Irritable Bowel Syndrome Expanded Version

Irritable bowel syndrome (IBS) is a common disorder affecting over 15 percent of the population. The following information has been prepared to help patients and their families understand IBS, including the symptoms, causes, evaluation, and treatment options.

IBS is one of a range of conditions known as functional gastrointestinal disorders. While no structural abnormalities exist and nothing abnormal is seen on tests, the bowel may function abnormally.  IBS is sometimes referred to as spastic colon, spastic colitis, mucous colitis or nervous stomach . These are outdated terms. IBS should not be confused with Inflammatory Bowel Disease (commonly referred to as IBD) which is primarily made up of ulcerative colitis and Crohn’s disease. Importantly, treatment for IBS is medical, and surgery is not indicated for this problem.

WHAT ARE THE SYMPTOMS OF IBS?

People with IBS may experience abdominal pain and changes in bowel habits, either diarrhea, constipation, or both at different times. Patients often have symptoms that tend to be more diarrhea-predominant or constipation-predominant. Symptoms may be mild or severe and vary from person to person. The symptoms may come and go and can change over time. The most common symptoms of IBS are abdominal pain, fullness, gas and bloating. Other symptoms associated with IBS include abdominal cramps, generalized abdominal aches, abnormal stool consistency, and passage of mucous, urgency or a feeling of incomplete bowel movements. Symptoms often occur when there is a change in the frequency of bowel movements. IBS discomfort is often improved after a bowel movement.

WHAT CAUSES IBS?

While there is no definite cause of this syndrome, the symptoms of IBS seem to occur as a result of abnormal functioning or communication between the nervous system and the muscles of the bowel. This abnormal regulation may cause the bowel to be “irritated” or more sensitive. The muscles in the bowel wall may contract too forcefully or too weakly, or even too slowly or rapidly at certain times. Although there is no physical obstruction to stool, a patient may feel the cramps as if there were a blockage to the passage of stool through the colon.

IBS happens nearly twice more often in women than men. Sometimes IBS occurs after an intestinal infection — known as post-infectious IBS. Environmental factors, genetic factors, bacterial fermentation in the gut, bacterial overgrowth, food intolerance, altered bowel motility, intestinal hypersensitivity, altered nervous system processing, and alterations in hormonal regulation have all been considered as possible causes of IBS.

Recent studies suggest that IBS symptoms are not all caused by a single mechanism, but are the result of different mechanisms acting on the intestines. Intestinal irritants, such as poorly digested carbohydrates or fats, excess bile, intolerance of certain foods and genetic predisposition to intestinal inflammation may all play a role in the symptoms of IBS. These various factors in the intestines or bowel wall may activate reflexes that change intestinal function or secretion. Irritants may also stimulate nerves in the bowel wall leading to intestinal hypersensitivity and pain.

WHAT ROLE DOES STRESS PLAY IN IBS?

IBS is not caused by stress. It is not a psychological or psychiatric disorder; however, emotional stress may contribute to IBS symptoms. Many people may experience increased symptoms of IBS when nervous or anxious. Reducing the sources of stress in our lives may help to alleviate the symptoms of IBS.

HOW CAN I TELL IF THE PROBLEM IS IBS OR SOMETHING ELSE?

No test can confirm the diagnosis of IBS. Instead, it is often considered a “diagnosis of exclusion”, meaning other diseases must be ruled out before calling the problem IBS in a given patient. However, there are specific features that are needed to make the diagnosis of IBS, including abdominal pain or discomfort at least 3 days per month in the previous 3 months with two or more of the following features: improvement of symptoms after a bowel movement, onset associated with a change in frequency of stool and/or change in the form (appearance) of stool. A careful history and physical examination by a gastroenterologist, colon and rectal surgeon or other physician are needed to exclude more serious disorders. Tests may include blood tests, stool tests, flexible sigmoidoscopy or colonoscopy, and x-ray studies.

Fever, anemia (low red blood cell levels), rectal bleeding and unexplained weight loss are not symptoms of IBS and must be promptly evaluated by your physician. Other signs or symptoms that call for special consideration include: new onset of symptoms at age 50 or older, nighttime symptoms that awaken the patient, changes in symptom quality, recent use of antibiotics or family history of other intestinal diseases such as inflammatory bowel disease or cancer.

Eating a lactose-free diet for 2 weeks may help your physician check for a possible lactose intolerance that can cause similar symptoms.

HOW IS IBS TREATED?

Understanding that IBS is not a serious or life threatening condition may help relieve anxiety and stress, which contribute to the problem. Stress reduction, use of behavioral therapy, physical therapy, biofeedback, relaxation or pain management techniques can help relieve the symptoms of IBS in some individuals. Use of a diary may help identify certain foods or other factors that cause symptoms. Surgery is not indicated for IBS.

