10 symptoms of irritable bowel syndrome (IBS)

Irritable bowel syndrome is a chronic condition that affects up to 7 - 24% of the world’s population depending on the sources in literature. Basically it affects a lot of people and is very common. Statistics show that up to 12% of patients in primary medical care complain about symptoms related to IBS. Among patients seen in gastroenterology clinics, those with IBS are the largest subgroup. There is a growing body of evidence that points out the significance of the brain-gut connection. It seems our guts can trigger not only feelings of anger when hungry (“hangry”) but also have the potential to shape our immune system, behavior, and overall health. Unfortunately, when it comes to IBS, there are a lot more unanswered questions than answered about its pathophysiology. Regarding the symptoms, patient's may experience just one or two of them, whilst their severity and number may vary over time. 1. Constipation. While some patients with IBS suffer diarrhea predominantly, others suffer from constipation. Also, there is a third group called “mixed IBS” referring to periods of constipation followed by periods of diarrhea. Constipation relates to a condition of irregular bowel movement. Besides the irregularity, the stool is often very dry and hard. Bristol Stool Scale (BSC) is an internationally recognized scale for describing different types of stools. According to the scale, constipation is characterized by a dry lumpy stool, or separate hard lumps that pass hard (types of 1 and 2 on BSC). Keep in mind that there is no “recommended frequency of bowel movement”. Different people have different bowel movement rhythm. Most people have movements once a day, while for some, it is every other day and for others, it is every three or four days. The frequency also depends on the amount of food taken. The key word here is “irregular” and “lumpy, dry stool”. More symptoms on next page... 2. Diarrhea. Diarrhea is another common symptom of IBS. According to the BSC above, diarrhea is characterized by a mushy or liquid consistency stool with no solid pieces (types 6 and 7). Patients often report up to 10 low volume bowel movements in a day which interferes with their quality of life. The urge to go to the toilet is often almost uncontrollable, which can cause social anxiety and the never-ending cycle of nervousness/diarrhea/social anxiety, especially in younger patients. Keep in mind that IBS is a functional disorder that can follow people throughout their entire lives. Having diarrhea for a few days is not a sign of IBS. 3. Abdominal pain. Abdominal pain sometimes presents as a diffuse low-intensity pain and in some patients as severe, sharp cramps. Typically, patients with diarrhea complain of cramps followed by bowel movement. During cramp attacks, patients often report gurgling sounds in the stomach. Sometimes, the pain occurs after a meal as the stomach empties; food is passed to the guts which trigger the cramps. All of the above leads to malnutrition, weight loss, fatigue and other symptoms that interfere with a patient’s quality of life. 4. Bloating and flatulence. Bloating is an entirely subjective sensation, and is caused by a buildup of gas in the intestines. Almost all patients with IBS have increased gas in their intestines, but not all report having problems. Bloating is caused by an imbalance in gut flora and increased fermentation in the guts. While the food passes through the gut, the bacteria ferments the sugar from the food (both “good” and “bad” gut bacteria) which causes the release and buildup of gases. Some patients complain of passing gas too much, while others describe that they feel like “their stomach is inflated”. 5. Hemorrhoids. Both diarrhea and constipation can be the cause of hemorrhoids. In cases of IBS with diarrhea, frequent bowel movements and irritation due to the use of toilet paper can cause the typical hemorrhoids symptoms - pain, itch, and discomfort. In such cases, it is recommended to use alcohol-free wet wipes or warm water instead of toilet paper whenever it’s possible. In cases of IBS with constipation, a significant amount of fecal mass in the colon and straining while passing the stool can cause hemorrhoids. In such cases, sufficient intake of water and adequate amount of fiber in diet can help. Treating hemorrhoids and IBS means establishing and maintaining proper digestion. 6. Weight loss. IBS with diarrhea means food passes through the intestines too quickly, so there is not enough time to absorb all the nutrients. This causes weight loss. Losing weight further deepens the problem by putting psychological pressure on the patient, causing malnutrition, fatigue, and anxiety. All IBS symptoms are somehow connected, causing and strengthening each other thereby putting the patient in a difficult position for treatment. 7. Malnutrition. Similar to weight loss, malnutrition is another problem in patients with IBS. It takes a precise amount of time to absorb macro and micronutrients. If the food passes through too slowly, bacteria will use most of the nutrients and overgrow, and if it passes too fast a lot of nutrients will stay out of body’s reach. Brittle nails and hair, white spots on nails, dry and scaly skin, anemia, decaying teeth, and poor immune function are just some of the signs of malnutrition . 8. Fatigue. Constant discomfort, digestion problems, malnutrition, psychological pressure and other symptoms drain energy out of patients with IBS. Fatigue is an unspecific symptom and interpreting it often needs an experienced physician. In general, fatigue that lasts for weeks, even months without obvious explanation (such as recovery after a severe injury, disease or surgery), requires a detailed medical examination. Diarrhea can cause a severe loss of electrolytes and subsequent exhaustion, muscle cramps, muscle pain, weakness, low blood pressure, sleepiness, and dehydration. As the patient enters the period of recovery, fatigue slowly diminishes leaving no severe repercussions. 9. Anxiety. Regarding psychological problems, a particularly sensitive portion of IBS patients are teens and people in their 20’s. Most of those in their 30’s and beyond have accepted the disease and learned to live with it. Those who can’t tolerate changes to bowel movement well feel tremendous psychological pressure whenever going out, or traveling, not to mention the inconveniences that might occur during a date and other “sensitive” social interactions. The thought of possible inconvenience causes nervousness and anxiety. The psychological tension then triggers other symptoms (cramps, bowel movement, flatulence, etc.). 10. Chronic abdominal discomfort. Abdominal discomfort is a common denominator of all patients with IBS. Some may complain of pain, some report cramps, others talk about diarrhea and/or constipation, but the report of abdominal discomfort is common to all of them. Doctors often hear something like “I always feel something in my stomach”. Although these sensations may not be easy to describe (it’s not pain, nor flatulence, nor feeling bloated), they cause a lot of problems to patients.

9. Anxiety

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