Good Medicine: IBS: A Common Disorder, Cause Unknown

Irritable bowel syndrome (IBS) is a poorly understood disorder afflicting over 15 million Americans. The symptoms of diarrhea, constipation, bloating and cramping are hard to manage, resulting in 3 million medical visits annually. Sufferers often go without eating, impacting proper nutrition. Many people with IBS avoid socializing and absenteeism is common, with an average of 13 days of work or school missed every year.

Considered a disorder of the brain-gut-microbe interaction, IBS occurs because of poorly coordinated signals between the brain and an overly sensitive bowel, resulting in erratic intestinal muscle contractions. This dysmotility affects gut transit time (making it too fast or too slow; sometimes alternating between the two). This in turn impacts the delicate balance between normal gut bacteria and fungi, interfering with digestion and causing classic IBS symptoms.

IBS symptoms typically start around age 30, and afflict women twice as often as men. Family history is a risk factor, and food sensitivities may cause flares — common triggers include cruciferous vegetables like cabbage or Brussels sprouts, dairy products or foods containing gluten, like bread or cereal. Colonic injury from infectious diarrhea can lead to IBS; a history of childhood trauma such as neglect or abuse is a risk factor, too.

IBS can produce symptoms similar to ulcerative colitis and colon cancer, but the National Institute of Health reports that only 5% of sufferers seek medical help.

A physical exam is of foremost importance to identify IBS and rule out other diseases. Patients may then be referred to a gastroenterologist for a colonoscopy and upper endoscopy. A breath test is often ordered to rule out lactose intolerance or bacterial overgrowth, as well as a stool specimen to screen for pathogens and parasites.

No single IBS treatment works well. Sufferers often overuse medications — laxatives, fiber supplements, antidiarrheals and antispasmodics — in an attempt to ease symptoms. Medical providers prescribe antidepressants, antibiotics and pain relievers with mixed success. Drug interactions and side effects can aggravate IBS.

New research shows that diet alone can effectively control the severity and frequency of symptoms in 75% of IBS patients. The FODMAP regimen (fermentable oiligosaccharides, disaccharides, monosaccharides and polyols — all starches that are poorly absorbed in the small intestine) cuts out certain carbohydrates, like those found in beans, dairy, gluten and some fruits and vegetables, such as pears and onions.

High FODMAP foods are eliminated from the diet for several weeks, then systematically reintroduced to identify which ones trigger symptoms (and therefore should be avoided).  A registered dietician or nutritionist can help patients navigate their diets; keeping a food journal is a great way to monitor progress.

Studies also support the daily use of oral probiotic supplements to foster healthy gut bacteria. Brands using five or more different probiotic strains work best, including bacillus coagulans – good bacteria that are naturally occurring in sauerkraut, kimchi and yogurt, which are off-limits to IBS sufferers. Physician’s Choice Ultra Probiotic is a good choice.

Stress management also helps IBS. Good self-care with improved sleep habits and regular exercise, hypnotherapy or biofeedback can all help. Resistant cases may require judicious use of medication, only of course, with the approval of a medical provider. 

Dr. Mary Jenkins, a contributor to the Herald and member of its board of directors, retired after nearly 40 years as a family practice physician in New York state.