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Irritable Bowel Syndrome
LESSON 1

What is IBS?

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WRITTEN LESSON

What is Irritable Bowel Syndrome?

Irritable bowel syndrome, also known as IBS, is a common, chronic gastrointestinal condition that affects approximately 1 in 10 people worldwide.

Common symptoms of IBS include:

  • abdominal pain or discomfort
  • bloating
  • cramping
  • diarrhea
  • constipation
  • gas

IBS symptoms can be unpredictable, ranging from minimal or no symptoms on some days to significant, even debilitating symptoms on others.

IBS is one of the most common conditions managed by primary care and gastroenterology providers. Studies suggest up to 30% of people have never sought care for their IBS symptoms.

IBS is a Disorder of Gut-Brain Interaction

IBS is a disorder of gut-brain interaction (DGBI). DGBI are a family of conditions in which abnormal bidirectional communication occurs between the brain and the gut, without evidence of structural disease such as ulcers, blockages, or visible inflammation on endoscopy or colonoscopy. Other DGBI include functional dyspepsia, chronic idiopathic constipation, and functional diarrhea.

In IBS, abnormal communication between the brain and the gut can lead to:

  • Motility issues which affect how quickly digestive contents move through the gastrointestinal tract. This can result in diarrhea, constipation, or a combination of both.
  • Sensory symptoms which can result in abdominal pain, discomfort, and bloating.

Common Misconceptions about IBS

Although IBS is a common condition, there are many misconceptions about it among patients, the general public, and even healthcare providers. This can make the experience for someone with IBS feel confusing and frustrating.

Here are some of the most common misconceptions about IBS:

Misconception

IBS is a "diagnosis of exclusion" or a catch-all diagnosis for someone with chronic gut symptoms that aren't explained with testing or when there is no identified cause of symptoms.

The reality

IBS is considered a positive diagnosis, which means there are specific clinical criteria and established mechanisms across the gut-brain axis that lead to symptoms.

Defining characteristics of IBS include:

  1. Changes in bowel movement frequency or form (appearance). Most commonly, this is experienced as diarrhea, constipation, or a combination of both.
  2. Abdominal pain or discomfort, which may include bloating or cramping.
  3. Pain or discomfort that changes with bowel movements; this can be an improvement or worsening of symptoms before, during, or after a bowel movement.

When someone is diagnosed with IBS, it's important that symptoms fit this pattern. Otherwise, an alternative diagnosis should be considered.

Misconception

IBS is a purely psychological condition and is a manifestation of stress and anxiety; or IBS is "all in your head."

The reality

IBS is not a psychological disorder. It is a condition in which abnormal communication occurs between the brain, gut, and microbiome, and is considered a multi-system disorder.

Since abnormal bidirectional communication between the brain and gut plays a central role in IBS, psychological conditions such as stress, anxiety, and depression can impact IBS symptoms. However, it is important to understand that factors external to the brain, such as food, infection, or antibiotics, can also influence IBS symptoms. Most patients notice that both psychological and non-psychological triggers can impact their IBS symptoms.

Misconception

IBS is caused by food in your diet

The reality

Diet plays an important role in IBS. It can help manage symptoms and it can also be a trigger for symptoms; however, food does not cause IBS.

Some patients with IBS will notice certain foods are a consistent trigger for their symptoms, and in those cases avoiding those foods can play an important role in managing symptoms. However, more commonly, patients will notice that certain foods trigger symptoms on some days and cause no symptoms on other days. Furthermore, some patients will notice that food in general is a trigger for their symptoms, which reflects a gut that is extra sensitive rather than food being the cause of symptoms.

It is important to remember that IBS is a complex multi-system disorder, and while food is an important part of symptom management, it is not the only aspect of managing IBS.

Misconception

IBS increases your risk of gastrointestinal cancer

The reality

Multiple studies have shown that patients with IBS do not have an increased long-term risk of developing gastrointestinal cancer. Additionally, IBS is not associated with an increased risk of overall mortality. Several studies show that patients with IBS may have an overall lower risk of death, including death attributed to cancer, likely due to increased engagement with the healthcare system.