Digestive Disorders > IBS

Irritable bowel symptoms: All you need to know

Dr. med. Andre Sommer

Dr. med. Andre Sommer

Irritable bowel symptoms differ from person to person. In general, symptoms often include the following:

  • Acute stomach pain,
  • Feeling of fullness,
  • Flatulence, and/or
  • Irregular stool and bowel movements.

However, sufferers can experience various irritable bowel symptoms of different intensities. While women mainly report abdominal pain and constipation, men with IBS more often report diarrhea as the main complaint. Doctors usually cannot find an organic cause for IBS symptoms, which is often frustrating for those affected. Current irritable bowel research, however, has opened up new explanations for the development of chronic bowel disease and is accelerating the development of new therapy formats.

Taking into account the latest research, we at CARA CARE have developed an app with a special IBS program to help people affected by IBS.

When do symptoms of IBS appear?

IBS symptoms can start gradually. Some sufferers say they have always had a sensitive stomach until they seek help with more severe symptoms. In other cases, irritable bowel symptoms develop after gastrointestinal infection (known as post-infectious IBS) or after antibiotics. Often, the first thing you notice is a change in the stool frequency and shape of the stool.

The symptoms do not appear equally in all affected people. Some irritable bowel patients suffer from the symptoms in phases and experience days, sometimes weeks and months, during which they are almost symptom-free. In periods of increased stress **and mental tension, the symptoms are often more pronounced than at the weekend or on vacation.**

Typically, intestinal complaints appear in the morning after getting up and throughout the day, but do not make themselves felt at night when sleeping. Nevertheless, sleep disorders can also occur as a result of the burdens of the disease. The symptoms of an irritable bowel often weaken after bowel movements (defecation). However, some people suffer from the feeling that they cannot empty their bowels properly.

What are the different types of symptoms in IBS?

Basically, IBS** **can be divided into different types:

  1. **Diarrhea type **(diarrhea type, IBS-D), with diarrhea in the foreground
  2. Constipation type,** **(constipation type, IBS-C) in which constipation dominates
  3. Pain type, in which abdominal pain is the main symptom
  4. Flatulence type, in which flatulence is particularly stressful
  5. **Mixed type **(mixed type, IBS-M), in which both diarrhea and constipation occur

Before an IBS diagnosis can be made, other causes, such as food intolerance or chronic inflammatory bowel disease (e.g. Crohn's disease or ulcerative colitis), should be ruled out using appropriate diagnostics.

Once the diagnosis is made, those affected often start a long search for the triggers. New therapeutic methods for irritable bowel treatment, which can alleviate the symptoms, have been available for some years. Long-term, an irritable bowel-friendly diet is usually more effective than available medication.

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What are the main symptoms of IBS?

The symptoms very often manifest themselves in a change in the stool frequency and the shape/nature of the stool. The symptoms are very variable and affect not only the gastrointestinal tract, but also the psyche and the autonomic nervous system. The most common irritable bowel symptoms are explained in more detail below.

1. Urgency

Sufferers often feel like they have to go to the restroom, which is associated with multiple visits each day. Some people experience this symptom especially in the morning. Normal stool frequency can include up to three bowel movements a day, but a change in the stool frequency, for example from one bowel movement to four bowel movements a day, is a burden and is an indication of IBS.

2. Diarrhea

According to the Bristol stool scale, a classification of the different stool types, diarrhea is extremely watery stool with hardly any solid components. Many sufferers, however, also suffer from very pulpy stool with little or no firm lumps, which occurs with increased frequency. It is important in the diagnosis that no other cause for the diarrhea can be found.

Functional diarrhea is when two of the following symptoms occur over a period of at least three months:

  • Mashy or watery bowel movements more than 75 percent of the time
  • Increased stool frequency from three or more bowel movements per day occurring over 50 percent of the period
  • Increased stool weight compared to the normal population

3. Constipation

Very lumpy, hard, sausage-shaped stool is a sign of constipation. Along with this, the frequency of bowel movements is usually reduced. As long as the shape of the stool is soft and smooth-edged, a stool frequency of two days is considered normal. However, further diagnosis should be initiated with every type of change in stool frequency at the onset of the intestinal complaints. Constipation increases the risk of hemorrhoids.

4. Stomach pain

For many sufferers, pain is a very stressful irritable bowel symptom, which limits them significantly in everyday life. Often, the pain cannot be assigned to one point, but is distributed diffusely throughout the abdomen. The extent of the pain is not always the same, but has stronger and weaker episodes. The intensity can vary during the day, but also between different days. Abdominal cramps are also episodically responsible for an increase in pain. It is believed that the sensitivity of the internal organs to pain is increased with IBS (this is also known as visceral hypersensitivity).

