairments -- Adults, Section 5, Digestive System.

To our knowledge, the only regulation that specifically recognizes IBS as a disability is the Veterans Affairs, Veterans Education and Benefits Expansion Act of 2001, Public Law 107-103 signed by President Bush on December 27, 2001. Section 202 -- Payment of Compensation for Persian Gulf War Veterans with Certain Chronic Disabilities -- includes this provision: (2) For purposes of this subsection, the term "qualifying chronic disability" means a chronic disability resulting from any of the following (or any combination of any of the following): (B) A medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms. The law authorizes funding to expand and increase educational, housing, burial and disability benefits for chronic multi-symptom illnesses to the list of service-connected conditions for Gulf War veterans.