Beating the Bloat: What’s the Word on Irritable Bowel Syndrome?

by Nidhi Malhotra, MD, Gastroenterologist
June 12, 2020

Every day, millions of Americans experience the debilitating symptoms of irritable bowel syndrome (IBS). If you have recurrent abdominal pain at least once a day over the course of three months, you may be suffering from this chronic gastrointestinal (GI) disorder.

It affects the large intestine, causing two major symptoms—abdominal pain/cramping and a change in bowel movement frequency or form. Other symptoms can include:

  • Abdominal bloating
  • Straining
  • Urgency with bowel movements
  • Passage of mucus
  • Sense of incomplete evacuation

Underlying Causes

Patients may not be aware they have IBS because several different GI issues may cause similar symptoms. It may overlap with another underlying disorder that hasn’t been diagnosed, or it may develop after an acute episode of gastroenteritis, aka, the stomach flu.

A growing body of literature indicates that small intestinal bacterial overgrowth, or SIBO, may be a major overlapping cause of similar symptoms. Treating SIBO can actually help improve chronic underlying bowel issues.

The disorder may also be accentuated by the gut-brain axis, meaning the nerves in the gut react to stress, depression, anxiety, and other mental stresses felt in the brain.

@DrNidhiMalhotra says that IBS could be caused by an underlying disorder that’s not been diagnosed. https://bit.ly/2UrHd3G via @MedStarWHC
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Women and Younger People Are Affected Most Often

This disorder has a 30% higher prevalence in women. And although my practice has a predominance of females with this disorder, it certainly can affect males as well.

Also, the incidence is traditionally lower in people over the age of 50 compared with patients younger than that.

How MedStar Washington Hospital Center Can Help

MedStar Washington Hospital Center has a comprehensive approach to patients suffering from this GI disorder. We want to make sure we conduct a full history and physical exam, to identify the red flags and apply appropriate interventions or diagnostic procedures, such as a colonoscopy or endoscopy when appropriate.

At MedStar Washington Hospital Center, we have the ability to diagnose SIBO via an objective test called the lactulose breath test. Using the lactulose breath test, we can objectively diagnose or rule out SIBO as an underlying cause of gastro-intestinal issues and begin to treat patients appropriately.

We have a registered dietitian as part of our team, which means that a patient who may need to go on a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet—one that avoids complex carbohydrates and alcohols that trigger digestive symptoms—can do so under supervision and guidance. Our team also has physicians who have advanced training in diagnosing and treating inflammatory bowel disease (IBD), if that’s pinpointed as the underlying cause of a patient’s symptoms.

Identifying Inflammatory Bowel Disease

Generally, physicians can check for blood markers to look for inflammation, a good way to differentiate between IBS and inflammatory bowel disease.

A stool study called the fecal calprotectin test can help with this differentiation and potentially avoid unnecessary diagnostic testing, while at the same time pointing toward the need for endoscopy, if abnormal.

Discovering the Right Treatment Approach

First and foremost, we look to rule out SIBO, which is increasingly identified as the cause of bloating and diarrhea in patients with irritable bowel syndrome.

We usually treat SIBO with a non-absorbable antibiotic, meaning an antibiotic not absorbed out of the GI tract. It stays in the GI tract. We may follow that with a low-FODMAP diet for a short period of time under the guidance of our dietitian.

The low-FODMAP diet has been shown to decrease symptoms of bloating and diarrhea in patients with SIBO and IBS. But rigorous trials of dietary manipulation in patients with the syndrome are lacking, so it’s difficult to make strong recommendations, but certainly helpful to try, especially with diagnosed SIBO.

Identifying Anxiety and Depression

If patients are suffering from concurrent anxiety or depression, their existing IBS may be exacerbated. Treating the anxiety or depression, in conjunction with treating the disorder both pharmacologically and with dietary manipulation, leads to a longer and more durable road of recovery.

Diagnosing the Disorder: What to Expect

No one specific test can diagnose this syndrome. Physicians may take an extremely detailed medical history and perform a thorough physical exam. The point of the physical exam and diagnostic testing is to make sure another disease isn’t causing similar symptoms—for example, celiac disease, IBD, microscopic colitis, or lactose intolerance.

Generally, physicians can check blood markers to look for inflammation, a good way to differentiate between the disorder and inflammatory bowel disease. If symptoms began after an episode of gastroenteritis, the physician may sample the fecal matter to ensure there’s no lingering infection.

The syndrome may not be very apparent from the physical exam, but your doctor may ask if you’re experiencing additional symptoms that may occur concurrently with the disorder and affect your quality of life:

  • Fatigue
  • Brain fog
  • Headaches

Because patients with the syndrome may also have a higher prevalence of other functional diseases, your doctor may also ask you about your experience with:

  • Fibromyalgia
  • Chronic fatigue syndrome
  • Functional dyspepsia
  • Non-cardiac chest pain

Therapies to Relieve Symptoms

For constipation

Certain FDA-approved drugs may help with constipation associated with this disorder. If a patient has constipation, we can prescribe linaclotide (brand name LINZESS®) or lubiprostone (brand name AMITIZA®). If a patient has pain as a major symptom, we can use an antispasmodic or a neuromodulator.

For diarrhea

An FDA-approved medication called eluxadoline (brand name VIBERZI®) can be helpful for diarrhea. Approaches such as using purified peppermint oil granules (brand name IBGard®) and other products that contain peppermint that are naturally antispasmodic can also be helpful.

Exercise has a huge role in treating diarrhea. Moderate-level exercise, yoga, meditation, and acupuncture can all help patients via the mind-body connection.

For associated urgent symptoms

Natural therapies such as caraway seed oil, menthol, and ginger supplements may help if patients have concurrent nausea.

Lifestyle changes can help

Patients can take steps to work with their doctors in managing IBS, including:

  • Use of some prebiotics and probiotics
  • Avoiding foods with preservatives and additives
  • Adhering to a natural and clean diet
  • Staying away from foods loaded with sugar because high sugar content tends to cause a lot of bloating, diarrhea, and pain
  • Incorporating at least low- to moderate-intensity exercise into their daily routine
  • Practicing mindfulness to tackle the subconscious

Also, I would advise patients to find a gastroenterologist they truly connect with. Mutual trust and respect can go a long way to help patients with irritable bowel syndrome and improve their quality of life.

Tired of pain and bloat?

Our specialists are here to help.

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Category: Healthy Living     Tags: ga-1hIBDIBSinflammatory bowel diseaseirritable bowel syndrome