Irritable bowel syndrome

and Christiane Fux, medical editor

Ricarda Schwarz studied medicine in Würzburg, where she also completed her doctorate. After a wide range of tasks in practical medical training (PJ) in Flensburg, Hamburg and New Zealand, she is now working in neuroradiology and radiology at the Tübingen University Hospital.

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Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

More posts by Christiane Fux All content is checked by medical journalists.

Irritable bowel syndrome is caused by a functional disorder of the bowel. Typical symptoms are abdominal pain, gas, and diarrhea or constipation. They often increase with stress. The disease can be very stressful, but it is not dangerous. To make a sure diagnosis, the doctor must rule out other possible causes. Here you can read everything you need to know about symptoms, triggers and treatment options for irritable bowel syndrome.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. K58

Irritable bowel: quick reference

Most common symptoms: abdominal pain, diarrhea and / or constipation, gas
Possible causes: impaired barrier function of the intestinal wall, impaired bowel function, increased immune activity in the intestinal wall, increased pain perception
Diagnosis: inflammatory bowel diseases, food intolerance, gastrointestinal infections, gynecological causes must be excluded for the diagnosis of irritable bowel syndrome (exclusion diagnoses).
Treatment: always an individual treatment concept with medication, herbal remedies, homeopathy, probiotics, diet change, stress reduction

Irritable bowel syndrome: symptoms

With an irritable bowel (Colon irritabile), the bowel function is disturbed. Therefore, the stool changes: patients often suffer from diarrhea or constipation.

In some patients, however, bowel movements are unchanged. Above all, they suffer from pain or flatulence, a flat stomach and absent intestinal winds. However, these symptoms often occur in combination with diarrhea and constipation.

Irritable Bowel Symptoms: The Four Types of Disease

Depending on which symptoms are in the foreground, irritable bowel syndrome is divided into four types of disease: type of diarrhea, type of constipation, type of pain and type of flatulence. In addition to these four main forms, mixed types also occur. In addition, one type of disease can pass into another or they alternate. For example, diarrhea and constipation can occur on the same day.

In all four types of disease, the following additional irritable bowel symptoms are common:

Bloating
Feeling that the bowel does not empty completely when defecating
Mucus build-up on the stool

It is also typical of irritable bowel syndrome that the various symptoms improve after a bowel movement.

Irritable bowel pain

Abdominal pain is a major symptom of irritable bowel syndrome. The pain can appear in different places in the abdomen and have different characteristics, for example:

constant burning or stabbing pain
rather cramp-like pains in waves
Stitch-like pain in the side
dull pain, like a constant feeling of pressure in the lower abdomen

The abdominal pain in irritable bowel syndrome is caused on the one hand by the irritated intestinal mucosa, on the other hand due to the expansion of the intestinal wall due to the increased formation of gas. The intestinal muscles respond with contractions.

Irritable bowel diarrhea

In irritable bowel patients of the diarrhea type, the stool is very soft to fluid. The number of bowel movements increases to more than three per day. Some IBS patients with diarrhea also suffer from a sudden, strong urge to defecate. As a result, they hardly dare to venture further away from a toilet.

Constipation in irritable bowel syndrome

Conversely, symptoms of constipation can occur with irritable bowel syndrome. Those affected have very hard stools that are reminiscent of sheep droppings. Often these patients can only go to the bathroom three or less times a week.

Flatulence and bloating in irritable bowel syndrome

Every healthy digestion creates gases in the intestines. In the case of irritable bowel syndrome, however, they can form in excess due to disturbed bowel movements and food utilization. This is particularly uncomfortable for the patients, as their intestinal wall reacts more strongly than usual to the stretching stimulus from the gas bubbles. Cramp-like abdominal pain is often the result.

If the intestinal winds cannot escape sufficiently, a bloated stomach forms, which can be inflated like a drum and is painful.

More changes in bowel movements

Although the various symptoms usually improve after a bowel movement, some IBS patients find the bowel movement itself painful.

In addition, many sufferers have the feeling that the bowel could not be properly emptied. This leads some to use laxatives. However, such drugs do not help and can make the irritation worse. If laxatives are really needed, they should be viewed as a short-term solution because of the potential side effects.

Mucus deposits on the stool are also common with irritable bowel syndrome.

