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Irritable Bowel Syndrome (IBS)

Gary M. Gray, M.D.

Irritable bowel syndrome (IBS), also known as spastic colon or functional bowel syndrome, is a very common condition, affecting as many as 10 or even 20 percent of adults in the Western world.(1) IBS symptoms usually include moderately intense abdominal pain, most often in the left lower area, and bouts of "loose bowels," or multiple stool passages over several days, alternating with periods of infrequent stool output (constipation). From time to time, many of us have these symptoms. It's only when they recur regularly and last several weeks that one should begin to consider they might be caused by IBS.

IBS is usually diagnosed in young adulthood and is at least twice as common in women as in men. Although most people with IBS simply accept their symptoms as a nuisance and never seek medical attention,(2) it is still the most common gastrointestinal problem seen by family doctors and internists.(3)

IBS is usually diagnosed in young adulthood and is at least twice as common in women as in men.

Women, more than men with IBS, are more likely to complain of constipation and abdominal bloating(4) but both often feel a sensation of fullness and distension in the abdomen.(5) The bloating sensation is rarely associated with actual gas retention or passing unusually large amounts of gas.(6)

Though sufferers report characteristic multiple stool passages, it is not true "diarrhea" because the stools tend to be small in volume. They are passed in relatively rapid succession, typically in the early morning, over a period of 30 minutes to an hour. A mucus coating is often observed but there is no visible blood.

An important distinction is whether there is a brief "squirt" of stool or a "gush" that lasts for several seconds. The first is typical of IBS, while the second would point to an infection, or perhaps an inflammatory condition.

Before the diagnosis of IBS can be made, your physician will search for other possible causes of the altered stool output. A flexible sigmoidoscopy and barium enema, or a full colonoscopy should be done. These flexible fiberoptic instruments enable the doctor to exclude infection or inflammatory bowel disease (ulcerative colitis or Crohn's disease), both of which can cause similar symptoms. Because inflammation of the colon can sometimes be difficult to detect even with these methods, the doctor will often take a tiny piece of tissue, a biopsy, for microscopic evaluation.

Associations and Risk Factors

More than one-third of people with IBS have symptoms that are also typical of functional, or "non-ulcer," abdominal discomfort ("dyspepsia").(7) In contrast to dyspepsia, abdominal discomfort in IBS is not usually associated with ingestion of meals.

IBS is associated with a variety of seemingly unrelated conditions in ways that are not well understood. For example, those with recurring episodes of abdominal pain in childhood and adolescence are at greater risk of developing IBS as adults.(8) Psychologically depressed patients are 10 times more likely to develop IBS.(9) Panic disorder,(10) schizophrenia(11), sexual dysfunction and the occurrence of physical or sexual abuse during childhood(12),all seem to be associated in some way with the development of IBS.(13)

Some studies point to gastroenteritis, caused by infection, as a pre-existing cause of IBS.(14)(15)

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