5. Bloating and flatulence

Food with a potential for fermentation in particular is metabolized in the large intestine by bacteria that produce gases such as methane. These gases lead to the typical irritable bowel symptom of increased gas excretion. Flatulence is normal up to 20 times per day. If bloating occurs increasingly and there is no organic cause (such as lactose intolerance), this is considered functional bloating. However, an imbalance in the intestinal flora, as is often the case with irritable bowel patients, can lead to increased gas formation and thus bloating. Certain nutritional supplements, such as creatine monohydrate (used frequently by those interested in fitness), can also lead to malodorous flatulence. In addition, food intolerance can be a cause of flatulence.

5. Feeling of fullness, distended belly

While healthy people also experience a feeling of fullness after a particularly opulent and high-fat meal, those with IBS report a pronounced feeling of fullness even when they eat less. Increased gas formation cannot always be demonstrated objectively if you feel you have a bloated stomach. A change in pain perception via the bowel-brain axis could cause hypersensitivity, so even small amounts of gas in the intestine cause pain. An irritable bowel-friendly diet can help, here.

Small intestine colonization with bacteria is also responsible for painful gas formation and a bloated stomach, which can be diagnosed by a glucose-lactose breath test.

6. Nervous-system over-excitement with restlessness

The intestinal flora (microbiome), the intestinal nervous system, and the brain (central nervous system) influence each other. The connection is also called the microbiome-gut-brain axis and plays an important role in the development of IBS symptoms. The mutual influence of the gut and brain takes place via certain messenger substances and the autonomous (vegetative) nervous system. In irritable bowel patients, there is usually overactivation of the autonomic nervous system, which has a negative impact on the psyche (e.g. in the form of restlessness and anxiety).

Other symptoms that often occur in combination or as a result of IBS are:

  • Fatigue and exhaustion
  • Inner restlessness and nervousness
  • Depressed mood, anxiety disorders
  • Acidic regurgitation
  • Other stool changes, such as mucus admixtures
  • Headache and body aches
  • Sleep and concentration disorders
  • Circulatory problems

In the event of acute, unclear severe pain, bleeding or other noticeable symptoms, a doctor should always be consulted immediately.

Some important warning signs are:

  • Blood in the stool
  • Fever
  • Weight loss
  • Nighttime pains or colic

What symptoms lead to an IBS diagnosis?

The typical symptoms described above, such as feeling of fullness or diarrhea, do not automatically meet the diagnostic criteria of IBS. Rather, the diagnosis is made by excluding other diseases.

Likewise, there is no specific combination of symptoms required for an IBS diagnosis. However, as a guide, there are three criteria that must be met to diagnose IBS:

  • There are chronic (longer than 3 months) symptoms, such as abdominal pain and bloating, which are related to the intestine according to the patient and doctor and are usually associated with changes in bowel movements
  • The irritable bowel symptoms are so severe that the quality of life is significantly impaired and help is sought
  • It must be excluded that the irritable bowel symptoms are caused by other diseases

So far, the lack of physical causes and the exclusion of other diseases has been the focus, but now physical correlates are becoming more clear, such as micro-inflammations in the intestinal mucosa and changes in the intestinal flora (microbiome).

Every gut reacts differently to different foods. Did you know that a customized diet is one of the best ways to calm an irritated bowel? We offer special help to IBS sufferers through our digestive health app.

Layer, P. et al., 2011. S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Verdauungs-und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM). Z Gastroenterol, 49(2), pp.237-293. Online: http://www.dgvs.de/fileadmin/userupload/Leitlinien/Reizdarmsyndrom/LeitlinieReizdarmsyndrom.pdf, downloaded on 23/01/2016.

Fukudo, S., Kaneko, H., Akiho, H., Inamori, M., Endo, Y., Okumura, T., Kanazawa, M., Kamiya, T., Sato, K., Chiba, T. and Furuta, K., 2015. Evidence-based clinical practice guidelines for IBS. Journal of gastroenterology, 50(1), pp.11-30. Online: http://link.springer.com/article/10.1007%2Fs00535-014-1017-0, downloaded on 23/01/2016

Ford, A.C., Moayyedi, P., Lacy, B.E., Lembo, A.J., Saito, Y.A., Schiller, L.R., Soffer, E.E., Spiegel, B.M. and Quigley, E.M., 2014. American College of Gastroenterology monograph on the management of IBS and chronic idiopathic constipation. The American journal of gastroenterology, 109, pp.S2-S26.

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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