How Is IBS Diagnosed?
There is no medical test for IBS, so doctors use something called the Rome IV Criteria as a guide.
These criteria say that if you have suffered from stomach pain for, on average, at least one day out of every week in the last three months, you may have IBS if you also suffer from at least two of these problems:
- Symptoms that are related to having a bowel movement. For example, the pain might subside once you have been to the toilet.
- You go to the toilet either more or less than usual.
- You notice a change in the look of your stools, for example, they may be thinner or lumpier, looser or more watery.
IBS cannot be diagnosed unless you have suffered from these symptoms for at least six months, so by definition, it’s a long-term disorder, and you won’t receive a quick diagnosis.
In the past, it was common for IBS to be seen as a diagnosis of exclusion. This meant that doctors would test for disorders that could cause similar symptoms like Crohn’s disease and celiac disease and then label the patient with IBS if tests came back negative – they had excluded all other possibilities so it could only be IBS.
However, nowadays more doctors are willing to use the Rome criteria alone which avoids putting patients through unpleasant tests like colonoscopies.
If you have any “red flag” symptoms, then further testing may be a good idea. These are symptoms that are not usually found in IBS like bleeding from the anus, anemia (lack of healthy red blood cells), weight loss, night-time symptoms, fever or first starting to suffer from gut symptoms over the age of 50.
Treatment for IBS
There’s no cure for IBS, and the bad news is that there’s no set treatment plan. Different approaches work for different people, and you may need to experiment with a combination of different treatments before you find relief.
That’s not to say you need to suffer forever, of course, as there are a range of medications, diets, and supplements that are effective for many people, plus psychological treatments that can help to reduce stress and the emotional impact of IBS.
Medications for IBS
Options include over-the-counter remedies for IBS, peppermint oil, and prescription medicines.
The first line of drug treatment includes over-the-counter remedies such as Imodium or Pepto-Bismol for diarrhea and Miralax for constipation.
Anti-spasmodics like Bentyl or Levsin can help to ease crampy feelings by relaxing the muscles in the bowel, although they are not particularly powerful.
Peppermint oil acts as a natural anti-spasmodic for some people, as long as the capsules are enteric-coated – this coating protects the capsules when they are in your stomach but lets them dissolve in the intestine where they are needed.
There have been a handful of prescription drugs available over recent years.
- Lotronex treats diarrhea in women, but its use is now restricted due to fairly rare but serious side effects. You may still be able to get the drug if your diarrhea is so bad it is affecting your quality of life, and you have tried other treatments without success.
- Viberzi is a newer medication which can reduce diarrhea and stomach pain.
- Zelnorm was used briefly to treat constipation but then withdrawn due to heart-related side effects, but Linzess, Amitiza, and Trulance are all available for IBS-C.
- A wide range of laxatives can help, although those that stimulate contractions in the bowel like Exlax or Dulcolax may be quite painful for IBS sufferers and can be too powerful, turning constipation into diarrhea. More gentle alternatives like milk of magnesia draw water into the bowel instead and can work overnight.
- Antibiotics like Xifaxan may help if doctors find that you have an overgrowth of bacteria in your small intestine.
- There is some evidence to show that probiotics can be helpful, as long as the product contains enough bacteria (billions, not millions) and is stored correctly; check the packet to see if it needs to be kept in the fridge.
- If you’ve had your gallbladder removed and suffer from diarrhea, you may benefit from a bile acid binder like Colestid or Welchol.
Fiber and Supplements for IBS
Soluble fiber supplements like Metamucil and Citrucel can be swallowed with water and will help to soften stools and add bulk.
Contrary to popular belief these products are not laxatives in the traditional sense – they may help you go the bathroom if you’re constipated, but they can also reduce diarrhea by firming up soft stools.
There are many different ingredients in these products so you may have to try several before finding the best one for you. They should always be taken with plenty of water.
Calcium has a constipating effect, particularly calcium carbonate, so products like Caltrate Plus can help IBS-D. Magnesium citrate pills have the opposite effect in doses above about 400mg.
If you’re female and find you get diarrhea before or during your monthly cycle it may be due to prostaglandins in the body; choose painkillers like Advil which contain ibuprofen to combat this effect, rather than Tylenol.
Psychological Treatments for IBS
Patients can be understandably reluctant to try psychological treatments because they’ve spent years having their symptoms dismissed as “all in the mind” or feel they are being told their anxiety is the cause of their own illness, when of course many of us are only stressed in the first place because of our messed-up bowels.
However, if there is a strong link between stress in your life and the strength of your symptoms it is worth considering treatments such as cognitive behavioral therapy.
Types of Therapy
- Behavioral therapy can help you to develop robust coping and relaxation strategies and face difficult situations, for example traveling, without becoming overcome with worry and ending up stressing out your bowel as well.
- Gut-directed hypnotherapy was specifically developed to address IBS. A therapist will help you enter a deeply-relaxed state when you should be more receptive to suggestions that help you feel less pain and discomfort.
- Biofeedback involves the use of electrical sensors to monitor how your body is working. It may help to retrain muscles that are tight or tense and allow them to relax and may be useful for constipation.
Different Diets for IBS
The FODMAPs diet involves avoiding some specific carbohydrates present in foods such as wheat, onions, and garlic.
There is lots of evidence to show avoiding FODMAPs can work very well for people with IBS-D or alternating IBS, particularly in reducing pain and bloating, but unfortunately, the diet hasn’t been studied nearly as much in constipation sufferers.
It’s best to follow this diet with the help of a doctor or dietician as it can be quite daunting at first to figure out what you can and can’t eat.
A gluten-free or dairy-free diet is also worth a try as both of these foods are known to cause gut problems. If you’re not having any luck with any of these diets, then try keeping your own food diary of everything you eat and drink and look for links between your diet and your worst IBS days.