Bloating

Regardless of whether patients with irritable bowel syndrome have diarrhea or constipation, they often experience a permanent feeling of fullness. This usually improves after a bowel movement, but can also occur if the person concerned has not eaten any food and the bowel is relatively empty.

Risk of confusion with other diseases

The symptoms of irritable bowel syndrome are unspecific. This means that they also occur with a large number of other diseases. Therefore, before a diagnosis of irritable bowel syndrome is made, these must be ruled out. Possible other causes for the discomfort are

Food intolerance, including to lactose, fructose or gluten
Inflammatory bowel disease such as ulcerative colitis or crohn's disease
Gastrointestinal infections
Gynecological diseases, including ovarian cancer

Caution! Misleading symptoms

The following symptoms are not typical irritable bowel symptoms. You need a quick medical assessment because they can be the cause of potentially dangerous illnesses.

Diarrhea, which occurs mostly at night
Fever (acute or chronically recurring)
Blood in the stool
Severe unwanted weight loss

Irritable bowel syndrome: causes and risk factors

There are numerous hypotheses about the development of irritable bowel syndrome, for which there is, however, only little reliable evidence.

However, scientists have been able to determine a number of typical changes in the intestines of those affected. These changes do not only occur in irritable bowel syndrome, but also occur, for example, in chronic inflammatory bowel diseases. This includes:

Disturbed intestinal peristalsis (motility disorder)

It is believed that the natural bowel movement is disturbed in irritable bowel syndrome. This means that the movements to transport the digested food are not optimal.

The intestinal peristalsis is regulated by an independent nervous system with which the intestinal wall is equipped. This is also known as the "abdominal brain".

The abdominal brain senses when food enters the intestines and stretches the wall. Together with the messenger substance serotonin, the intestinal nervous system controls digestion. It stimulates the intestinal muscles to alternately tense and relax.

In irritable bowel syndrome, the nervous system gives incorrect instructions to the intestinal muscles. As a result, the muscles contract too quickly, too slowly, or at the wrong moment, or they no longer relax properly. The food pulp is therefore transported too quickly in some patients. Then not enough water can be withdrawn from it in the large intestine. The result is diarrhea.

The opposite is also possible: if the muscles move too slowly, constipation can occur. Irritable bowel cramps, on the other hand, occur, among other things, when the muscles contract too tightly and for too long, or when they no longer relax properly.

Increased permeability of the intestinal mucosa

An unnaturally strong permeability of the intestinal mucosa can also trigger irritable bowel symptoms. In the intestinal mucosa, neighboring cells are normally closely connected to one another by a type of adhesive bridge (tight junction). They tightly seal the connection between the cells so that no foreign substances or pathogens can get through between the cells.

As long as these adhesive bridges between the cells are intact, the totality of the intestinal mucosal cells forms an effective barrier. It prevents foreign substances from entering the body from the intestinal cavity in an uncontrolled manner.

In people with irritable bowel syndrome, these adhesive bridges break down faster than normal. As a result, the cells are no longer so tightly connected to each other, which weakens the barrier function of the intestinal mucosa. For example, foreign substances or pathogens can more easily penetrate the intestinal mucosa and trigger an immune reaction there.

Increased immune activity in the intestinal mucosa

There is increased immune activity in tissue samples from the intestinal mucosa of affected people. For example, more defense cells of the immune system and their messenger substances can be detected in the mucous membrane. It is not yet known why the increased activity occurs in irritable bowel syndrome.

Infections of the gastrointestinal tract as a cause of irritable bowel syndrome

Several studies show that irritable bowel syndrome can sometimes be the result of a gastrointestinal infection. In particular, irritable bowel syndrome with severe diarrhea occurs. Certain bacteria, such as Campylobacter jejuni, may be responsible for this more often than other species. However, only about one in ten cases of irritable bowel syndrome can be traced back to a previous gastrointestinal infection.

Disturbed intestinal flora

Disturbed intestinal flora can also contribute to irritable bowel syndrome. If the natural mix of beneficial bacteria in the intestine is out of balance, this can impair intestinal function and encourage gas formation. Drugs such as antibiotics can cause a disturbed intestinal flora, but also gastrointestinal infections.

Helpful gut bacteria

Various gut bacteria taken orally can help with irritable bowel syndrome, such as bifidum MIMBb75.

