IBS: Subtypes, Diagnosis & Treatment Options

IBS, or inflammatory bowel syndrome, affects individuals of all ages, even children. IBS is a common gastrointestinal disorder and it is estimated that 10-15% of the world’s population suffers from it. Women experience IBS more frequently than men. Two out of every three people diagnosed with this syndrome are female! The exact cause of IBS is unknown but it is believed that a disturbance in the way the gut, brain and nervous system interact plays a role in the development of the syndrome. IBS severity varies from person to person and it is important to receive a confident diagnosis from a qualified healthcare provider if you are concerned about your GI symptoms. There are both conventional and naturopathic approaches for treatment of IBS. Due to the varying nature of symptoms, treatment success differs between individuals. Some IBS patients may thrive with one treatment plan while others will need a different approach.

The exact cause of IBS is unknown but it is thought to be a multifactorial disorder that is influenced by interactions between the GI tract, gut bacteria, the nervous system and external factors such as stress. It is theorized that the development of IBS can be triggered by past use of systemic antibiotics taken for a GI infection, alcohol abuse, food allergies or sensitivities, physical and/or emotional stress, abnormal peristalsis, acute infection or hypersensitivity of the nerves in the GI tract. All individuals with IBS experience abdominal pain related to bowel movements. Variations in the syndrome occur depending on whether there is constipation, diarrhea or a mixture of both present and thus IBS is divided into three subtypes, IBS-D, IBS-C and IBS-M.

IBS-D, irritable bowel syndrome with diarrhea, affects individuals of any age and gender. Interestingly, young females are the demographic most commonly affected. Those suffering from IBS-D experience loose and frequent stools that can include mucus and occur during waking hours. Abdominal bloating is common in the IBS-D subtype. Individuals with IBS-D commonly report symptoms seemingly unrelated to the gut including irregular menstrual cycles, decreased sexual function or urinary changes. Triggers for IBS-D vary between individuals but can include certain foods and/or increased stress levels. 

Irritable bowel syndrome with constipation, or IBS-C, is a type of IBS where constipation accompanies abdominal pain. Constipation occurs when bowel movements do not happen frequently enough, typically less than three times per week. Changes in bowel function with this subtype include straining, hard or lumpy stools and/or a feeling that the bowels have not been emptied completely. Bloating and/or gas can also occur with IBS-C. Abdominal discomfort often times improves after a stool has been passed in individuals with this IBS subtype.  

IBS-M, or IBS-mixed (also known as IBS-alternating), includes both constipation and diarrhea. People with this subtype of IBS alternate between experiencing diarrhea and constipation. This alternation is due to a fluctuation in bowel transit time. Changes in stool type can change over hours or days. Individuals with this subtype may experience more abdominal pain than those with IBS-C or IBS-D and can also experience gas, bloating, a feeling of incomplete stool passage and/or mucus in the stool. 

It is important to receive a confident diagnosis from a healthcare provider if you are concerned you have IBS. An IBS diagnosis is made by a thorough review of health history, physical examination and further investigative testing if deemed necessary. There is no one laboratory test or imaging study used to diagnose IBS. That being said, labs and imaging can and should be used to rule out other conditions that can cause similar symptoms to IBS such as celiac disease or inflammatory bowel disease (IBD). The Rome IV criteria is useful in determining an IBS diagnosis. This criteria states that IBS is likely if you experience recurrent abdominal pain, on average, at least one day per week in the last three months and that pain is associated with two or more of the following: 1) your pain is related to bowel movements 2) you experience a change in stool frequency 3) you experience a change in stool appearance. These criteria must be fulfilled for at least 3 consecutive months with symptom onset at least 6 months before diagnosis. An accurate IBS diagnosis will allow your healthcare provider to treat you with the most indicated and effective therapy available.

There are a variety of conventional and naturopathic treatments available for IBS. Different treatments may work better for certain patients and thus an individualized treatment plan is necessary to achieve optimal results. Treatments range from dietary and lifestyle interventions to nutraceutical and/or pharmaceutical use. Stress management is an important cornerstone in any treatment plan. Although IBS is not a psychological disorder, stress, depression, anxiety and panic can influence and worsen GI symptoms. Dietary interventions can be very effective including identification and removal of food allergens and sensitivities and increasing fiber in the diet, among others. Nutraceuticals, including probiotics, can also be helpful when indicated. Naturopathic physicians often recommend herbs and supplements that help to decrease inflammation in the GI tract and thus decrease symptom severity. Pharmaceuticals can be beneficial to decrease IBS symptoms in more severe cases or when the patient desires this type of therapy.

IBS is a very common GI disorder that affects people of all demographics. It can greatly affect quality of life for those that suffer from its’ symptoms. A diagnosis of IBS from a qualified healthcare provider should be investigated if you are concerned about GI symptoms you are experiencing. This will not only allow you to receive the best treatment available, but it is also important to rule out other (possibly more serious) conditions. There are a variety of treatment modalities available to best suit your needs as an individual. It is possible to feel better and live your life without persistent abdominal pain, constipation and/or diarrhea.

References:

1. American Society for Gastrointestinal Endoscopy
2. Wilkins, Thad MD et al. Diagnosis and Management of IBS in Adults. American Family Physician. 2012 Sep 1;86(5) 419-426.
3. GI Society: Canadian Society of Intestinal Research
4. Definition & Facts: Irritable Bowel Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. November 2017. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/definition-facts