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Irritable Bowel Syndrome (IBS)

What is Irritable Bowel Syndrome?

Digestive troubles are very common to be experienced by everyone, once in a while. Irritable Bowel Syndrome (IBS) is something different, though, it’s usually a lifelong problem that tends to come and go over time, and can last for days, weeks or months at a time, but there are no visible signs of structural damage in the gastrointestinal system.

The main symptoms of IBS are experienced through a belly pain along with a change in bowel habits and movements, which includes constipation, diarrhea, or both. Additionally, it may cause stomach cramps, bloating, flatulence, nausea, and tiredness and a lack of energy. The persistent pain and frequent trips to the bathroom can make everyday life hard.

These symptoms aren’t always persistent, they can ease, only to come back. However, some people do have continuous symptoms for larger periods of time. In women, the IBS symptoms tend to appear around the time of menstruation or they may exacerbate during this period of time. On this note, it’s important to point out that anyone can get irritable bowel syndrome, but this condition is twice as common among women as it is among men and the symptoms usually start before the age of 35. In fact, it’s uncommon for people over 50 to get IBS for the first time.

What are the causes and how is it diagnosed?

Doctors struggle yet to know the exact cause of IBS. However, one theory is that the signals between the brain and intestines get disrupted and this miscommunication may trigger irregular contractions in the intestinal muscles that result in cramping, pain and changes in the speed of digestion. Or it can also be related to the intestinal hyper-sensitive nerves to certain triggers, such as certain foods or stress.

To complicate things, there is no single test to check for IBS. Doctors usually make a diagnosis based on a person’s description of the symptoms and on several tests to rule out other possible structural causes of the symptoms presented.

How does it affect your life?

As a non visible condition, IBS can be a problem not taken seriously enough. However, beyond the physical suffering, patients with IBS report high rates of psychopathology, such as mood disorders, poor quality of life, more absence from work, lower productivity and more use of healthcare resources. Furthermore, it’s an uncomfortable set of symptoms that can make you feel anxious and alert about being able to get a bathroom on time, or even ashamed about having the symptoms at a bad time, for instance while at work, in the middle of a conversation or in any situation where it’s hard to leave. In severe cases, people tend to avoid social situations or leave the house.

Triggers and the role of stress and anxiety?

The first step toward managing IBS symptoms is to figure out what exacerbates them. Besides stress, common triggers include eating a meal, hormonal changes, intense emotional reactions, and certain medications. It’s important to note that no particular foods are linked to IBS symptoms, each person is different.

It’s not yet clear how stress, anxiety and IBS are linked or which one comes first, but studies show they can not only occur together but also feed back on each other.

Nevertheless, it is estimated that, when IBS is diagnosed, 60% of the patients will meet the criteria for one or more mental disorders. It appears that more than 60% of these patients suffer from generalized anxiety disorder or other anxiety-related illnesses, another 20% suffer from depression, and the rest of the patients have other disorders.

Currently there are several theories about the link between IBS, stress and anxiety. First, although psychological problems like anxiety don’t cause irritable bowel syndrome, people with this condition may be more sensitive to emotional troubles. Secondly, strong and intense emotions trigger chemicals in the brain that release pain signals in the gut, causing irregular bowel movements, since these automatic movements (motility) of the digestive system are controlled to a great degree by the nervous system. This means that emotional deregulation can affect the nerves, making the digestive system overactive, and the colon may be overly responsive to even slight disruption of the nervous system (also, abnormal serotonin levels in the colon are related to these irregular bowel movements). Third, stress and anxiety may increase awareness of spasms in the colon, causing the mind to hyper focus on the gut signals and amplify them. Last but not least, it is also believed that IBS is affected by the immune system, which is affected by stress.

What can help?

Apart from the recommendations regarding eating and other lifestyle habits, and medications, it’s not uncommon for antidepressants to also be part of the IBS treatment plan, since the condition is linked to the nervous system, but this does not suggest that all your symptoms are “psychological” or caused by depression. As a matter of fact, antidepressants act on the chemical messengers in the digestive tract and ward off pain and cramping.

Additionally, studies show that managing your stress levels can help prevent or ease IBS symptoms. The explanation for this is that the gut has what is called “a brain” of its own - technically called enteric nervous system (a large division of the peripheral nervous system responsible to control gastrointestinal behavior independently) that also causes that “butterfly” feeling in the stomach when we are nervous. This “second brain” controls how food is digested and it's actually always communicating with the “actual brain”.

In that sense psychotherapy can help with the stress and anxiety (and with other mental disorders that are common in IBS patients) of the condition, by providing new and healthy ways to manage and cope with triggers and flare-ups. In psychotherapy, people with IBS can learn how to break the mind-body cycle that may be worsening the symptoms.

Long-term prognosis

Irritable bowel syndrome is a chronic and ongoing condition. There might be periods of time that the symptoms calm down and the flare up. But, over time the symptoms typically do not get worse, and IBS is not life-threatening and does not lead to more serious digestive conditions, such as inflammatory bowel disease or cancer.

It’s important to remember that IBS patients can achieve a high quality of life despite their condition. Make sure you keep a personal journal of food, feelings, and symptoms so that you can be aware and address any possible triggers.

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