Overview of irritable bowel syndrome (IBS)
The fact that you are reading this article is a good indication that your health is not ideal. In other words, nobody is reading about irritable bowel syndrome for the fun of it. There is very little fun when it comes to IBS, though it does have many symptoms that make people giggle.
What is IBS? A common academic definition basically says that irritable bowel syndrome is a general term for a range of chronic digestive problems – such as cramping, uncomfortable bowel movements, and bloating. This is basically street language saying that IBS is gastrointestinal bomb that blows up when you eat certain foods. IBS is commonly known as, basically, a bowel disaster.
But growing research and awareness about IBS is beginning to uncover the fact that IBS is not merely a colon-catastrophe, and that it has diverse causes, symptoms, and effects on lifestyle and well-being. People who suffer from IBS may experience the most obvious or “acute” symptoms in their gut, but there is also an unwholesome slew of other non-GI symptoms that range from embarrassing to depressing.
Overview of IBS symptoms
Most people are also unaware of the fact that IBS symptoms aren’t merely a result of the food you eat. Other elements like hormone fluctuations, foreign invaders in the bowel, toxic environmental factors, and stress often play an integral role in exacerbating symptoms. IBS should not be confused with irritable bowel disease (IBD) (includes Crohn’s disease and ulcerative colitis), which is a more serious clinical condition.
It is concerning that many mainstream websites tend to only discuss the digestive factors of IBS, and even then they hardly discuss the more embarrassing symptoms of IBS (see next section). Moreover, mainstream sites barely touch on the fact that dealing with IBS involves picking apart your diet, lifestyle choices, and environment. In short, it’s about as fun as doing your own colonoscopy (which, ironically is basically what managing your IBS is).
There are two primary subcategories of IBS:
IBS-C is associated with fewer than 3 actual bowel movements per week, and IBS-D is associated with more than 3 bowel movements per day. Quite a range.
Common IBS symptoms you won’t see on other websites
If you are a medical professional, you are probably familiar with these symptoms. If you are like most people searching for symptoms online, chances are you haven’t seen these symptoms of IBS. Why? Because the following symptoms are more “improper” and embarrassing than most mainstream symptoms you will read about.
Yet these symptoms are important markers of IBS. They are also kind of funny and provide IBS victims with plenty to giggle about (after the fact).
Fecal incontinence: Clinical term for “diapers required”
Fecal incontinence is the inability to control bowel movements. “Losing control” can be a source of great embarrassment and anxiety for people with IBS. Yet the fact is that fecal incontinence and/or “near misses” are not uncommon for IBS victims.
Pruritus ani: clinical term for itchy anus
Pruritus ani is an extremely common IBS symptom that you won’t see listed on any mainstream sites. Unfortunately, irritable bowel also means inflamed bowel, which causes uncomfortable itching and tingling around the part of the bowel that is exposed to air: the anus.
Proctalgia fugax: clinical term for painful anus
Another symptom not generally listed on other sites is proctalgia fugax. But people with IBS can sympathize with this symptom. In addition itchiness, an inflamed bowel can also cause extremely sharp pain located around the anus, as if a bee stung you there.
Foul smelling stools/gas: a public restroom’s worst nightmare
Being in other people’s homes or in a public restroom can be a major source of anxiety for people with an inflamed bowel because it can cause disastrously putrid smelling power-movements and flatulence. It is usually caused by malabsorption of fats and nutrients in food, and/or rapid fermentation of the food in the bowel before it can be digested.
Tenesmus: clinical term for feeling the need to “blowout” the bowel
For many people struggling with IBS, tenesmus is the frustrating “hallmark” of their symptoms. Tenesmus is the feeling of needing urgent relief, but having nothing to relieve (empty bowel). It often leads to long, frustrating stretches in the bathroom, accompanied by much unfruitful straining and pushing, which only exacerbates other IBS symptoms.
Chronic hemorrhoids: you can’t seem to ditch the “piles”
The inflammation of the bowel caused by irritable bowel syndrome can put excess pressure on veins around the anus. The result is hemorrhoids.
Rosacea: always have an embarrassed look
Rosacea makes your face look like you’ve been spending too much time in freezing weather. Flushed cheeks and nose, sensitive dry skin that can itch and burn, and small red bumps generally characterize Rosacea.
Acne: creams, washes, and ointments don’t clear skin issues
There is growing research to show that IBS victims often suffer from acne as well as other chronic skin problems, such as eczema, rashes, and rosacea.
Common IBS symptoms you may have already read about
Rapid Relief: you are an ultra-urgent pooper
For most people, the term is “nature calls.” For many people with IBS the term would better be described as “nature screams in your ear.” An extremely common sign of people with IBS (IBS-D) is having to go right now. As in, holding it is not an option. Just the sudden urge for a “bio-break.”
