The ABCs of IBS

As the Jackson 5 once sang, A-B-C….it’s as easy as 1-2-3. But you know what isn’t as easy as ‘A-B-C, 1-2-3, baby you and me girl?’ Dealing with IBS!

IBS, or Irritable Bowel Syndrome: I was diagnosed with this functional disorder at age 20, during my third-and-final year of college. Having IBS means I suffer from inconsistent bowel movements related to my dietary choices, as well as systemic symptoms like bloating, cramping, fatigue and pain.

If you have IBS or are a caretaker for someone with IBS, then you understand that this disorder makes daily life a struggle. For example, breakfast is my favorite meal of the day – but as someone in recovery from orthorexia, oftentimes I dread it, knowing my belly will never be as flat as it was first thing in the morning….thanks to a little thing called FODMAPs. (More on those later!)

Whether you have IBS yourself or are seeking to understand more about the condition to help someone you love, this simple dictionary will teach you – from A to Z – what it means to have IBS, and little ways to support recovery and remission from this disorder.

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A is for Alternating. Most commonly, you hear about IBS-C or IBS-D. But a less common type, which I have, is IBS-A, meaning the patient’s symptoms fluctuate between varying degrees of constipation and diarrhea.

Some doctors say this is actually IBS-C in disguise, thanks to something called “overflow diarrhea” (Google it next time you feel like being scarred for life). However, many medical practitioners believe – as I do – that it is a distinct subtype of IBS!

B is for Bloating. This symptom overlaps with many digestive disorders, but when all other causes are ruled out, can be a hallmark of IBS. It is both one of the most uncomfortable and one of the most embarrassing symptoms of IBS, since it is difficult to hide from others. In my opinion, bloating also contributes to the mental health challenges of having IBS, since it can affect a patient’s body image and self-esteem.

C is for Constipation. Constipation isn’t cute – but it’s something many of us with IBS have to live with on a weekly, if not daily, basis. Doctors define it as hard, dry stool that is difficult to pass, and/or fewer than three bowel movements per week.

Some sources say IBS-C is the most common subtype of IBS. Luckily, there are both OTC remedies and prescription medications to help with this distressing symptom. Drinking more water, and eating more dietary fiber, is a start!

D is for Diarrhea. Diarrhea is constipation’s looser, more liquidy twin. Formally, it is defined as passing loose or watery stools three or more times per day. This type of IBS occurs less often than IBS-C, but more often than IBS-A.

E is for Eating. It’s common to experience symptoms of IBS after eating. Many times, you may suspect the symptoms are linked to the foods you eat, but find it challenging to identify a clear culprit. Keeping a food diary detailing every food and drink you imbibe, as well as every symptom you experience, may help you pinpoint the source of your struggles.

F is for FODMAPs. FODMAPs are several categories of foods identified by researchers at Monash University to cause symptoms in many IBS patients. Some of these problem foods include lactose, gluten, fructans and polyols.

The low-FODMAP diet is the most well-proven diet for controlling IBS flares. Because it is not intended as a long-term lifestyle choice, the first phase of the low-FODMAP diet is an elimination phase, followed by a gradual reintroduction phase to determine which foods are your most powerful triggers – and which you can safely consume or consume in limited amounts.

G is for Gluten. Gluten is a common IBS trigger, and is one of the major food categories eliminated in the first phase of the low-FODMAP diet. In fact, many IBS patients also suffer from non-celiac gluten sensitivity (NCGS).

NCGS differs from a gluten allergy in that the body does not attack itself when it comes into contact with gluten. It also differs from celiac disease, in that patients with NCGS who consume gluten do not suffer long-term intestinal damage as a consequence of their dietary choices. All three, however, are valid reasons why someone may avoid gluten – and all three result in digestive discomfort when gluten is ingested.

H is for H. Pylori. Because IBS is a diagnosis of exclusion, many doctors perform a number of tests before concluding a patient suffers from IBS. One test you may receive is a breath test for H. pylori, an organism responsible for stomach ulcers that can cause symptoms similar to those of IBS – such as bloating and abdominal pain.

I is for Intestinal Contractions. Unfortunately, we don’t have conclusive research to tell us what IBS is or how we can cure it. But one theory doctors currently have is that patients with IBS suffer from a hypersensitive gut. Some say patients’ nerve endings are hypersensitive to normal intestinal contractions, while others say patients with IBS have stronger or more irregular contractions than usual. Either way, it’s suspected that contractions of the large intestine are responsible for some of the unpleasant symptoms of IBS.