The goal of treatment is to relieve symptoms. Lifestyle changes such as regular exercise and improved sleep habits may be helpful. Dietary changes can also be helpful in some patients. Several different types of food substances seem to contribute to symptoms in patients with IBS. These foods are often referred to by the acronym FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) and include complex sugars such as lactose, fructose, galactose, sorbitol, mannitol and xylitol. A low FODMAP diet may be beneficial in some people with IBS. Gluten intolerance may also contribute to symptoms in patients with IBS, even if they do not have celiac disease. Gas producing foods such as beans, cabbage, cauliflower, broccoli, brussel sprouts and onions may contribute to bloating and discomfort in people with IBS.

Dietary fiber can play either a positive or negative role in IBS. Soluble fiber such as that found in citrus fruits, flaxseeds and legumes may help soften stool and lessen the severity of cramps. Insoluble fiber found in cellulose, cereals and bran can absorb water and lessen diarrhea. In some people, too much fiber can increase bloating and cause discomfort.

Probiotics or “good bacteria” may also improve the symptoms of IBS and can be used to supplement other dietary changes. Probiotics come in different forms and it may take some trial and error to find one that works best for you.

Individuals with moderate to severe IBS may benefit from prescribed medication. No one medication will work for everyone. Medications that your doctor might try include: anticholinergic medications to help control intestinal spasms, such as dicyclomine, propantheline, belladonna, or hyoscyamine. Side effects may include dry mouth, difficulty urinating, blurred vision and racing heart beat. Bisacodyl can be used to treat constipation. Loperamide may be used to treat diarrhea. Antidepressants in low doses have been shown to be helpful in some with IBS. Rifaximin, an antibiotic used for 2 weeks, has been shown to be helpful in some patients without constipation who have IBS. This suggests that intestinal bacteria may play a role in causing IBS in some people.

HOW LONG DOES THE TREATMENT TAKE TO RELIEVE SYMPTOMS?

Relief of IBS symptoms is often a slow process. It may take six months or more for definite improvement to be appreciated. Patience is very important in dealing with this problem. The tendency for the intestine to respond to stress will always be present. With attention to proper diet and in some cases, use of appropriate medications, the symptoms of IBS can be greatly improved or eliminated.

WHAT IF I CHOOSE TO DO NOTHING?

IBS does not lead to more serious problems, and it does not cause cancer, bleeding or inflammatory bowel diseases such as ulcerative colitis. If nothing is done, symptoms will usually continue. The symptoms may come and go, they may get better or worse with time and may continue to impact your quality of life.

QUESTIONS FOR YOUR DOCTOR:

  • What is IBS?
  • What causes IBS?
  • Does stress cause IBS?
  • How is IBS diagnosed?
  • Are there tests to confirm IBS?
  • Do I need a colonoscopy or more tests?
  • Is IBS a “serious illness”?
  • Can IBS lead to other serious diseases?
  • What are my options for treating IBS?
  • Do certain foods affect my symptoms?
  • Will my IBS symptoms resolve?

WHAT IS A COLON AND RECTAL SURGEON?

Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum, and anus. They have completed advanced surgical training in the treatment of these diseases, as well as full general surgical training. Board-certified colon and rectal surgeons complete residencies in general surgery and colon and rectal surgery, and pass intensive examinations conducted by the American Board of Surgery and the American Board of Colon and Rectal Surgery. They are well versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions, if indicated to do so.

DISCLAIMER

The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention and management of disorders and diseases of the colon, rectum and anus. These brochures are inclusive but not prescriptive. Their purpose is to provide information on diseases and processes, rather than dictate a specific form of treatment. They are intended for the use of all practitioners, health care workers and patients who desire information about the management of the conditions addressed. It should be recognized that these brochures should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtain the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient. 

SUGGESTED  READINGS AND WEBSITES

Pub Med Health. Fact Sheet: Irritable Bowel Syndrome.
www.aboutibs.org/site/about-iffgd/
www.mayoclinic.com/health/irritable-bowel-syndrome/D5000106