Urgent but constipated: pooping is a major project
On the other hand, many people with IBS (IBS-C) have the opposite problem of ultra-urgent relief. For these people, bathroom use is both frequent and extended. IBS Warriors with this symptom suffer from the feeling of having to go right now, but at the same time experience extremely frustrating constipation.
Bowel changes: every poop is a new experience
Some of us IBS warriors are always ultra-urgent poopers (IBS-D); others are urgent but constipated (IBS-C). There is also a third IBS tip-off though: every poop is different. This means that the quality of stools (color, consistency) changes from poop to poop. It also means having alternating periods of constipation, followed by periods of ultra-urgency. Additionally, over the course of a month your poo may have more variety in terms of color and consistency than French restaurant’s soup menu.
Chronic gas: you are a gas-passing champion
Gas is practically an IBS community pastime. It’s also one of the lovely side effects that is ubiquitous in the irritable bowel syndrome community. Flatus is basically just particles of unabsorbed, fermented food. For normal people, output emissions are about 15 times per day. For people who struggle with IBS they can average the same number or more every hour.
Chronic bloating: you are “food-pregnant” all the time
Does it seem like everything you eat makes you look 6 months pregnant? Welcome to the average post-meal experience of someone struggling with IBS. Chronis gas is often accompanied by chronic bloating. Bloating is basically a gas-tank (literally) in your gut that is the source of the chronic flatus (see above) and chronic burping (see below).
Chronic burping: reflux king/queen
Burping and reflux is annoying and embarrassing. IBS is not just a problem in the back door, but the front door also. While IBS victims suffer from gas, others get the brunt of the beating with frequent burping, reflux, and heartburn.
Upset stomach: abdominal pain as a lifestyle
This is less of a specific symptom than it is a “lifestyle” for IBS victims. When IBS isn’t under control, all of the gas, poop-problems, and burps result in constant stomach aches, cramping, and nausea.
You might also like:
- Your Colon a Bio-Brothell? Symptoms of Parasites That Nobody Wants to Talk About
- Itchy Butt: Why You Squirm and What To Do About It
Non-digestive symptoms of IBS
As discussed, the gastro-intestinal symptoms of IBS receive most of the focus. Yet people with IBS usually experience a number of seemingly unrelated but none-the-less extremely frustrating set of symptoms that they tend to never associate with their belligerent bowel. These symptoms are important because they highlight the fact that IBS is functional sickness rather than a just a digestive one.
What functional sickness means is that IBS will stick a hot poker in many areas of your life besides your rear-end. People who suspect that they have IBS should carefully consider the following well documented symptoms of IBS:
- Chronic fatigue (51%)
- Muscle pain
- Sleep disturbances
- Sexual dysfunction
- Low back pain
- Joint-pain (fibromyalgia) (49%)
- Brain Fog
- Cognitive Changes
- Frequent urination
- Bad breath and/or bad taste in mouth
- Chest pressure
- Anxiety (50%-90%)
- Depression (50-90%)
- Muscle aches
- Cold, clammy or trembling hands
- Heart palpitations
- Pain during menstruation or intercourse
- Chronic pelvic pain (50%)
- Temporomandibular joint disorder (64%)
- Associations with autism
A trend you may have noticed above is that many of the non-GI symptoms are cognitive-mood in nature. It’s important to realize that 95% of your body’s serotonin is found in the gut. A disconnect in the brain-gut axis can also be a disconnect between the brain and serotonin.
What causes irritable bowel syndrome
The frustrating answer is that there isn’t a clear, singular cause for what causes irritable bowel syndrome. Most sources on IBS will say that it is a “complex” disorder because there is a whole range of overlapping reasons a person suffers from IBS.
What this means is that understanding your IBS involves careful examination of your body, your lifestyle, and your environment (Disease, Prevention, and Treatment). Here are several areas to consider when looking for causes of IBS.
Environmental illness and IBS is a blanket way of saying that the causes of IBS are varied and complex, and that IBS may develop for a combination of reasons. It’s not exactly reassuring “cause.”
A growing list of food sensitivities is often what initially clues people into the fact that there is “something extremely unpleasant going on” with their body. Many parts of IBS exhibit responses similar to food allergy/sensitivities. A food allergy/sensitivity is when the body “attacks” particles of problematic foods with antibodies.
The brain and gut connection
What most IBS “experts” agree upon is that your brain and gut in a state of colonic cold war. The brain and the gut actually are closely connected, and communicate constantly via the vagus nerve so that the gut can receive signals from the central nervous system. With IBS, this relationship (known as the “brain-gut axis”) is disrupted, causing abnormal regulation and reactions in the gut.
