Basics About Irritable Bowel Syndrome

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Abdominal discomfort and diarrhea or constipation are the hallmarks of this chronic condition. During Irritable Bowel Syndrome Awareness Month, learn the basics about IBS from a Kaiser Permanente gastroenterology chief.

Everyone has the occasional gastrointestinal upset caused by the wrong food or a bug, perhaps. But up to 10-15 percent of North Americans suffer from a chronic condition called irritable bowel syndrome, or IBS. It’s defined as a disorder of the gastrointestinal, or GI, tract.

Pauline Mysliwiec, MD, treats Kaiser Permanente members at the Vallejo Medical Center, where she is the chief of the Gastroenterology Department. Her interest in GI began with clinical nutrition. Today she shares 3 cornerstones to understanding IBS. “I reassure my patients that we understand that it is a painful and challenging condition and that it affects their quality of life. However, it is not life-threating and it is treatable.”

Pauline Mysliwiec, MD

#1 – Symptoms

Characteristics of IBS include abdominal pain and alteration in bowel habits with constipation, diarrhea or both at least once weekly, for at least 3 months. Many can experience painful bloating.

People over 50 may require additional testing to rule out another disease. Additional red flags include symptoms such as blood in stool, escalating abdominal pain, weight loss, and getting up in the middle of the night to have a bowel movement. “These are symptoms that may suggest triggers that it may be more than irritable bowel.”

IBS is exacerbated by stress and other illnesses, from a flu to additional chronic conditions such as diabetes. New medications may affect IBS, too.

#2 – Causes

While clinicians are not certain what causes irritable bowel syndrome, the condition is usually diagnosed in young adulthood, the prevalence is slightly higher in women, and there seems to be a genetic link because it is seen in twins.

Among the several factors that play a role in IBS, abnormalities in the intestinal nerves may cause a person to experience greater than normal discomfort when the abdomen stretches from stool or gas. Some poorly coordinated nerve signals between the brain and gut can cause the body to overreact.

There are a host of other links to IBS, including socioeconomic and cultural influences, environmental factors, and one’s coping skills and cognitive skills, including how people perceive or have issues with pain and the bowel.

“We think of GI issues as disorders of gut and brain interactions because there is a 2-way street between the brain and the intestinal tract. There is a little higher incidence of depression among IBS sufferers, as well as anxiety and chronic pain. But it is not a psychological diagnosis. Patients have a problem at the gut level that feeds back to certain centers in the brain.”

#3 – Treatment

A lot has changed in the treatment of IBS. Over the past decade, there is increased interest in starting IBS treatment with a simple reassessment of diet. Sufferers who are constipated may try a plant-based diet rich in natural roughage, while those with diarrhea may try a gluten-free diet.

Short chain carbohydrates that are poorly absorbed into the small intestine are called FODMAPs, which stands for “Fermentable Oligo-, Di-, Mono-saccharides And Polyols.” Restrictions of these carbs — including fructose, lactose, and sugar alcohols — have been shown to reduce symptoms of bloating, pain, and gas, as do probiotics.

The next step is looking at medications. For those affected by constipation, laxatives can be effective. Neuromodulators and anti-depressants can help with pain. They can target the receptors in the gut and the brain to manage the pain better.

“There are some good studies on mindfulness meditation — not specific to IBS but concerning functional GI overall — that show the practice can be very helpful. There are also cognitive behavioral and other therapies, too. Finally, I encourage my patients to exercise since the elevated endorphins make everyone feel better.”

Discussion7 Comments

  1. It’s so great to hear Kaiser Permanente docs are prescribing diet changes with plant-based diets and educating members on it. We need more of this!

    • I agree and I am also excited to see a recommendation to eat a plant diet. Exercise is also important and vital to a healthier lifestyle.

  2. Kaiser offers health classes about this and other GI conditions. I was having some IBS-related symptoms and the class was very helpful in understanding IBS and possible solutions. It turned out that the first suggestion (fiber supplements) worked great for me and relieved my symptoms. I’ve recently been experimenting with adding yogurt/kefir to my diet to promote a healthy gut microbiome and so far it seems to be helping also. There are many possible solutions that work differently for different people so if something isn’t working for you don’t be afraid to try something else!

  3. Margaret Flaherty

    I was hoping to read that Kaiser was looking into the recent discovery of microbiome issues and how they relate to IBS. In Great Britain, they are using fecal transplants to help some patients with this diagnosis. Maybe that will come in the near future?

    • Hi Margaret,

      I heard fecal transplants are being done in Northern Ca – Kaiser Oakland. I don’t know the specifics or if that is still happening but I heard this within the last 2 months. I hope this helps.

      • They have done some of that at our Kaiser Permanente in San Jose, too, I believe — mostly for patients with intractable diarrhea that is not helped by anti-diarrheal medication or other things over a long period of time. Sometimes for those with C-diff; but I don’t think IBS is ever at the stage to my knowledge where they would have to do that … not sure. I have it and it is miserable at times, but usually watching my diet and stress levels helps a lot.

  4. Thanks so much for this article. I was diagnosed with IBS a while back due to a chronic pain in my gut and bloating. I became interested in diet and decided to go gluten free (and not cheat at all) as many had recommended that option to my problems. I read books too that confirmed that gluten is the cause of many health issues (at least gluten in the United States, which has been modified so much that it does not resemble the wheat of yesterday). Anyway, back to my success outcome. I stopped eating gluten and the pain in my gut went away, the bloating went away and other health issues did too (pain in hip from leaky gut, rosacea, acid reflex and dizzy spells from vestibular neuritis). So I am a walking example of how a gluten free diet can change one’s health for the better! I also can tell when I have been exposed and it does not take much. And btw I do not have celiac disease, I am gluten intolerant. There is a test out there but a lot of modern medicine facilities don’t do it for some reason. So if anyone has been diagnosed with IBS or any other intestinal issue, please try a gluten free diet! It takes about 6 months for it to leave your system so don’t give up!

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