Disturbed serotonin balance

The serotonin balance could also be disturbed in irritable bowel syndrome. The messenger substance serotonin is responsible, among other things, for how pain is perceived. If the nervous system of the intestine is activated in an irritable bowel, it cannot optimally regulate how much messenger substances it releases. It can happen that those affected perceive their bowels more than usual and feel pain.

Stress as a trigger and amplifier

Be it fear, nervousness, anger, grief or stress at work: Irritable bowel symptoms often worsen under psychological stress. If the stress subsides again or if you relax in a targeted manner, the symptoms usually improve as well.

Acute stress has been shown to lead to changes in the gastrointestinal tract. The gastric juice production increases, the bowel movements increase and the local immune reaction in the intestine changes.

However, people react very differently to stress. While some sufferers have developed methods to deal with stress, others suffer enormously from the emotional and physical consequences.

Irritable bowel syndrome and its triggers

Irritable bowel syndrome has various triggers. Usually several come together at the same time.

Connection with concurrent illnesses

There are some diseases that often occur with irritable bowel syndrome (comorbidities). It is possible that patients with these conditions are more likely to develop irritable bowel syndrome. These diseases include:

depression
Anxiety disorders
Chronic fatigue syndrome
Fibromyalgia
Fatigue syndrome
Chronic (head) pain

Irritable bowel syndrome: examinations and diagnosis

The diagnosis of irritable bowel syndrome is a so-called exclusion diagnosis. This means that the doctor must first rule out other possible causes for the symptoms before one can assume irritable bowel syndrome.

The right person to contact if you suspect irritable bowel syndrome is a specialist in internal medicine who specializes in diseases of the digestive tract: a gastroenterologist. At the doctor's appointment, the doctor first inquires about your current symptoms and any previous illnesses (anamnesis). The doctor might ask you, for example, the following questions:

Where exactly do you have pain and in which situations does it occur?
Do you have diarrhea or constipation?
Have you noticed a connection between the pain and certain foods?
Are you currently in stressful living conditions?
Have you noticed blood in your stool, do you have a fever or have you accidentally lost weight? All of this would be atypical for irritable bowel syndrome.

In many cases it makes sense to keep a nutrition log and diary of the exact symptoms and to discuss the results with the doctor. In particular, a connection between certain foods and the complaints can often be uncovered in this way. There are also specific questionnaires for irritable bowel syndrome.

Physical examination

The symptoms of irritable bowel syndrome primarily affect the digestive tract. That is why the abdominal cavity is the focus of the physical examination. The doctor first listens to the abdomen with a stethoscope (auscultation). He can hear the bowel activity, but also determine when the bowel is moving little or not at all. With irritable bowel syndrome, the bowel often moves excessively.

The doctor then taps the abdominal wall lightly with his fingers. The sound differs depending on whether the intestine is filled with stool or air.Since the intestine is increasingly filled with air in the case of flatulence, a characteristic resonance arises when tapping.

At the end, the doctor feels the abdomen with his hands first superficially and then a little deeper. He can determine whether certain sections of the intestine are thickened and whether the examination causes pain.

Abdominal ultrasound

The ultrasound examination of irritable bowel syndrome is only of limited value for assessing the intestine, as the intestinal gases disrupt the ultrasound image. But other causes of the complaints, such as diseases of the gallbladder, the biliary tract, the liver, the kidneys and the pancreas can be discovered. The doctor can also use ultrasound to see whether the intestinal wall is thickened. That would indicate inflammation.

Laboratory tests

Various substances in the blood, urine and stool can be searched for in the laboratory. For example, they give indications of inflammation or infection. In the case of irritable bowel syndrome, however, the laboratory values are usually normal.

Gastroscopy and colonoscopy

In many cases, if the digestive tract symptoms are unclear, a gastric and colonoscopy must be performed. During the examination, the doctor can also take a small sample (biopsy) of the mucous membrane. Irritable bowel syndrome shows certain changes in the intestinal mucosa. However, these also occur in chronic inflammatory bowel diseases (Crohn's disease, ulcerative colitis).

Food intolerance tests

Food intolerance such as lactose intolerance or fructose intolerance as well as celiac disease (gluten intolerance) cause symptoms that are similar to those of irritable bowel syndrome. They can be confirmed or excluded through simple tests.

