Abdominal pain, cramping, diarrhea, constipation: Today most doctors recognize these symptoms as possible signs of irritable bowel syndrome (IBS). But standardized criteria to diagnose this condition didn’t exist until the 1980s. Prior to then, some doctors dismissed IBS as a psychosomatic issue due to the absence of physical evidence related to IBS (e.g., bleeding, growths, obstructions). With one in six Americans suffering from this disorder, you may find that hard to believe. And that's not the only thing that might surprise you about IBS, says Michael Brown, MD, a gastroenterologist at Rush University Medical Center. According to Brown, there are a few other common misconceptions about this disorder, so he offers the following facts:
- Men get it, too. While young and middle-aged women tend to attract more media attention when it comes to IBS, it affects men as well. In fact, one third of those suffering from IBS are men. Doctors also diagnose it in children and older adults.
- And yes, doctors do diagnose IBS. Diagnosing IBS involves a process of elimination and can take time. But make no mistake, the condition is real and has a set of clearly defined diagnostic criteria that can reduce the need for invasive and expensive testing. If you experience symptoms that interfere with your daily living, you should definitely discuss it with your primary care physician or a gastroenterologist. To diagnose the condition, doctors will refer to the Rome criteria, [see below] which specifies the types and duration of symptoms that define IBS and its subtypes. To have IBS, one must have continuous or recurring symptoms of abdominal pain or discomfort for at least three months, and two of the following must be true: Pain is relieved by bowel movements; the onset of pain is accompanied with a change in frequency; or the onset of pain is accompanied by change in the appearance of stools. Bloating is a common but not uniform feature of IBS.
- Stress plays a key role, but it's not the source. While stress can trigger and even worsen symptoms — perhaps because of disruption in communication between the gut and the brain — it isn't what causes IBS. Actually, no one knows for sure what causes IBS, but the nerves and muscles surrounding bowels appear to be super sensitive in people with IBS, which can cause sensitivity to only mild bowel irritation and gut movement abnormalities that result in constipation, pain and diarrhea.
- Irritable bowel syndrome differs from inflammatory bowel disease. While some symptoms may be similar, IBS is not inflammatory bowel disease, or IBD, a term covering Crohn's disease and ulcerative colitis. While doctors define these two conditions as diseases, they categorize IBS as a syndrome. Why? Because to be classified a disease, a condition must have a known cause, and IBS has none, yet. Another difference: Both Crohn's and colitis can cause rectal bleeding; IBS does not. And unlike colitis, IBS does not increase the risk of colon cancer.
- Diet alone won't relieve symptoms. Like stress, some foods spark IBS symptoms, and even the simple act of eating can sometimes bring about symptoms. While food affects everyone differently, for those with IBS, certain culinary culprits appear to be especially problematic, including caffeine, alcohol, artificial sweeteners, dairy products, fried foods and red meat. Brown recommends keeping a food and symptom diary to help identify problematic foods. But changing your diet is typically not enough to curb symptoms. Managing stress and anxiety can also play an important role in alleviating symptoms, as can medications for more severe cases. Some patients may also benefit from physical therapy which can help tighten (or loosen) the pelvic floor and abdominal muscles, areas that may contribute to IBS symptoms. To get an individualized treatment plan from a multidisciplinary team of specialists that tackles IBS on multiple fronts, contact the Program for Abdominal and Pelvic Health at Rush or Michael Brown, MD, whose clinics focus on functional bowel disorders.
Rome III Criteria for Irritable Bowel Syndrome
Duration of recurrent abdominal pain or discomfort* of at least three months, with onset occurring at least six months prior. Regarding pain or discomfort, two or more of the following must be true:
- Improvement with defecation
- Onset associated with a change in frequency of stool
- Onset associated with a change in form (appearance) of stool
*Discomfort means an uncomfortable sensation not described as pain.
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Please note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.
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