Identifying what provokes your irritable bowel syndrome symptoms can bring relief.
Irritable bowel syndrome (IBS) is a common problem affecting millions of people across the United States. The American College of Gastroenterology estimates up to 15% of American adults have IBS, but that less than half of those have received a diagnosis.
Is there a cure for IBS that can eliminate it quickly and permanently? Unfortunately, there is not — but that doesn’t mean IBS patients have to just live with it.
Treatments and lifestyle factors can help patients better manage their uncomfortable IBS symptoms and avoid flare-ups.
What is IBS?
Although not a life-threatening condition, “IBS is a disease that affects your quality of life, so it’s important to get it treated,” says Nipaporn Pichetshote, MD, a gastroenterologist who regularly treats patients with IBS in her role at the USC Esophageal and Foregut Disorders Center, part of the USC Digestive Health Institute and Keck Medicine of USC.
She describes IBS as a chronic disorder in which the digestive system functions abnormally, specifically the small and large intestines.
Symptoms of IBS include:
- Bloating and excess gas
- Abdominal pain and cramping
- Constipation
- Diarrhea
- Mucus in the stool
Nausea is not a symptom of IBS, explains Dr. Pichetshote, who is also an associate professor of clinical medicine at the Keck School of Medicine of USC. However, she says it’s common for patients with IBS to also experience functional dyspepsia, which refers to an upset stomach without a known cause. “These two conditions often overlap, so if an IBS patient has nausea, we look at that as a diagnosis, as well.”
What causes IBS?
There is no definitive explanation for why some people develop IBS while others do not. However, gastroenterologists have identified several factors that can lead to IBS and/or provoke symptoms:
Food poisoning
“One of the most common causes we’re aware of is an episode of food poisoning because that can alter your microbiome,” says Dr. Pichetshote. She explains that microbiome changes can impact gut motility, which refers to the body’s natural mechanisms for digesting food.
Gut infections
Intestinal viruses are another major culprit. Dr. Pichetshote says she analyzes a patient’s medical history for previous cases of gastroenteritis, otherwise known as the stomach flu, when diagnosing IBS.
COVID-19
COVID-19 may also play a role. She says some COVID-19 patients who experienced gastrointestinal symptoms later developed IBS.
Stress
Dr. Pichetshote says there is disagreement within the medical community about the link between chronic stress and IBS. “Some physicians believe stress can cause IBS to develop, but I’m not one of them. I think stress can worsen your IBS symptoms, but not give birth to the disease.”
Food and alcohol
Specific foods or alcohol consumption may trigger symptoms in patients with IBS, depending on the individual’s specific sensitivities. However, Dr. Pichetshote says there isn’t enough evidence to suggest that foods or alcohol actually cause IBS to form in the first place.
How is IBS treated?
Treatments for IBS depend on what provokes an individual patient’s symptoms. There is no one-size-fits-all approach, but there are a few common scenarios.
IBS medication targeting the nervous system
For some patients, the solution lies in the nervous system. “There is a brain-gut connection,” explains Dr. Pichetshote. “For people with a very sensitive gut, normal digestive activity can send distress signals to the brain. This is called visceral hypersensitivity.”
To treat patients whose nerves are misfiring like that, Dr. Pichetshote says neuromodulation medication can be a good option.
Antibiotics for bacteria
Patients who experienced a food poisoning incident or a stomach infection may develop small intestinal bacterial overgrowth, which can be diagnosed via a lactulose breath test. Dr. Pichetshote says the problematic bacteria are usually treated with antibiotics, although the medication doesn’t permanently cure the underlying IBS.
Lifestyle changes
Diet-specific approaches usually involve eliminating specific foods to identify which ones may be setting off IBS symptoms. Dr. Pichetshote recommends patients consult with a dietitian about dietary changes.
She says getting enough quality sleep and exercising regularly can also be beneficial for keeping IBS symptoms under control. “Lack of sleep can negatively affect how our bodies process pain and lead to flare-ups,” says Dr. Pichetshote. “And exercise helps promote digestion.”
Dr. Pichetshote emphasizes that patients with IBS shouldn’t blame themselves for the condition. “It’s important for people to know that IBS is real, because in the past some people may have thought it was just in their heads,” she stresses. “But it’s not.”
Even though there is no known cure for IBS, Dr. Pichetshote reminds patients that there are actions they and their providers can take to keep it under control. “We can manage symptoms very well. Rather than trying to find a solution on your own, talk to your doctor so they can help you come up with an effective treatment.”
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