Understanding IBS Symptoms

Types of IBS

There are three main subtypes of IBS. These are classified depending on the type of bowel movements you may be experiencing. They are:

• Constipation-predominant IBS (IBS-C)
  You experience a lower number of bowel movements than usual. Stools are harder and more difficult to pass.

• Diarrhea-predominant IBS (IBS-D)
  You experience diarrhea, usually in the morning or after eating. You may experience an urgent need to go to the bathroom, and your stools are loose and watery.

• IBS with mixed symptoms (IBS-M)
  You experience both episodes of diarrhea and constipation.

Symptoms of IBS

IBS abdominal pain

Abdominal pain is the most common symptom of IBS. In fact, if there is no abdominal pain, then your other symptoms may not be related to IBS. This pain is usually located in the lower part of the abdomen or entire abdomen and not usually in the upper abdomen alone.

It’s quite common for this pain to go away or reduce after you’ve had a bowel movement.

The cause of abdominal pain in IBS is thought to be a miscommunication between brain and gut signals. Usually, the brain and gut communicate through nerve signals, hormones, and gut bacteria. However, in IBS, this communication becomes distorted, leading to painful sensations in the abdomen.

IBS constipation

IBS with constipation (IBS-C) is the most common type of IBS, accounting for nearly half of all those with IBS.

Constipation is when you have fewer bowel movements than normal, generally less than three per week.

This happens because the movement of digested material through your digestive tract slows down. As it slows, your intestines absorb more and more water from the stool, so it becomes hard and difficult to pass.

The slowing of material through your digestive tract is thought to be because of miscommunication between your gut and brain.

IBS diarrhea

People who experience diarrhea symptoms as part of their IBS have loose, watery stools or a frequent need to have a bowel movement. IBS with Diarrhea (IBS-D) is the second most common type of IBS, accounting for approximately 30% of IBS cases.

While it may seem obvious that diarrhea is the opposite experience to constipation, it’s interesting to note that this symptom happens when the gut sends stools through your digestive tract faster than usual. Less water is absorbed from the stool into the intestines and this in a sense of urgency to use the toilet, and loose, watery stools.

IBS gas and bloating

Bloating is the buildup of gas in the stomach and intestines, producing an uncomfortable feeling. Bloating is a common IBS symptom, with over 80% of people with IBS experiencing it.

Research has suggested that bloating may occur as a result of hydrogen gas produced by bacteria in the gut. Avoiding certain foods, such as those high in FODMAPs, is thought to reduce bloating and gas.

Other IBS symptoms

Besides those symptoms required for a diagnosis, other symptoms of IBS include:

Fatigue

One study reported over half of people with IBS report fatigue. IBS has been shown to lower perceived energy levels and limit physical capacities at work, and in social settings.

Difficulty sleeping

Approximately 15% of people with IBS reported reduced sleeping quality, according to one study. IBS can also result in feeling less refreshed upon awakening.

Mucus in stools

IBS can cause mucus to accumulate in stools. If you’re seeing mucus, it isn’t a cause for concern. Mucus is a normal secretion of the bowel, but may simply happen more for people with IBS.

Gender differences in IBS symptoms

Women more commonly experience IBS than men. During menstruation, women may have more symptoms than usual, while rates of IBS are lower after menopause. Men experience the same symptoms of IBS as women, but research shows that they are less likely to see a doctor.

IBS and psychological symptoms

Research has shown that there is a relationship between anxiety, depression, and IBS. In fact, one study showed that people with IBS are 80% more likely to have depression than those without IBS.

However, it is not clear which way the influence lies. Is it possible that IBS is caused by anxiety and depression, or is the IBS affecting mental health?

Either way, a vicious cycle can occur in which IBS symptoms can trigger feelings of anxiety or distress, and they, in turn, create more intense IBS symptoms.

Several mind-body therapies have been shown to improve the physical symptoms of IBS. These include psychotherapy and hypnotherapy. It is thought that these therapies may help to reduce feelings of anxiety and restore the connection between the brain and the gut, eventually reducing the physical symptoms of IBS.

When should you seek help?

If you are experiencing abdominal pain, constipation, diarrhea, or any other gut symptoms regularly, then talk to your doctor. They will be able to take you through the criteria for an IBS diagnosis and suggest management options. They can also investigate whether your symptoms are related to other conditions such as Crohn’s disease or lactose intolerance.

Symptoms that may suggest another condition that is not IBS, are:

• Rapid weight loss

• Rectal bleeding

• Nausea

• Fever

• Abdominal pain that occurs at night that doesn’t improve with bowel movements.

Managing IBS Symptoms

Once you have an IBS diagnosis, there are several options available to help you manage your symptoms. These include:

• Low FODMAP diet: this involves eliminating or reducing foods high in short-chain carbohydrates called FODMAPs that are common triggers for IBS.
  

• Probiotic supplements: which have been shown to improve IBS symptoms by altering the composition of bacteria in the gut.
  
  

• Gut-directed hypnotherapy: which involves guided relaxation and suggestions targeting symptoms of IBS. Several studies have shown this to be among the most effective therapies for relieving symptoms of IBS.
  
  

• Over-the-counter medications: such as laxatives for IBS with constipation, or pain medications to manage abdominal pain.
  
  

• Antidepressant medications: most commonly prescribed for IBS are tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).

The Wrap Up

The most common symptoms of IBS are abdominal pain, constipation, and/or diarrhea. Other common IBS symptoms include gas and bloating, fatigue, mucus in stools, and trouble sleeping. IBS commonly occurs in people dealing with anxiety and depression. Fortunately, a range of evidence-based treatment options are available to manage IBS symptoms, including gut-directed hypnotherapy, the low FODMAP diet, and antidepressant medications.

References

1. Choung, R.S. and Locke 3rd, G.R., 2011. Epidemiology of IBS. Gastroenterology Clinics of North America, 40(1), pp.1-10. https://europepmc.org/article/med/21333897

2. ‍Azpiroz, F., Bouin, M., Camilleri, M., Mayer, E.A., Poitras, P., Serra, J. and Spiller, R.C., 2007. Mechanisms of hypersensitivity in IBS and functional disorders. Neurogastroenterology & Motility, 19, pp.62-88. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2982.2006.00875.x

3. ‍Schmulson, M., Vargas, J.A., López-Colombo, A., Remes-Troche, J.M. and López-Alvarenga, J.C., 2010. Prevalence and clinical characteristics of the IBS subtypes according to the Rome III criteria in patients from a clinical, multicentric trial. A report from the Mexican IBS Working Group. Revista de gastroenterologia de Mexico, 75(4), pp.427-438. https://europepmc.org/article/med/21169110=

4. Lacy, B.E. and Patel, N.K., 2017. Rome criteria and a diagnostic approach to irritable bowel syndrome. Journal of clinical medicine, 6(11), p.99. https://www.mdpi.com/2077-0383/6/11/99

5. ‍Quigley, E.M., 2018. The gut-brain axis and the microbiome: clues to pathophysiology and opportunities for novel management strategies in irritable bowel syndrome (IBS). Journal of clinical medicine, 7(1), p.6.