J is for Job Limitations. The U.S. government identifies IBS as one of many disabling conditions that can make you eligible for protections under the Americans with Disabilities Act (ADA). Under the ADA, your employer must make reasonable accommodations for your disability to help you complete your job – for example, seating you at a desk that is close to a restroom, or allowing you to work from home in the event of an IBS flare-up.

The ADA not only addresses job limitations, but also addresses limitations at home. Your landlord must also make reasonable accommodations for your disability if necessary – for example, permitting you to keep an Emotional Support Dog on the premises, even if dogs aren’t normally allowed. (I took advantage of these protections with my dog, Chandler – and it’s one of the best decisions I’ve ever made!)

K is for Killer Cramps. One of the hallmarks of IBS is intense pain and cramping associated with eating certain foods and/or having (or not having) bowel movements. These can present as pain and pressure, feeling almost as if you have to “go” (even if you really don’t). Other times, they may present as a sharp or stabbing pain.

As with any chronic illness, some ignorant people will always suggest that the pain is all in your head or that IBS is not a “real” disorder. At one point in my IBS journey, however, I visited an emergency room for IBS cramps that were so bad, I could hardly breathe, stand or move when they hit. So, here I am to tell you, with 110% certainty: IBS pain is very, very real – at least for those of us who have it!

L is for Lactose. Lactose, like gluten, is another food group that triggers many people’s IBS symptoms. It is also eliminated in the first phase of the low-FODMAP diet.

Many patients may also suffer from lactose intolerance, meaning their body does not produce enough lactase – the enzyme which digests the sugar found in milk (a.k.a. lactose). While some patients may avoid dairy products or dairy products high in lactose, others may choose to take a lactase supplement with dairy-containing foods, or choose lactose-free dairy products with lactase added to them to aid digestion.

M is for Motility. Motility refers to how fast food and fecal matter pass through the digestive tract. When you suffer from constipation-predominant IBS, you present with slower motility than would be expected for a patient with similar characteristics. Alternatively, when you have diarrhea-predominant IBS, you may have faster motility than average. Regardless, no matter what type you have, IBS always causes a change in your digestive motility.

N is for New Research. Unfortunately, we don’t yet know why people get IBS or what forces are at work behind it. But new research comes out every week addressing the causes of and treatments for IBS. Everything from Vitamin D to cognitive-behavioral therapy has been studied to determine if they relieve IBS symptoms. Yet we still have so much more uncharted territory to cover!

The future of IBS treatment, according to some doctors, may lie in drugs that have not yet been developed. However, many of the studies supporting the use of these drugs come with weak evidence. Further research will be necessary in the future to find a definitive treatment for IBS.

O is for Osmotic, Stimulant and Bulk-Forming Laxatives. Under the advisement of your doctor, you may decide to try taking laxatives for your IBS. There are three major types of laxatives: osmotic, stimulant and bulk-forming types.

Osmotic laxatives work by drawing water into the stool from the bowel. They should be taken with plenty of water to avoid inadvertently exacerbating constipation!

Stimulant laxatives force the bowel to contract, emptying its contents. Often, these cause diarrhea and discomfort. They are rarely recommended for IBS, since painful stomach cramps are usually what we’re trying to avoid!

Bulk-forming laxatives comprise fiber that adds bulk to the stool. Psyllium husk and methylcellulose are both safe options for someone with IBS. Again, make sure to drink plenty of water when taking these laxatives!

P is for Pills. Usually, medication is not the first line of treatment for IBS – but many patients still take pills for the disorder! Some medications prescribed for IBS include antispasmodics (which decrease painful contractions of the digestive tract) and antidepressants (which relax the digestive tract, just as they relax the mind).

It’s also not uncommon for patients with IBS to rely on over-the-counter medications to control their symptoms. Many patients use acetaminophen or NSAIDs to relieve the pain associated with their IBS. Others may take dietary supplements or OTC medications like Lactaid (lactase enzyme), Bean-O, antacids or probiotics, each targeting specific symptoms of IBS.

Q is for Quality of Life. Unsurprisingly, one of the reasons why IBS symptoms can debilitate patients is because they affect quality of life. Many patients may feel embarrassed by their symptoms, worry that others will notice or judge them or suffer pain that limits their daily activities.

For example, some patients feel constrained in their daily activities because they feel a need to remain close to a bathroom at all times. Others may avoid social gatherings where food may be present for fear they may experience a flare-up. Whatever the case may be, you can see how having IBS presents a challenge for those who suffer from it – and for the loved ones who support them!