CITATIONS

Foxx-Orenstein, A. IBS: Review and What’s New. Med. Gen. Med. 2006:  8-20
Nikfar, S., et.al.: Efficacy of Probiotics as a Treatment in Irritable Bowel Syndrome: A Meta-Analysis of Randomized Controlled Trials. Dis. Col. Rectum; 51(12): Dec.2008; 1775-1780
Talley, N.: Dietary Modification as a Treatment for Irritable Bowel Syndrome. Gast. Hep.; Aug. 2012; 552-554
Pimentel, M., Lembia, A., Chevy, W.D., et. al.: Rifaxamin Therapy for Patients with Irritable Bowel Syndrome Without Constipation. N Engl J Med; 2011; 364: 22-32
Camilleri, M.: Peripheral Mechanisms in Irritable Bowel Syndrome. N Engl J Med 2012; 367: 1626-1635
Madhulika G. Varma and Brooke H. Gurland, Chapter 32,”Constipation and Functional Bowel Disorders”. Chapter in Beck, D. E., Roberts, P. L., Saclarides, T. J., Senagore, A. J., Stamos, M. J., Wexner, S. D., ASCRS Textbook of Colon and Rectal Surgery, 2nd Edition. Springer, New York, NY; 2011.



Filter by Language:

ANAL ABSCESS AND FISTULA An anal abscess is an infected cavity filled with pus near the anus or rectum.  An anal fistula (also called fistula-in-ano) is a small tunnel that tracks from an opening inside the anal canal to an outside opening in the skin near the anus. ...
WHAT IS AN ANAL ABSCESS OR FISTULA? An anal abscess is an infected cavity filled with pus found near the anus or rectum.  Ninety percent of abscesses are the result of an acute infection in the internal glands of the anus. Occasionally, bacteria, fecal material or foreig...
The anal canal is a short tube surrounded by muscle at the end of your rectum. The rectum is the bottom section of your colon (large intestine). When you have a bowel movement, stool leaves your body from the rectum through the anal canal. Cancer begins when some of the b...
  Anal cancer is an abnormal growth of cells in or around the anus or anal canal, the short passage through which bowel movements pass. The most common type of cancer found in this location is believed to be related to a type of viral infection linked to causing other ty...
The anal canal is a short tube surrounded by muscle at the end of your rectum. The rectum is the bottom section of your colon (large intestine). An anal fissure (also called fissure-in-ano) is a small rip or tear in the lining of the anal canal. Fissures are common, but a...
  WHAT IS AN ANAL FISSURE? An anal fissure (fissure-in-ano) is a small, oval shaped tear in skin that lines the opening of the anus.  Fissures typically cause severe pain and bleeding with bowel movements.  Fissures are quite common in the general population, but are of...
Anal pain can occur before, during, or after a bowel movement. It can range from a mild ache that can get worse over time to pain that is bad enough to restrict daily activities. Anal pain has many causes, most of which are common and treatable. However, if anal pain does not...
Anal warts (condyloma acuminata) are caused by the human papilloma virus (HPV), the most common sexually transmitted disease (STD). The warts affect the area around and inside the anus, but may also develop on the skin of the genital area. They first appear as tiny spots ...
WHAT ARE ANAL WARTS? Anal warts (also called "condyloma acuminata") are a condition that affects the area around and inside the anus. They may also affect the skin of the genital area. They first appear as tiny spots or growths, perhaps as small as the head of a pin, and may...
Colorectal Cancer Risk Colorectal cancer—cancer of the colon and rectum—is the second leading cancer killer in the United States affecting both men and women.  Your risk increases as you age.  Some people are at even higher risk depending on their personal or family history....
WHY IS IT SO IMPORTANT? Colorectal cancer — cancer of the colon and rectum — is the second leading cause of cancer-related deaths in the United States for both men and women combined. The general population faces a lifetime risk for developing the disease of about 5 percent,...
WHY SHOULD THERE BE A POSTOPERATIVE FOLLOW-UP PROGRAM? Surgery is the most effective treatment for colorectal cancer. Even when all visible cancer has been removed, it is possible for cancer cells to be present in other areas of the body. These cancer deposits, when very...
Following treatment for either colon or rectal cancer, ongoing follow-up to detect recurrent disease is considered an important part of patient care for colorectal cancer. Colorectal cancer follow-up refers to a systematic approach to monitoring patients for new or recurr...
Colon cancer (commonly referred to as colorectal cancer) is preventable and highly curable if detected in early stages. The colon is the first 4 to 5 feet of the large intestine. Colorectal cancer tumors grow in the colon’s inner lining.  FACTS AND STATS In 2017, nearly...
Colon cancer is a common malignancy in the United States. The treatment of patients with colon cancer can be complicated and may require a team of surgical and medical specialists. This review provides general information for patients and their families, covering colon ca...
There are many myths and legends surrounding colon cancer, which can be entirely preventable. The following helps to set the record straight. If you are concerned about colon cancer, or if you have a strong family history of colorectal cancer, ask your doctor if you need ...
