Irritable bowel syndrome (IBS) affects between 6–18% of people worldwide. This condition involves changes in frequency or form of bowel movements and lower abdominal pain. Diet, stress, poor sleep and changes in gut bacteria may all trigger symptoms. Triggers are different for each person, making it difficult to name specific foods or stressors that everyone with the disorder should avoid. 
Diagnosing IBS
There is no test to definitively diagnose IBS. Your doctor is likely to start with a complete medical history, physical exam and tests to rule out other conditions. If you have IBS with diarrhea, you likely will be tested for celiac disease.
After other conditions have been ruled out, your doctor is likely to use one of these sets of diagnostic criteria for IBS:
- Rome criteria.These criteria include abdominal pain and discomfort lasting on average at least one day a week in the last three months, associated with at least two of these factors: Pain and discomfort related to defecation, frequency of defecation is altered, or stool consistency is altered.
- Manning criteria.These criteria focus on pain relieved by passing stool and on having incomplete bowel movements, mucus in the stool and changes in stool consistency. The more symptoms you have, the greater the likelihood of IBS.
- Type of IBS.For the purpose of treatment, IBS can be divided into three types based on your symptoms: constipation-predominant, diarrhea-predominant or mixed.
Additional Conditions
Your doctor will also likely assess whether you have other signs or symptoms that might suggest another, more serious, condition. These signs and symptoms include:
- Onset of signs and symptoms after age 50
- Weight loss
- Rectal bleeding
- Fever
- Nausea or recurrent vomiting
- Abdominal pain, especially if it’s not completely relieved by a bowel movement, or occurs at night
- Diarrhea that is persistent or awakens you from sleep
- Anemia related to low iron
If you have these signs or symptoms, or if an initial treatment for IBS doesn’t work, you’ll likely need additional tests.
Additional Tests
Your doctor may recommend several tests, including stool studies to check for infection or problems with your intestine’s ability to take in the nutrients from food (malabsorption).
Tests can include:
- Flexible sigmoidoscopy.Your doctor examines the lower part of the colon with a flexible, lighted tube.
- Under sedation, your doctor uses a small, flexible tube to examine the entire length of the colon.
- X-ray or CT scan.These tests produce images of your abdomen and pelvis that might allow your doctor to rule out other causes for your symptoms, especially if you have abdominal pain.
- Upper Endoscopy. Under sedation a long, flexible tube is inserted down your throat into your mouth and down to your stomach. A camera on the end of the tube allows the doctor to inspect your upper digestive tract. Your doctor might recommend endoscopy if Celiac Disease is suspected.
Laboratory tests can include:
- Lactose intolerance tests.Lactase is an enzyme you need to digest the sugar found in dairy products. If you don’t produce lactase, you may have problems like those caused by IBS, including abdominal pain, gas and diarrhea. Your doctor may order a breath test or ask you to remove milk and milk products from your diet for several weeks.
- Breath test for bacterial overgrowth.A breath test also can determine if you have bacterial overgrowth in your small intestine. Bacterial overgrowth is more common among people who have had bowel surgery or who have diabetes or some other disease that slows down digestion.
- Stool tests.Your stool might be examined for bacteria or parasites, or indicators of malabsorption.
Treatment
The treatment of IBS focuses on relieving symptoms so that you can live as normally as possible.
Many symptoms can often be controlled by managing stress and by making changes in your diet and lifestyle; beginning with:
- Avoiding foods that trigger your symptoms
- Eating high-fiber foods
- Drinking plenty of fluids
- Exercising regularly
- Getting enough sleep
Your doctor might suggest that you eliminate from your diet:
- High-gas foods: You might avoid items such as carbonated and alcoholic beverages, caffeine, raw fruit, and certain vegetables, such as cabbage, broccoli and cauliflower.
- Some people with IBS report improvement in diarrhea symptoms if they stop eating gluten (wheat, barley and rye) even if they don’t have celiac disease.
- Some people are sensitive to certain carbohydrates such as fructose, fructans, lactose and others, known as FODMAPs — fermentable oligo-, di-, and monosaccharides and polyols. FODMAPs are found in certain grains, vegetables, fruits and dairy products. Your IBS symptoms might ease if you follow a strict low-FODMAP diet and then reintroduce foods one at a time.
If you think you may have IBS the doctors at Hunterdon Gastroenterology can help!Make an appointment today by calling 908-483-4000.
References:
9 signs and symptoms of Irritable Bowel Syndrome. Healthline. 2019
Irritable Bowel Syndrome. Mayo Clinic. March 2019.
