What Are the First Signs of Irritable Bowel Syndrome (IBS)?

The early signs and symptoms of IBS are abdominal pain and alterations in bowel habits. Abdominal pain may worsen after meals. Both diarrhea or constipation are common. 

Irritable bowel syndrome (IBS) is a common intestinal disorder that is characterized by abdominal pain and changes in bowel habits. Older terms for IBS include spastic colon, irritable colon, and nervous colon.

The exact cause of irritable bowel syndrome is unknown. However, some factors which appear causative are:

• Intestinal muscle hyperactivity
• Decreased or increased intestinal motion
• Oversensitive nerves of the intestine
• Alterations in populations of gut microorganisms (microbiome)
• Intolerance to certain foods
• Being younger than 35
• Being a woman in the Western world

Women in Western countries are two to three times more prone IBS than men. Hispanics, Asians, and Africans have a lesser prevalence of IBS than other ethnicities.

• Intolerance to fatty foods leads to abdominal fullness and related symptoms
• Consuming milk and milk products may aggravate the symptoms
• Drinking carbonated beverages can lead to gas formation and eventually abdominal pain
• Sugar and sugar substitutes can cause excess burping, cramping and diarrhea.
• Intake of caffeine and legumes can worsen symptoms of abdominal discomfort and anxiety.

Consumption of the following foods may exacerbate IBS symptoms:

• Wheat products
• Onions
• Shallots
• Garlic
• Barley
• Cabbage
• Broccoli
• Pistachio
• Artichoke
• Chicory root
• Asparagus

The early signs and symptoms of IBS are abdominal pain and alterations in bowel habits. Abdominal pain may worsen after meals. Both diarrhea or constipation are common. Other symptoms include:

• Abdominal fullness
• Indigestion
• Heartburn
• Nausea
• Vomiting
• Painful intercourse
• Poor sexual desire
• Increased urine frequency and urgency
• Increased muscle pain
• Incomplete emptying of stools
• Worsening of symptoms before the start of the menstrual period

The following are symptoms are not consistent with the IBS and should be reported to the physician:

• Fever
• Weight loss
• Appetite loss
• Blood in the stools
• Symptoms worsening at night
• Symptoms worsening over time
• The onset of disease in the middle age or the later stage of life
• Abnormally smelly stools
• Diarrhea without abdominal pain
• Gluten intolerance

Diagnostic tests include

• Laboratory tests
  • Complete blood cell count to screen for anemia, inflammation, and infection
  • Stool examinations to detect pathogens or microorganisms
  • Thyroid function tests to diagnose hyperthyroidism or hypothyroidism
  • Erythrocyte sedimentation rate to detect inflammation
  • C-reactive protein for inflammation
• CT scan to screen for tumors, obstruction and pancreatic disease
• Colonoscopy
• Gall bladder ultrasonography would be recommended in case of frequent indigestion and post-meal pain.

Treatment options include:

• lifestyle changes
• stress management
• dietary changes
• managing the symptoms with medications

No cure for IBS exists. Therefore, treatment is focussed on eliminating or lessening the severity of symptoms.

Anti-diarrheal drugs such as loperamide help in reducing the frequency of bowel movements, and laxatives, such as milk of magnesia or polyethylene glycol, may soften the stools to relieve constipation.

Other drugs that may be used to treat IBS include:

• spasm-relieving drugs (antispasmodics)
• antidepressants
• antibiotics

Antibiotics, such as rifamixin, may be used to treat the overgrowth of bacteria in the intestine.

Probiotics are an excellent source of essential gut bacteria; however, their use remains unclear.

• IBS is a chronic disease and may take years to resolve.
• Lifestyle modifications and dietary changes help control the disease.
• Dietary fiber can resolve constipation.
• Managing or avoiding stress may help to tackle the disease.
• The relapse rate for IBS is high; however, life expectancy is not affected.
• Antidepressants are prescribed for anxiety or depression, which exacerbate IBS symptoms.