  WHAT IS COLONOSCOPY? Colonoscopy is an effective procedure to diagnose abnormalities of the large intestine and to screen for colorectal cancer and colorectal polyps. A colonoscope is a long, thin flexible instrument that provides magnified views of the colon and rectum...
WHAT IS CONSTIPATION Constipation, a common complaint, is usually simple to prevent and easy to treat when it occurs. However, constipation may reflect a more serious problem that will require the help of your medical provider to suggest tests, medical intervention and, ...
  Constipation is a very common complaint affecting upwards of 15% of all Americans.  Fortunately, constipation usually is simple to avoid and easy to treat when it occurs.  However, symptoms of constipation may be a sign of a more serious problem requiring medical atten...
Crohn’s disease is an incurable inflammatory disorder that can affect any part of the gastrointestinal tract. The gastrointestinal tract is a system of body organs responsible for carrying and digesting food, absorbing nutrients, and getting rid of waste. Inflammation (re...
OVERVIEW Crohn's disease is a chronic inflammatory disease of unknown origin potentially affecting all parts of the gastrointestinal tract.   While medical management of the disease is the first choice, surgery may be indicated for specific reasons.  This information was...
Diverticular disease is the general name for a common condition that causes small bulges (diverticula) or sacs to form in the wall of the large intestine (colon). Although these sacs can form anywhere in the colon, they are most common in the sigmoid colon (part of the l...
OVERVIEW The purpose of this patient education piece is to provide patients with information on the background, causes, and treatments of diverticular disease and its complications.  It may also be useful to the friends, families, and caregivers of patients dealing with ...
  Enhanced recovery after surgery, known as ERAS is a multimodal approach to surgical care that has been shown to improve recovery after surgery, especially in patients undergoing colorectal surgical bowel resections. Patients typically experience less pain, faster reco...
WHAT IS FECAL INCONTINENCE? Fecal incontinence (also called anal or bowel incontinence) is the impaired ability to control the passage of gas or stool. This is a common problem, but often not discussed due to embarrassment. Failure to seek treatment can result in social ...
OVERVIEW The purpose of this patient education piece is to provide patients and their families with information on the background, causes, and treatments of fecal incontinence.  This is intended for a general audience. WHAT IS FECAL INCONTINENCE? Fecal incontinence is ...
What is colorectal cancer? Colorectal cancer is cancer of the colon and rectum that begins with the development of pre-cancerous polyps from the lining of the colon and rectum. What is a polyp? Polyps are mushroom-like growths that form when cells lining the colon grow, di...
Often described as "varicose veins of the anus and rectum,” hemorrhoids are enlarged, bulging blood vessels in and around the anus and lower rectum. The rectum is the bottom section of your colon (large intestine). The tissues supporting the vessels stretch. As a result, ...
WHAT ARE HEMORRHOIDS? It is important to note that all people have hemorrhoidal tissue as part of their normal anatomy. Only in a minority of people do hemorrhoids become enlarged or otherwise symptomatic. Hemorrhoidal tissue lies within the anal canal and perianal area ...
THE ROLE OF GENETICS Genes are inherited from each parent. They determine various physical features and may predispose people to certain diseases. All cancers, but especially colon and rectal cancers, commonly referred to as colorectal cancer (CRC), have hereditary facto...
THE ROLE OF GENETICS Genes are made up of DNA. They are the basic units inside a cell by which we inherit traits from our ancestors and pass down traits to our children. Our genetic information, found in our DNA, determines much about us: for example, our eye and hair co...
Irritable bowel syndrome (IBS) is a common disorder, affecting an estimated 15% of the population. It is one of the several conditions known as functional gastrointestinal disorders. This means the bowel may function abnormally, but tests are normal and there are no detec...
Irritable bowel syndrome (IBS) is a common disorder affecting over 15 percent of the population. The following information has been prepared to help patients and their families understand IBS, including the symptoms, causes, evaluation, and treatment options. IBS is one ...
Laparoscopic or “minimally invasive” surgery is a specialized technique for performing surgery. In the past, this technique was commonly used for gynecologic surgery and for gall bladder surgery. Over the last 10 years the use of this technique has expanded into intestinal s...
  Many diseases and conditions of the colon and rectum are treated surgically. A surgeon may use traditional (open) or minimally invasive techniques depending on the individual case.   TRADITIONAL COLON AND RECTAL SURGERY In open abdominal surgeries, surgeons typicall...
OVERVIEW There are a variety of diseases and conditions of the colon and rectum for which surgery is recommended.  In addition to the decision to undergo surgery, patients are often faced with a choice of traditional or minimally invasive surgical techniques.  In order t...
Obstructed Defecation Syndrome (ODS)
