Patient FAQs

Advice from experts that may help your patients better understand IBS

Diagnosis

Why are more women than men affected by IBS?

Reported rates of IBS overall are typically 1.5- to 3-fold higher in women than in men.1,2 However, this difference is seen in IBS-C rather than in IBS-D, where the prevalence is similar between men and women.3 These differences may be due to female sex hormones or other factors4,5

My mother has IBS – does it run in families?

IBS has been shown to aggregate in families, and having a mother or father with IBS is an independent risk factor for having IBS.1,6,7 Several potential candidate genes associated with IBS have been identified, with an individual’s genetics and living environment potentially increasing susceptibility8

Symptoms

Why does stress worsen my IBS, and what should I do?

The brain and gut are connected in several ways, and one can have an effect on the other. Stress is thought to contribute to the onset or worsening of symptoms in some people with IBS.9 Exercise and other techniques to reduce stress may help10,11

Why do I get worsening of IBS symptoms during my menstrual cycle?

Some women report worsening of IBS symptoms during their menstrual cycle. This appears to be at least in part due to fluctuations of hormones including estrogen and progesterone; further studies are needed to better understand mechanisms12,13

Treatment

Is acupuncture useful in treating IBS?

There are mixed conclusions regarding whether acupuncture is effective in treating IBS; however, a meta-analysis of five studies demonstrated that acupuncture did not improve symptoms or quality of life in patients with IBS.10,14,15 More research is needed to determine whether acupuncture can be as beneficial to patients as pharmacological therapies

Diet

Is there an IBS diet that I can follow?

Although there is no single diet that works for all patients, particular types of food or poor eating habits may trigger onset or worsening of IBS symptoms; reducing intake of so-called “trigger foods” and practicing healthy eating habits may help prevent or reduce symptoms. Diets low in milk and other dairy products, non-starch polysaccharides such as bran, and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may be beneficial.16 Keeping track of foods that trigger symptoms in a diary may be helpful to determine what to avoid through trial and error17,18

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I get bloated when I eat more dietary fiber. Should I eat soluble or non-soluble fiber?

Soluble and non-soluble fibers may have different effects on GI symptoms in patients with IBS. Insoluble fibers such as bran are known to frequently cause bloating and abdominal discomfort, while soluble fibers have been shown to be effective in treating IBS.19 The American College of Gastroenterology guidelines on IBS management recommend use of fiber supplements, soluble fibers, and psyllium to increase stool frequency when constipated18

Why are my IBS symptoms better on a gluten-free diet if I don’t have celiac disease?

Foods containing gluten have been shown to trigger symptoms for some patients with IBS; however, gluten-rich foods such as wheat may contain carbohydrates such as fructans and galactans, which may also cause symptoms.10,20 Gluten and the other carbohydrates, including FODMAPs, exacerbate symptoms by acting as substrates for bacterial fermentation that stimulate gas production in the GI tract, triggering symptoms8,21

Management of IBS with other conditions

Can celiac disease and IBS overlap?

Gluten-related disorders such as celiac disease and non-celiac gluten sensitivity have overlapping symptoms including bloating, abdominal pain, and chronic diarrhea. In fact, 4% of patients with IBS actually have celiac disease.22 Based on the evidence of overlap, routine serologic screening for celiac disease is recommended in patients with IBS-D or IBS-M23

I had a colonoscopy and upper endoscopy 2 years ago, and my new gastroenterologist wants to repeat these tests. My IBS symptoms are the same. What is the reason to have the tests repeated?

A repeat colonoscopy is often performed to rule out the possibility of other diseases. A biopsy can help to rule out microscopic colitis or IBD. In patients aged over 40 who have a family history of colorectal cancer, or whose bowel symptoms have changed, a repeat colonoscopy can also help to rule out colon cancer

I have Crohn’s disease but between my Crohn’s disease flares I have a lot of bloating, intermittent abdominal discomfort, and constipation. Can a person with Crohn’s disease also have IBS?

IBD (Crohn’s disease or ulcerative colitis) may overlap with IBS. During IBD flares, patients are treated with medications directed at their IBD. At times, symptoms of IBS may be interpreted as a persistent IBD flare, and patients may be viewed as having “refractory IBD”. In this case, it is helpful to assess for evidence of bowel inflammation using diagnostic tests such as measurements of stool calprotectin or blood C-reactive protein, and possibly colonoscopy or other imaging testing. The patient’s IBD treatment may be escalated. In our practice, patients with overlapping IBD and IBS often require more testing to determine the cause of their bowel symptoms at that particular time. When work-up shows no evidence of active IBD, suggesting that the patient is in between IBD flares, patients receive treatment for their IBS symptoms24

I have endometriosis and IBS. How do I know what is causing my lower abdominal pain?

