Common questions about irritable bowel syndrome

Apr 4 2007

Will adding fiber to my diet bring relief? Are dairy products really off limits? Is there a way to actually diagnose what I have, or is it all in my head?

Those are just some of the many questions asked by people suffering from irritable bowel syndrome, or IBS, an often painful disorder of the lower intestine that causes cramping, abdominal pain, bloating, constipation and diarrhea.

While IBS is a common disorder – affecting 10 to 15 percent of the U.S. population – it's also one of the most misunderstood among patients and physicians alike, says William D. Chey, M.D., a gastroenterologist at the University of Michigan Health System.

“There are a wide spectrum of symptoms that IBS patients can experience, which can make it challenging to diagnose,” says Chey, director of the Gastrointestinal Physiology Laboratory in the U-M Division of Gastroenterology. “While we know diet does play a role in symptoms for many patients with IBS, those trigger foods often vary from person to person.”

To help people with IBS gain a better understanding of the condition and how it's diagnosed, as well as what foods may trigger symptoms, and the over-the-counter and prescription treatments available, Chey offers these seven tips to help separate IBS fact from fiction.

7 common myths – and facts – about IBS

1.MYTH: IBS is psychosomatic
FACT: For many years, physicians believed IBS was a psychological condition – it only existed in the patient's head. While some patients with IBS experience depression or anxiety, it is likely that psychological distress or stress worsen IBS, but may not be the primary cause of it.

2. MYTH: IBS only affects young women
FACT: Although IBS does tend to occur more frequently in women, Chey says, “it's important that people know that there are many men diagnosed with IBS, and it also affects the elderly. In fact, there's some early evidence to suggest that IBS affects 8 to 10 percent of older individuals.”

3. MYTH: IBS is not an important condition
FACT: “Many physicians believe that IBS is not an important condition because it does not affect a person's lifespan,” says Chey. While that may be the case, IBS
can significantly impact a person's quality of life and ability to function on a day-to-day basis, and should be taken seriously by doctors and patients alike.

4. MYTH: IBS is related to lactose intolerance
FACT: About a quarter of patients with IBS are also lactose intolerant. However, Chey notes that about a quarter of the general population who don't have IBS are lactose intolerant as well. So, he says, while lactose intolerance may play a role in some patients, it is not the cause of symptoms in the vast majority of patients with IBS.

5. MYTH: IBS means a lifetime of bland food
FACT: “A lot of patients with IBS end up on these very bland diets, and I think most of the time it is not justified,” says Chey. Instead, Chey has his patients keep a diary to record all of the food that they eat, and any symptoms they may experience.

“At the end of a two week period, it's possible to get a fairly good idea about whether there are specific trigger foods associated with the onset of symptoms. Those foods then can be easily eliminated from a patient's diet.” Certain foods, however, such as fatty foods, milk products, chocolate, alcohol, caffeine and carbonated drinks are more likely to aggravate symptoms in some IBS patients.

6. MYTH: IBS cannot be accurately diagnosed
FACT: Contrary to what some physicians believe, Chey says most patients do not need a lot of medical tests to be diagnosed with IBS. “Identifying the presence of persistent or recurrent abdominal pain in association with altered bowel habits, and excluding warning signs (e.g. new symptoms occurring after age 50, GI bleeding, unexplained weight loss, nocturnal diarrhea, severe or progressively worse symptoms or a family history of colon cancer, inflammatory bowel disease, colon cancer or celiac disease), is enough to accurately diagnose IBS in most patients.”

7. MYTH: There are no good treatment options for IBS
FACT: Not true, says Chey. With effective counseling, dietary and lifestyle intervention, and use of over-the-counter or prescription medications, IBS can be effectively managed. “Treating infrequent or mild symptoms with over-the-counter medication is effective for most patients,” he says. “If symptoms are persistent, however, it's important to see your physician because the excessive use of over-the-counter medications can actually lead to more gastrointestinal symptoms.” If symptoms doe not improve with changes in diet and lifestyle, or over-the-counter medications, prescription medications are available for people with IBS.