Digestive Disorders > IBS

IBS basics: All you need to know

Dr. med. Andre Sommer

Dr. med. Andre Sommer

Irritable bowel syndrome (IBS) is a complex and multifaceted disease. Below is an overview of what makes the disease different, what causes it, and what you can do if you experience this syndrome.

What is irritable bowel syndrome?

IBS is a group of symptoms of functional gastrointestinal disorders. A disease is considered “functional” if no physical (organic) causes for the symptoms can be found through medical examinations.

Many people have had gastrointestinal problems in their lives before, or have sporadically had a sensitive stomach. About 20 percent of the population, however, is affected by IBS, making it one of the most common functional gastrointestinal disorders. IBS sufferers have complaints such as stool urgency, diarrhea, distended abdomen, bloating, abdominal pain, and constipation; these symptoms can permanently affect one’s quality of life.

So it is not surprising that every second patient with gastrointestinal complaints is affected by IBS. Irritable bowel syndrome can thus be described as a widespread disease, similar to, for example, diabetes, hypertension, and depression.

It can occur in all age groups. Between the ages of 10 and 30, women are twice as likely to be affected as men. Overall, women are more likely to suffer from IBS than men.

How does IBS develop?

Despite extensive research, physicians cannot find a clear physical (organic) cause for the symptoms involved in irritable bowel syndrome.

Psychosomatic connections are primarily responsible for IBS. “Psychosomatic” means that there are interactions between the body and the mind involved. We often speak of the so-called “gut-brain axis” in this context. Mental factors, such as stress, can worsen IBS because they affect the physical and mental processes through the nerves and stress hormones. Conversely, physical processes can also affect the mind.

Examples of these physical processes include the smallest inflammation of the intestinal mucosa, a disturbed immune system in the intestine, and changes in the bacterial composition of the intestinal flora (microbiome).

An imbalance of the bacterial intestinal flora can be caused, for example, by a strong gastrointestinal infection; in this case one refers to postinfectious irritable bowel syndrome. It is assumed here that postinfectious IBS is a kind of “scar” in the infected intestine. Irritable bowel symptoms can persist for weeks, months, and years in this case.

In addition, it is thought that a disturbed function of the gut-brain axis could play a role. For example, sufferers perceive stronger pain stimuli from the intestine. The autonomic nervous system, which controls the handling of stress, is usually overactive in irritable bowel patients. In addition, the mobility and activity (motility) of the intestine is disturbed in those affected, so that food cannot be digested as usual and transported through the intestine. The disturbed motility probably also favors bacterial overgrowth in the intestine.

There is also a certain heredity (genetic predisposition) with IBS.

Why is irritable bowel so distressing?

Many sufferers must regularly deal with IBS symptoms, so their normal everyday life gets impacted. With increased bowel urgency, sufferers are constantly looking for a toilet so that they can go quickly if necessary. There are also often uncertainties and fears when at work; abdominal cramps, flatulence, and bowel sounds can complicate work.

Many people with IBS shy away from restaurant visits as many foods cause discomfort. Social activities are reduced to avoid problems. The resulting psychological stress can, in turn, reinforce irritable bowel symptoms and create a vicious cycle of physical and mental discomfort.

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How is irritable bowel diagnosed?

At present, an IBS diagnosis can only be made by excluding other diseases. For example, food intolerances and other diseases of the gastrointestinal tract should be excluded by careful examinations (e.g. colonoscopy, stool examinations). Other possible diseases (differential diagnoses) should also be excluded by appropriate tests. A specific IBS test using different blood parameters (biomarkers) is still in the clinical trial phase.

If other conditions have been ruled out, if the person feels their quality of life is reduced, and if the distressing symptoms appear over a period of more than three months, this fits the definition of irritable bowel syndrome.

What can be done for IBS?

Many sufferers feel they are in bad hands with their doctors because there is little time left in the practice for proper irritable bowel therapy. Irritable bowel treatment is also very individual, as the symptoms can vary greatly from person to person. Nevertheless, there are some effective treatment options that can relieve the symptoms of those affected.

There is no treatment method that is effective on its own, but the combination of different treatment options can provide relief.

  • **The low-FODMAP diet **has proven to be effective as a nutritional measure and relieves symptoms in more than 70 percent of those affected.
  • Food intolerances: It is also important to clarify the existence of food intolerances and to follow a corresponding diet (e.g., a lactose-free diet). Nutritional advice can be helpful here.
  • Psychotherapy, biofeedback and stress relief techniques can also be used. Biofeedback is a technique that makes certain body processes (“bio”), such as the heart rate, visible (“feedback”). This allows affected persons to practice having a positive influence on their own body.
  • Other factors: Moderate movement has been shown to have a positive effect, as has talking with other people who experience IBS (e.g.,in self-help groups).

The therapy should be individually and differently weighted for each affected person; a symptom diary can help to uncover specific connections.

Which medications help with IBS?

Some medications can relieve various symptoms of irritable bowel syndrome. Common to all remedies is that they can only alleviate symptoms; they do not combat the cause of IBS. In addition to probiotics, anticonvulsant substances, and herbal remedies, antidepressants are also occasionally used to treat IBS-related pain.

Is IBS dangerous?

Since the quality of life of sufferers is often impacted, many worry about whether life expectancy is reduced for those who suffer from IBS for a long period. So far, however, these fears have not been confirmed.

But this should not lead to physicians taking the symptoms of those affected lightly: IBS is more of a problem for those affected than many other chronic illnesses such as hypertension. On the contrary, therapy at different levels should alleviate IBS symptoms to help avoid psychological issues caused by the heavy burden.

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Dr. med. Andre Sommer

Dr. med. Andre Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara.

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