Complain to your doctor about constipation and/or diarrhea along with abdominal pain and chances are you’ll be told you have irritable bowl syndrome (IBS). An estimated five to seven percent of adults have IBS, making it the most common condition managed by gastroenterologists and primary care physicians, reports the American College of Gastroenterology (ACG).
But is IBS an actual condition or is it a catch-call diagnosis, a syndrome doctors rely on when they aren’t sure what is going on? A recent study suggests one form of IBS might actually be caused by a gallbladder dysfunction. Here’s what you need to know if you’ve been told you have IBS.
What is IBS?
A chronic disorder, IBS is characterized by abdominal pain and/or bloating and changes in your bowel habits for at least three months, according to the ACG. There are three types of the syndrome: IBS with diarrhea (IBS-D); IBS with constipation (IBS-C); or IBS with a mix of constipation and diarrhea (IBS-M). Experts don’t know why some people are prone to IBS. One theory is that IBS sufferers may have a super-sensitive GI tract. What is known: IBS is more common in women and symptoms can come and go.
How is IBS diagnosed?
“It’s really a diagnosis made by symptom recognition,” says Dr. Yuri Saito, assistant professor of medicine in the division of gastroenterology and hepatology at the Mayo Clinic, in Rochester, Minn. “In the GI world, if you have symptoms consistent with IBS for the most part we feel comfortable with that diagnosis.” Since celiac disease (an intolerance to the protein gluten in wheat) is common in people with IBS-D and IBS-M, your doctor may check you for that. She may also ask whether or not your symptoms occur after you have dairy products. If it looks like they do, a lactose hydrogen breath test may be a good idea to confirm or rule out lactose intolerance.
The ACG recommends against routine diagnostic tests unless you develop “alarm symptoms,” including rectal bleeding, weight loss, or anemia, or have a family history of diseases such as colon cancer, inflammatory bowel disease and celiac disease. But if your symptoms worsen or are so severe that they affect your quality of life, “you should see your physician and revisit the diagnosis,” advises Saito.
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How is IBS treated?
“Treatment depends upon what your most bothersome symptom is,” Saito says. Diet and lifestyle changes are usually the first place to start. Foods that contain fructose or sorbitol might worsen diarrhea as can drinking tons of coffee. Conversely, skimping on fiber can cause constipation. Minimizing stress helps, too. Researchers at the University of North Carolina at Chapel Hill have found that women who practiced mindful meditation for eight weeks reduced their IBS symptoms by 38 percent.
Anti-spasmodics, including peppermint oil, may take the edge off abdominal pain and anti-diarrheal medicines or laxatives may ease diarrhea and constipation, respectively. Occasionally an antibiotic may be prescribed if testing shows excess bacteria in the small intestine, Saito says. Other prescription medications such as receptor antagonists or chloride channel activators are options, but these have side effects. “Sometimes it’s better to stick with dietary and lifestyle modifications,” Saito says.
While more research is needed, if your IBS isn’t responding to treatment, it may be worth asking your doctor if your IBS could be related to a gallbladder dysfunction. Researcher Dr. Saad F. Habba, found that 41 percent of the 303 patients he studied did not have IBS-D. Rather, their gallbladder was misbehaving, dumping bile into the intestine. The result: The bile was acting as a laxative, triggering diarrhea. As with post cholecystectomy diarrhea—which commonly occurs after the gallbladder is removed, bile-induced diarrhea is treated with bile-binding agents, taken for life, notes Habba, a gastroenterologist at the Overlook Medical Center in Summit, New Jersey.
Whatever type of IBS you have, rest assured: You’re not imagining the symptoms. “IBS is a very real phenomenon and it is a real diagnosis,” says Dr. Saito.