Some resources will tell you the gastro-intestinal problems your mother and father had have nothing to do with your IBS. However studies has shown that if you have a relative with IBS, your chances of developing IBS increase two-fold (1)
Hormonal imbalances and changes, such as menstruation, menopause, and stress can aggravate symptoms of IBS. People with hormone regulation problems, such people with thyroid disease, may find it harder to treat their irritable bowel.
Stress is probably the most common cause of gut-motility instability in IBS victims. GI motility is the stretching and contracting of intestinal muscles. An erratic GI tract is an angry one.
Postinfectious IBS can unfortunately arises following a GI infection such as bacterial or parasitic infection. This is thought to be because of damage to the gut epithelium, which functions as the barrier between your gut and the “external environment” – i.e. the rest of your insides. Basically, you get sick and your bowel will never be the same. Yea, scary thought.
Certain medications can contribute to the development of IBS by altering colonic flora, which are the little guys that help you digest carbohydrates and vitamins, regulate antibodies and inflammatory cytokines, and are an essential part of the brain-gut axis.
Small Intestinal Bacteria Overgrowth (SIBO)
SIBO is present in a sizable number (about 36%) of people with IBS (2). SIBO is basically too many little digestive microbes in the gut, which causes fermentation of food before it has been digested very well, leading to excessive gas formation.
How IBS is diagnosed
If you have read this far, it may be clear that for many people there is no fine line between having and not having IBS. IBS doesn’t involve any structural problems in the gastro-intestinal tract, and there is not one specific IBS test to confirm diagnoses.
Confirming whether or not you do have IBS is something a medical provider will make after taking in all of the evidence of your symptoms and/or a physical exam. Testing can also be extremely helpful in supporting a diagnoses, such as:
- Comprehensive Stool Analysis with Parasitology x3 Specialty Test
- CBC ; Ferritin and TIBC and TIBC ; Vitamin B12: these tests are used to monitor anemia, which can be a big problem in IBS
- Small Intestinal Bacteria Overgrowth (SIBO) Home Breath Test: used to test for “foreign” bacteria in your gut, which some studies have implicated in potentially 80% of IBS patients
- Celiac Screening (Tissue Transglutaminase [tTG] and Transglutaminase Antibody [IgA]): a highly specific test to help identify gluten sensitivities
- Basic Food Sensitivity and Allergy (IgG) Panel: see exactly how many foods anger your bowel
Not-so-fun facts and figures about IBS
For people with IBS, statistics are can be a great source of community-level sympathy and personal interest:
- Women aged 20-40 account for most IBS patients (3), however this may also be because women are 3 times more likely to see their doctor about IBS symptoms(4)
- Most estimates agree that about 1/10 people suffers from IBS
- IBS is significantly less common among women 50 and older (5)
- About 40% of people have “mild” IBS, 35% “moderate” IBS, and 24% “severe” IBS (6)
- IBS is the leading cause of missed work days in the US (second only to the common cold) (7)
- People with IBS take about 2 times as many days off and those without IBS (8)
- Research has found that 50%-90% of individuals who seek IBS treatment has anxiety or depression(9)
- On average, people with live IBS for 6.6 years before a diagnoses is made (10)
- 20%-40% of all visits to gastroenterologists are due to IBS symptoms(11)
- IBS does not seem to affect life expectancy (Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol. 2014)
- For people with a biological relative with IBS, the risk for developing IBS is twice as high (ibid.)
- On average, people with IBS suffer acute IBS symtpoms on avage 8.1 days per month (Sayuk GS, Gyawali CP. Irritable bowel syndrome: modern concepts and management options. Am J Med. 2015)
How I learned to treat my IBS
Before I say anything, a legal disclaimer: for legal reasons we cannot offer “treatments” or “diagnoses.” The following are things that I have personally done for myself after research, working with my medical provider, and personal experimentation that have been instrumental in getting control over my IBS. They are in no way recommending a treatment or prescription for anyone else’s IBS.
Some websites or online health sources claim to “cure IBS.” Let’s be clear: no amount of personal experience, research, or scientific evidence indicates that that IBS is “curable.” The fact that we have to accept about IBS is that it is complex, can be life changing, and for many people will be a lifelong companion.
Controlling IBS is about being an IBS Warrior. For IBS Warriors, controlling IBS is a daily activity. For me, getting a handle on my IBS and becoming an IBS Warrior has been a process of:
- Developing an IBS Radar for what triggers my IBS symptoms
- Having a disciplined relationship with food
- Making the appropriate lifestyle changes
- Being aware of the toxins I am exposed to in my environment
- Taking the appropriate steps to receive a diagnoses from a medical professional
In general, these are the following areas that I have explored in my life in order to combat the functional illness aspect of IBS. Remember, IBS is not just about food sensitivities. The following are recommendations for dealing with IBS that are common on the internet.