Symptoms of endometriosis may sometimes be difficult to distinguish from IBS symptoms.25,26 Patients with IBS and endometriosis may have increased visceral hypersensitivity and exaggerated symptoms beyond patients with only IBS or only endometriosis. During menstruation, IBS symptoms in women with endometriosis may worsen. Women may become more constipated prior to menstruation and/or have diarrheal bowel movements during menstrual flow. One potential way to distinguish IBS symptoms from endometriosis is that abdominal pain due to IBS may decrease with defecation, which does not occur in endometriosis

Endometriosis can cause severe pain and cramping in some women, especially during the menstrual period, while others have only a little discomfort or notice nothing at all. Other endometriosis symptoms include very painful menstrual periods (dysmenorrhea), pain during sex (dyspareunia), abdominal pain in different parts of the abdomen that may radiate to the back or legs, and bowel problems including abdominal fullness and painful bowel movements. However, all of these symptoms can potentially be caused by IBS. Therefore, endometriosis cannot be clearly diagnosed based on symptoms alone. To elucidate the cause of abdominal pain that is worse during menstruation, a referral to a gynecologist, preferably one who is an endometriosis expert, is appropriate. In my practice, I have seen patients with IBS whose lower abdominal/pelvic pains resolved after hormonal or surgical treatment of their endometriosis

Additional information and advice

What websites would you recommend for me to visit to get more information about IBS?

The IBS network is a national charity for IBS that provides information, advice, and support for people with IBS, as well as patient resources such as the Self Care Programme, access to groups and forums, and a helpline
https://www.theibsnetwork.org

The International Foundation for Functional Gastrointestinal Disorders (IFFGD) is a non profit education and research organization that provides free articles written by medical professionals, updates on key issues, and a grassroots arm dedicated to fundraising for research and advancing legislation that benefits the functional GI community
http://www.iffgd.org/

AboutIBS.org is a resource provided by IFFGD for health knowledge, support, and assistance about functional GI and motility disorders, focusing on IBS
http://www.aboutibs.org/

The Irritable Bowel Syndrome webpage on the National Institutes of Health – National Institute of Diabetes and Digestive and Kidney Diseases website provides general information on IBS symptoms, causes, diagnosis, treatment, and diet
https://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/irritable-bowel-syndrome/Pages/overview.aspx

Learn more about IBS

References

  1. Canavan C et al. Clin Epidemiol 2014; 6: 71-80.
  2. Sperber AD et al. Gut 2016; doi: 10.1136/gutjnl-2015-311240 [Epub ahead of print].
  3. Saito YA et al. Am J Gastroenterol 2002; 97: 1910-1915.
  4. Adeymo MA et al. Aliment Pharmacol Ther 2010; 32: 738-755.
  5. Chang L, Heitkemper MM. Gastroenterology 2002; 123: 1686-1701.
  6. Saito YA. Gastroenterol Clin North Am 2011; 40: 45-67.
  7. Levy RL et al. Gastroenterology 2001; 121: 799-804.
  8. El-Salhy M. World J Gastroenterol 2015; 21: 7621-7636.
  9. Mayer EA et al. Nat Rev Gastroenterol Hepatol 2015; 12: 592-605.
  10. Chey WD et al. JAMA 2015; 313: 949-958.
  11. Qin HY et al. World J Gastroenterol 2014; 20: 14126-14131.
  12. Heitkemper MM, Chang L. Gend Med 2009; 6 Suppl 2: 152-167.
  13. Kane SV et al. Am J Gastroenterol 1998; 93: 1867-1872.
  14. MacPherson H et al. BMC Gastroenterol 2012; 12: 150.
  15. Manheimer E et al. Am J Gastroenterol 2012; 107: 835-847.
  16. McKenzie YA et al. J Hum Nutr Diet 2012; 25: 260-274.
  17. DeWeerdt S. Nature 2016; 533: S108-S109.
  18. Ford AC et al. Am J Gastroenterol 2014; 109 Suppl 1: S2-S26.
  19. Moayyedi P et al. Am J Gastroenterol 2014; 109: 1367-1374.
  20. Gibson PR, Muir JG. Gastroenterology 2013; 145: 693.
  21. Gibson PR, Shepherd SJ. Aliment Pharmacol Ther 2005; 21: 1399-1409.
  22. Ford AC et al. Arch Intern Med 2009; 169: 651-658.
  23. American College of Gastroenterology Task Force on Irritable Bowel Syndrome et al. Am J Gastroenterol 2009; 104 Suppl 1: S1-S35.
  24. Quigley EM. Therap Adv Gatroenterol 2016; 9: 199-212.
  25. Hickey M et al. BMJ 2014; 348: g1752.
  26. Issa B et al. Gut 2012; 61: 367-372.