R is for Rome Criteria. These snappy criteria are used by doctors to diagnose IBS. The criteria must be present, in most cases, for 3-6 months. Some of the diagnostic symptoms listed in the Rome Criteria are:

  • Recurrent abdominal pain or discomfort
  • Pain associated with a bowel movement
  • Pain relieved by having a bowel movement
  • Onset associated with a change in frequency of stool
  • Onset associated with a change in form of stool

S is for Stool. As a patient with IBS, one gets more familiar with their own stool than they might like to admit! But it’s important to be able to describe your bowel habits in a way your doctor can understand.

Some characteristics of your stool your doctor may be interested in include color, texture, size, frequency and shape. You can use an app or printed diary to keep track of your stool for a period of time, in order to more accurately report your bowel habits to your doctor.

T is for Therapy. Be skeptical if you want, but some patients swear that psychotherapy helps improve their symptoms of IBS. Patients with a comorbid anxiety disorder may find that controlling their anxiety also improves their IBS symptoms. Or, patients may seek therapy to help themselves cope with the unique, challenging feelings and interpersonal conflicts associated with having a chronic illness.

U is for Ulcerative Colitis (and Crohn’s Disease). As I mentioned previously, IBS is – ideally – diagnosed through a process of exclusion, meaning all the more serious illnesses whose symptoms resemble IBS are ruled out. One important condition to ensure your doctor tests for is IBD, or Inflammatory Bowel Disease.

Though often confused, IBD is distinct from IBS in that it is an autoimmune condition associated with inflammation of the digestive tract. In one subtype of IBD, ulcerative colitis, this inflammation is limited to the colon, while in the other subtype, Crohn’s disease, the inflammation can occur anywhere in the digestive tract, all the way from the mouth to the anus.

Many symptoms overlap, but so-called ‘alarm symptoms’ – such as weight loss, fever or blood in the stool – differentiate IBD from IBS. Tests for ruling out IBD include imaging techniques like CT scan, MRI and endoscopy, as well as less invasive procedures such as blood tests, fecal occult blood testing and fecal calprotectin measures. Be sure to mention these tests to your doctor if they are considering a diagnosis of IBS – especially if you happen to have a family history of IBD!

V is for Visceral Hypersensitivity. One problematic theory some doctors use to explain IBS is that patients with IBS simply have a lower threshold for pain than those who do not have the disorder, a condition known as visceral hypersensitivity. In these physicians’ point of view, patients with IBS are hyper-aware of the normal, everyday contractions of the digestive tract.

So, what’s the problem? Unfortunately, some doctors already see IBS as a problem of lesser concern. They may suggest that the pain is ‘all in your head’ – especially because IBS tends to occur more frequently in people of the female sex (more on that later!). This is just one reason why it is crucial to find a doctor you trust when dealing with a chronic illness like IBS!

W is for Women. For whatever reason, IBS affects more people of the female sex than people of the male sex. (I specify sex, rather than gender, because the genetically female body possesses different physical and genetic characteristics than the male body, which may contribute to the likelihood of developing IBS.)

Some doctors speculate differences in women’s brain and nerve cells may be responsible. Others have discovered genes linked to IBS that are only carried by female. Interestingly enough, however, others still believe people of the male sex simply may not seek medical care as often for their digestive discomfort, instead choosing to tough it out. Toxic masculinity is real, folks!

X is for anXiety. (Okay, I cheated a little there – so sue me! Not really, though; I’m broke.) IBS and anxiety go hand-in-hand. Granted, not all patients with IBS have an anxiety disorder, just as not all patients with an anxiety disorder will develop IBS – but on average, IBS patients tend to report more anxiety than those without IBS.

Additionally, high levels of stress and anxiety may exacerbate IBS symptoms, regardless of whether the patient has a formal anxiety disorder. Because of the disorder’s links to stress and anxiety, mindfulness and even hypnosis have been found to improve symptoms of IBS in some patients!

Y is for Young. Constipation and diarrhea: they tend to be problems we associate most often with children or the elderly. But did you know most patients with IBS are actually under the age of 50? You are far more likely to develop the disorder as a teenager or young adult than as a very young child or a senior citizen!

Z is for Zinc, Iron and Other Vitamins & Minerals. One unexpected way IBS affects your health is by potentially interfering with your absorption of vitamins and minerals. Especially if you are lactose or gluten intolerant, you may experience malabsorption with your IBS: fatty, greasy, smelly stools characterized by high fat contents. These stools may float or stick to the toilet bowl, even after flushing.

Because so many important vitamins and minerals – such as vitamins A, D, E and K – are fat-soluble, malabsorption can lead to deficiencies of certain nutrients. Your doctor may recommend testing your blood to determine your levels of these vitamins and minerals, then supplementing with any vitamins or minerals you may be deficient in.

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