The most acute symptoms of IBS often occur in response to dietary choices. Getting on top of my IBS has involved understanding what my body reacts to. This has meant everything from paying attention to specific foods, to GMOs, and to organic food choices.
Stress and hormone balance
Stress and hormone imbalance can significantly affect the severity of symptoms. Choosing stress relieving activities, such as meditation, yoga, and regular exercise have played a significant role in helping keep hormones in check and stress at a minimum.
Managing IBS symptoms with exercise has been critical in my journey with IBS, both in terms of gut symptoms and lifestyle symptoms (fatigue, depression, etc.). People with IBS may take up swimming, yoga, running, and any other forms of regular exercise.
Monitoring environmental toxins
There is plenty research out there about potential links between your gut and toxic environmental factors, such as GMOs and IBS, glyphosate and IBS (glyphosate is Monsanto’s roundup), and so on, that I have paid very careful attention to what I am exposed to, and it has made a big difference.
As said, monitoring my IBS has been a gradual lifestyle change in the way I eat, exercise, and approach my environment. I’ve simply been sick of being sick so many times (from making poor choices) that the choice to be healthy is fairly natural anymore.
The "benefits" of IBS
Just about everything you read online only discusses the negative symptoms people who have irritable bowel syndrome have to deal with. People who don’t manage their IBS are often (or mostly) miserable.
However, I’m not just searching anywhere for the silver lining when I say: for IBS Warriors there are natural benefits that develop if you are able to manage your IBS properly. This is because beating IBS has the following natural incentives:
- Understand your body
- Learn about nutrition and diet
- Eat healthy foods
- Practice self-discipline
- Find healthy ways to relieve stress
- Stick to physical exercise regime
It’s funny to think how similar being an IBS Warrior is to being some kind of monk living in a Buddhist monastery up in the mountains. If you have IBS and are disciplined about how you regulate your body, you may quickly find you are one of the healthiest people you know.
Your friends may describe you as a health nut or picky – but will also sympathize with your choice because – if they know you well enough – they have probably witnessed the repercussions of when you being lax. Just remember that for people with IBS: a lax lifestyle is a laxative lifestyle.
Daily journal log in the life of struggling IBS victim
Anyone who has struggled to gain control of their IBS may sympathize with the follow example daily log what life can be like if your IBS flares up.
4:45am – Woke up with terrible stomach ache. Shouldn’t have had the chowder last night. Headed directly to toilet.
6:00am – Finally finished on the toilet. Legs fell completely asleep from sitting too long. Rear end feels like it was hooked up to the end of a vacuum cleaner all morning. Out of Lysol again.
7:00am – Already in 4 cups of coffee. This isn’t going to be pretty. I’m still exhausted.
7:15am – 3 tablets of Gasex. Hopefully this will help. My lower back is killing me.
7:30am – Jeans don’t fit, too much bloating. Will leave them unbuttoned at work again. Shirt will cover it and no one will notice.
8:15am – Got 15 minutes of work done before first bathroom break. Boss probably wonders what game I’m playing on my cell phone in the bathroom. If he is ever in the stall next to me, he’ll know what’s really going on.
8:35am – Back to work. 1 more Gasex, 2 Tums, and another mug of coffee.
9:00am – Trouble concentrating. Head feels lost in the clouds. Do I have any sick days left?
9:30 – 2nd trip to bathroom. I actually had to run the last 10 meters. I don’t think anyone saw.
10:00am – John Doe asked if I was feeling alright. Somehow telling him that I had a “stomach ache” didn’t quite convey the storm raging in my gut or the smell of dead animal in the restroom.
11:00am – 3rd trip to the bathroom.
11:30am – Two people have already heard me “slip up.” Tried to make it sound like it was a squeaky chair. Don’t think they were convinced.
12:30pm – Ate 4 Tums, 3 Gasex, and a shot of Pepto-Bismol for lunch.
1:05pm – Still bloated. Still exhausted (what’s new?). Back still hurts. Rear end itches.
1:30pm – 4th trip to the bathroom. Tums, Gasex, and Pepto-Bismol stopped the diarrhea completely, only to be replaced by cataclysmic constipation combined with an urgent need to go. It’s going to be a long afternoon.
You get the idea. IBS can be an extremely uncomfortable, embarrassing, and anxiety ridden experience. When IBS is under control, it can be humorous to look back. But when symptoms flair up, it’s downright miserable.
Funny anecdotes: “You know you have IBS if…”
Please leave your own “You know you have IBS if…” anecdotes below in the comments!
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