IBS Can Cramp Your Style


By C. Butch Dunn, M.D.


Are you experiencing altered bowel habits, chronic abdominal pain, or bloating?  Ever have that the urge to get to the bathroom “immediately?”  Do you experience changes in stool form regularly?  If you answered yes, you might have irritable bowel syndrome (IBS).  IBS affects millions of people and is reported to be the second leading cause of missed work and diminished productivity in the workplace.  The prevalence is estimated as high as 15% or more of the general population and is slightly more likely to affect females.  The impact of IBS on quality of life is significant and often quite burdensome.

IBS symptoms are variable from one individual to the next, and all symptoms may not be present in each afflicted person.  The severity, frequency, and duration of periodic exacerbations vary widely.

Typical symptoms include an abdominal cramping sensation; however, the location and severity also vary.  Pain may be associated with precipitating factors such as the act of eating, defecation, and emotional stress.  Complaints of increased gas, bloating, belching, and flatulence are also frequently reported.  Many patients suffer from frequent loose or diarrheal stools.  Stools may have mucus from time to time, but bleeding is never associated with IBS.  It should also be noted that nocturnal diarrhea, greasy stools, large-volume diarrhea, and weight loss are other symptoms not found in IBS.  Some individuals describe a sensation of incomplete evacuation as well.

As noted above, a diarrhea-predominant pattern is referred to as IBS-D.  This entity is frequently associated with urgency.  If present, cramping may or may not be relieved by a bowel movement.  Precipitating factors can vary even in an individual patient making for unpredictable events. 

In many patients, the battle is constipation, infrequent bowel movements, or stool described as hard pellets or cigar-shaped.  This constipation-predominant variant is referred to as IBS-C.

Lastly, alternating stool form from loose/diarrheal to constipation or variable form stool is referred to as IBS-M for a mixed pattern of symptoms.  An unclassified pattern is for those with IBS but do not fit into one of these categories.

Your doctor or a gastrointestinal specialist may diagnose IBS by utilizing a carefully obtained detailed history of symptoms, a physical examination, basic laboratory testing, and possibly an abdominal X-ray.  If diarrhea is present, specialized blood and stool tests may be obtained.  It is not uncommon to perform an endoscopic procedure to rule out other organic diseases that may also present with similar symptoms.  The history should include precipitating factors, prescribed and over-the-counter medications, and any herbal or homeopathic treatments the patient uses.  A family history assessment should include inquiry regarding inflammatory bowel disease (Crohn’s or Ulcerative colitis), colorectal cancer, and Celiac disease.

Once IBS is diagnosed, the physician can prescribe a treatment plan that best fits that individual patient.  Frequently this specifically fashioned management plan will include adjustments to diet, the addition of prescription medicine, behavior modification, and often dietary supplements.