As a Primary Care Physician, IBS is a condition I regularly see in my clinics. In the US, it affects 10-15% of people.1 However, even though it is so common, it can leave people feeling confused. What exactly is it? And how do you find out you have it?
If you are wondering this, you won’t be alone. Let’s explore a bit more about it and find out 5 things you may not already know about IBS.
Tell me Doc — what is it?
IBS stands for Irritable Bowel Syndrome. It is a chronic condition (this means it is long term) which affects how the gut moves and functions.
It can cause a lot of different symptoms (that’s why it’s called a ‘syndrome’) and every person’s presentation will be unique to them. You may experience bloating, constipation, diarrhea or tummy pain or a mixture of all the above.
For some people, these symptoms may only be mild and infrequent but for others, the symptoms can be so severe that they affect them in every aspect of their day to day life.2
What you shouldn’t experience with IBS are symptoms like rectal bleeding or sudden unexpected weight loss among others. These are what some doctors refer to as ‘red flag’ symptoms and need to be looked into urgently.3
What are 5 things I may not know about IBS?
1. It doesn’t have one diagnostic test:
That’s right, there is not a diagnostic test you can do which confirms you have IBS.
As IBS symptoms are caused by the way the gut functions rather than something like a structural change, it cannot be picked up on tests at the moment.
The other tricky thing with IBS is that many of the symptoms are similar to those seen in other conditions, some of which you can test for. So this means you can go to a doctor thinking your symptoms sound like IBS but may leave with tests which are related to other conditions.
This is because it’s important for us to rule out another condition before we can rule in a diagnosis of IBS. This may feel a bit clunky but it’s an important way of keeping you safe and getting the diagnosis and treatment you need.
2. It is not IBD
Now just to confuse things more, two of the most common gut conditions have deceptively similar acronyms. We’ve already talked about IBS today but what is IBD?
IBD stands for Inflammatory Bowel Disease and is a term which mainly describes Ulcerative Colitis and Crohn’s disease. These are also long term conditions which affect the gut and can have similar symptoms to IBS.
However, they have different outcomes and overall management to IBS (and each other) and so, even if you and your doctor think your symptoms are most likely related to IBS, it is important to confirm it isn’t IBD. Make sense?
Luckily, this can be done relatively simply by a stool test. Blood tests can also be helpful to do as they can pick up any inflammation or Coeliac disease (another thing which IBS is not).5
3. There are different types of IBS:
Another thing which my patients can be suprised about is that there are different types of IBS. This is why your doctor will ask you so many questions about your poo!
- IBS-D: This is where diarrhea is a main symptom of someone’s history
- IBS-C: Compared to this when constipation is the the bigger factor
- IBS-Mixed: And some people experience a mix of the two
This is why two people with IBS are never the same and treatment should be tailored to the individual at hand.6
4. Diet and nutrition are key to good IBS care:
There are many ways to support someone with IBS but optimizing someone's diet and nutrition is key. Here are some top tips from Babylon Registered Dietitian Andrea McGrew:
“When it comes to treating IBS with nutritional therapies, there definitely is no such thing as “One size fits all.” Therefore diet and nutrition interventions need to be custom-tailored to fit each individual case of IBS. Research has proven that a low-FODMAP diet can bring relief for approximately 70% of IBS sufferers.
What is a FODMAP?
FODMAP is an acronym that stands for: Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are a type of simple carbohydrate that the small intestine does not absorb well in some individuals with IBS. When following a low-FODMAP diet, these foods, along with other potential intolerances and allergies, must be tested by the process of elimination to determine which specific substance is causing all your GI upset.
How does this process work?
A low-FODMAP diet follows a very specific 3 phase process:
Elimination (2-6 weeks)- During this phase, all foods considered high in FOADMAPs are eliminated from your diet.
Reintroduction (6-8 weeks)-In the reintroduction phase, you gradually reintroduce individual high-FODMAP foods back into your diet to determine if the food causes symptoms.
Integration (lifelong)- Once you and your registered dietitian have interpreted the foods that cause IBS symptoms, you can begin reintroducing foods and FODMAPs that were tolerated well back into your diet.
As mentioned earlier, there is no one single treatment that works for everyone. If you do not find relief after completing this process, there is no reason to continue restricting high-FODMAP foods. Also, if you feel this process is not something you are ready for, or you have tried it and it wasn’t for you, know that there are other options your health care team can discuss with you that may alleviate your discomfort.7
5. The brain has a part to play in IBS:
Have you heard of the gut-brain axis? Chances are it may not be something you speak about all the time but it is something which is believed to play an important part in IBS.
Whilst research is still ongoing, it is well recognised that in IBS there is a miscommunication between the gut and the brain. What this means for people with IBS is that there can be changes to the movement and sensitivity of their gut and changes to the processing in their central nervous system. This can all contribute to the symptoms they experience.8
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So there you have it, there’s a lot more to IBS than you may have realized and still a huge amount more for us to find out.
Most importantly, we are here to help. If you have symptoms that are troubling you or questions about next steps with your IBS treatment, don’t hesitate to book in with Babylon.
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References
- IBS FAQS, American College of Gastroenterology, Accessed March 2022, https://gi.org/topics/irritable-bowel-syndrome/#tabs3
- What is IBS, NHS, Reviewed Feb 2021, https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/
- Inflammatory Bowel Disease and Irritable Bowel Syndrome, Crohns Colitis Foundation, https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/ibd-and-irritable-bowel.pdf
- Getting diagnosed, NHS, Reviewed Feb 2021, https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/getting-diagnosed/
- What is IBD, CDC, Reviewed March 2019, https://www.cdc.gov/ibd/what-is-IBD.htm
- Irritable Bowel Syndrome, NICE CKS, Revised June 2021, https://cks.nice.org.uk/topics/irritable-bowel-syndrome/
- Nanayakkara, W. S., Skidmore, P. M., O’Brien, L., Wilkinson, T. J., & Gearry, R. B. (2016, June 17). Efficacy of the low fodmap diet for treating irritable bowel syndrome: The evidence to date. Clinical and experimental gastroenterology. Retrieved March 28, 2022, from https://www.ncbi.nlm.nih.gov/p...,on%20the%20low%20FODMAP%20diet.
- Irritable Bowel Syndrome, The Lancet 2020 ;396:1675, https://pubmed.ncbi.nlm.nih.gov/33049223/
