With irritable bowel syndrome (IBS) affecting an estimated 1 in 5 Americans, it is important to understand the signs of this condition. IBS does not progress to more serious conditions like colorectal cancer. Apart from occasional flareups, the condition may not always present with severe symptoms that requires medical attention. Therefore many people may be living with IBS and remain undiagnosed.
Meaning of IBS-D and IBS-C
Irritable bowel syndrome (IBS) is a condition marked by abdominal cramps and alterations in bowel habit. It is considered as a functional bowel disorder. This means that the symptoms arise from abnormalities in normal functions and processes. It appears that the abnormality is manly due to overactivity or underactivity of bowel motility (movement through the bowels) and possible increased sensitivity to bowel contractions.
The alteration in bowel habit may include diarrhea, constipation or diarrhea alternating with constipation. Irritable bowel syndrome where diarrhea is the main bowel habit abnormality is known as IBS-D (IBS with diarrhea, also known as diarrhea-predominant IBS). On the other hand irritable bowel syndrome where constipation is predominant is known as IBS-C (IBD with constipation, also known as constipation-predominant IBS).
Read more on diarrhea IBS.
What is an IBS flareup?
Some people living with irritable bowel syndrome (IBS) may experience mild symptoms on a daily basis whereas others may not have symptoms on a continuous basis. However, every now and then a flareup occurs where the symptoms usually arise suddenly and are very intense. These flareups can last for varying periods of time, usually days but sometimes for weeks.
Triggers of Flareups
The exact cause of irritable bowel syndrome (IBS) is unknown. It is not due to any pathology, such as inflammation, autoimmune abnormalities or hormonal disturbances. Flareups are triggered by a number of different factors including:
- Certain foods and beverages.
- Psychological stress.
- Hormonal changes.
- Various diseases.
However, sometimes a flareup can occur without any clearly identifiable trigger. Furthermore triggers can vary greatly among people with IBS, meaning that what triggers IBS in one person may not affect another person living with IBS. Similarly factors that ease IBS flareups are also not always known.
How do I know if I have IBS?
Irritable bowel syndrome should be diagnosed by a medical professional. Various tests may be conducted, which are usually not specific for diagnosing IBS. Rather these tests and scans are intended to exclude a host of other conditions that present with similar signs and symptoms as IBS. Only once these tests prove inconclusive, then the symptoms may be diagnosed as IBS provided that it meets with certain criteria.
Abdominal cramping and even pain are a defining feature of irritable bowel syndrome (IBS). This usually occurs in episodes and is accompanied by alterations in bowel habit. It is believed that the cramping and pain is due to spasm of the muscles that lie in the bowel wall. For a diagnosis of IBS, the cramps or pain should occur for at least 3 days in a month within the last 3 months and/or should be relieved with passing stool.
Diarrhea or Constipation
It is important to clearly understand what diarrhea or constipation means. Diarrhea is having more than three bowel movements a day while constipation is less than three bowel movements in a week. The stool also tends to be water in diarrhea and hard in constipation. Sometimes diarrhea and constipation may alternate, like in mixed-type IBS. This means a person experiences diarrhea, followed by constipation and then the diarrhea may recur.
Another common complaint with IBS is excessive gas in the gut which may be expelled with bleching but is more often released through flatulence. Despite this complaint, studies have not revealed any significant increase in intestinal gas in IBS sufferers. Often this gas correlates with a sensation of bloating as well as a bloated abdomen (distended tummy). Excessive gas may only be evident during flareups.
Bloating refers to two symptoms – a sensation of fullness or pressure within the abdomen and abdominal distension (increased girth). Both are believed to be due to excessive gas. While this may apply to a sensation of fullness, gas within the gut cannot cause distension of the gut. Instead there may be other factors that play a role like fluid accumulation in the abdominal cavity. However, this does not appear to be the cause in IBS.
Mucus in Stool
Mucus in the stool may not always be noticeable and not occur with every stool irritable bowel syndrome. It is also not unique to IBS. Most of the time mucus in the stool is only visible during a flareup. Mucus is not abnormal in the stool as it is secreted by the entire gut. Usually it is in small quantities and thoroughly mixed in the stool. When in excess then it may coat the stool or appear like a sticky and stringy substance in the stool.
Rectal bleeding is not a sign of IBS but may sometimes occur during flareups due to hemorrhoids. Both diarrhea and constipation can lead to hemorrhoids (piles). In severe cases there may be overt bleeding but in most cases of piles the blood is only noticed upon wiping after a bowel movement. However, if IBS symptoms are present as well as rectal bleeding but without hemorrhoids then it needs to be investigated further.
The signs and symptoms of irritable bowel syndrome are not unique to this condition. There are a host of gastrointestinal conditions that may present with the same symptoms. Some of these conditions are serious and possibly even life-threatening, whereas irritable bowel syndrome does not lead to fatal complications.
Read more on IBS vs IBD.
The following are considered to be red flag signs that require immediate medical investigation.
- Rectal bleeding (without hemorrhoids).
- Unintentional weight loss.
- Worsening abdominal pain.
The two conditions that may present with all of these warning signs as well as most of the symptoms of IBS includes colorectal cancer and inflammatory bowel disease (IBD). Therefore it is important to first exclude these other conditions before reaching the diagnosis of irritable bowel syndrome (IBS).