OVERVIEW An ostomy is a surgically created opening between an internal organ and the body surface. Ostomies are often created as a part of intestinal surgery when there must be a new way for intestinal waste to leave the body.  This information was prepared to help patie...
  Pelvic floor dysfunction is a group of disorders that change the way people have bowel movements and sometimes cause pelvic pain. These disorders can be embarrassing to discuss, may be hard to diagnosis and often have a negative effect on quality of life. Symptoms vary...
Pelvic floor dysfunction includes a group of disorders causing abnormalities of bowel storage and bowel emptying, as well as pelvic pain.   This information is intended to help patients gain a better understanding of the disorders making up pelvic floor dysfunction, as we...
Pilonidal disease is a chronic skin infection in the crease of the buttocks near the coccyx (tailbone). It is more common in men than women and most often occurs between puberty and age 40. Obesity and thick, stiff body hair make people more prone to pilonidal disease. ...
Colorectal polyps are commonly found during standard screening exams of the colon (large intestine) and rectum (the bottom section of your colon). They affect about 20% to 30% of American adults. Polyps are abnormal growths that start in the inner lining of the colon or rec...
Pruritis ani is a common medical problem affecting both men and women. This information was composed to help patients understand pruritis ani, its symptoms, evaluation, and treatment options.  This information may also be helpful to individuals or caregivers of patients w...
Pruritis ani means “itchy anus” in Latin. This condition causes irritation of the skin near the anus, resulting in a strong urge to scratch the area. In many cases, no specific problem is found to explain the itching. These cases are called “idiopathic” (from unknown caus...
The rectum is the last 6 inches of the large intestine (colon). Rectal cancer arises from the lining of the rectum. In 2012, more than 40,000 people in the United States will be diagnosed with colorectal cancer, making it the third most common cancer in both men and women. ...
Rectal prolapse is a condition in which the rectum (the last part of the large intestine) loses the normal attachments that keep it fixed inside the body, allowing it to slide out through the anal opening, turning it “inside out.” Rectal prolapse affects mostly adults, but wo...
This patient education piece is designed to help improve patients’ understanding regarding rectal prolapse, specifically its presentation, evaluation and treatment. This information may also be useful to the friends, families, and caregivers of patients dealing with rectal pr...
A rectocele is a bulging of the front wall of the rectum into the back wall of the vagina. The rectum is the bottom section of your colon (large intestine). This is a very common problem that often does not produce symptoms. Other pelvic organs can bulge into the vagina, incl...
WHAT IS A RECTOCELE? A rectocele is a herniation (bulge) of the front wall of the rectum into the back wall of the vagina. The tissue between the rectum and the vagina is known as the rectovaginal septum and this structure can become thin and weak over time, resulting in a r...
WHAT IS THE RISK OF COLORECTAL CANCER? Colorectal cancer is the fourth most common non-skin cancer, affecting all ethnic groups. 140,000 people will be diagnosed with colorectal cancer each year and more than 50,000 will die; the lifetime risk is 1 in 20 (5%).  An increa...
Colorectal cancer is a common malignancy for both men and women.  Screening for colorectal cancer is the process of identifying apparently healthy people who may be at increased risk of developing this disease. This information was prepared to help patients understand the...
Colorectal cancer — cancer of the colon and rectum — is the second leading cancer killer in the United States and all women and men aged 50 and older are at risk. The good news is that colorectal cancer is preventable and, if detected early, curable. Depending upon your ag...
Get regular colorectal cancer screenings beginning at age 45.* If you have a personal or family history of colorectal cancer or colorectal polyps, or a personal history of another cancer or inflammatory bowel disease, talk to your doctor about earlier screening. Eat plen...
Screening tests for colorectal cancer can save 30,000 lives each year. These tests not only detect colorectal cancer early, but can prevent colorectal cancer. In one test, non-cancerous polyps are removed before they become cancer. When you turn 45* years old, or if you are y...
WHAT IS THE COLON? The colon is also known as the large bowel or large intestine. It is an organ that is part of the digestive system (also called the digestive tract) in the human body. The digestive system is the group of organs that allow us to eat and to use the food we ...
WHAT IS ULCERATIVE COLITIS? Ulcerative colitis (UC) is an inflammatory disease potentially affecting the entire large bowel (colon and rectum). The inflammation is confined to the innermost layer of the intestinal wall (mucosa). UC can go into remission and recur. Medica...
WHAT IS HPV? HPV stands for human papillomavirus. HPV is a collection of 150 related viruses that can cause a variety of different problems of the genital and anal skin. It is the most common sexually transmitted infection (STI) and can cause genital and anal warts, a pr...