Various carbohydrate intolerances can be determined with the H2 breath test.
To diagnose celiac disease, the blood is examined for certain antibodies and a tissue sample from the mucous membrane of the small intestine is analyzed under a microscope.
With the help of the so-called lactulose-mannitol test, one can find out whether the barrier function of the intestine is disturbed.

Diagnostic criteria: irritable bowel syndrome

According to the recommendations of the German Society for Digestive and Metabolic Diseases (DGVS), irritable bowel syndrome is present when the following three points are met in a patient:

The patient suffers from chronic bowel-related complaints that last longer than three months, such as abdominal pain or flatulence, which are usually associated with changes in bowel movements such as diarrhea or constipation.
The quality of life is significantly impaired due to the complaints.
There are no changes characteristic of other clinical pictures that could explain the symptoms.

Irritable bowel: treatment

There is no generally applicable therapeutic approach for irritable bowel treatment. How the symptoms can be improved depends on the different symptoms, but also on the various triggers and the individual patient.

Irritable bowel patients should therefore watch closely how their body reacts. It makes sense to record complaints as well as diet and other influencing factors such as stress and psychological stress in a kind of diary. This is the fastest way to become an expert on your own disease.

Always make changes to therapy in small steps. With a little patience, you will find out the most sensible treatment strategy for you together with your doctor.

Irritable bowel syndrome: therapy for diarrhea

The diarrhea associated with irritable bowel syndrome can be treated with various medications. The most commonly used are tannins, the active ingredient loperamide or so-called bile acid binders.

Tannins are released when black tea or oak bark tea is steeped for a long time before drinking. But you can also buy it as a capsule in the pharmacy. They counteract inflammatory processes in the intestine, reduce secretion and slow down bowel movement.

Loperamide is a synthetically produced substance that is distantly related to opium, but it works almost exclusively locally on the intestine and immobilizes the overexcited intestinal muscles. The stool stays longer in the colon, so that more fluid can be withdrawn from it and it becomes firmer again. Loperamide, however, should only be taken for a short time and strictly according to the dosage instructions, as otherwise the drug would lead to pronounced constipation.

Bile acid binders like cholestyramine attach to bile acids. and thus prevent their diarrhea-promoting effect. Since bile acids play an important role in fat digestion, the drugs also disadvantageously hinder the absorption of fat-soluble vitamins (A, D, E, K) and drugs.

Water-soluble fiber such as psyllium, locust bean gum and pectin can also stop diarrhea. To compensate for the loss of fluid, one should increase the fluid intake accordingly. In the case of severe diarrhea or if a child suffers from irritable bowel syndrome, electrolyte mixtures from the pharmacy may be useful.

Irritable bowel syndrome: therapy for constipation

When irritable bowel syndrome is causing constipation, physical exercise can sometimes help get the bowels going again. In addition, those affected should drink two to three liters of fluid a day. Since this alone is usually not enough, fiber such as psyllium husks and water-absorbing substances such as macrogol can also be used

Laxatives from the pharmacy are, for example, the active ingredients bisacodyl and sodium picosulfate. They are mostly used as a suppository or mini-list.

Irritable bowel syndrome: treatment of cramps and pain

If the constipation is accompanied by cramps, herbal medications can help. For example the oils of peppermint and caraway, which are taken in capsule form. In this way, they reach their place of action in the intestine undamaged. Anise and fennel can also calm the intestines.

If herbal medicines are not enough, the antispasmodic active ingredient butylscopolamine has proven itself. It is often used in conjunction with the pain reliever paracetamol. Other active ingredients with an antispasmodic effect are mebeverine or trospium chloride. Unlike the herbal supplements mentioned, these may not be used permanently.

Irritable bowel syndrome: what helps against flatulence?

In irritable bowel syndrome, the impaired digestion of food and changes in the movement of the bowel can cause excessive gas to form. In people with irritable bowel syndrome, these often do not go away spontaneously and can also trigger cramp-like symptoms and distend the stomach.

Herbal remedies for flatulence such as caraway and peppermint oil, fennel or anise not only have an acute effect, but can also be taken preventively and long-term. If they are not enough, defoaming drugs such as simethicone and dimethicone relieve the symptoms.

Fennel for flatulence

Fennel can help and prevent acute flatulence. Anise, caraway and peppermint oils also calm the intestines.

Irritable bowel syndrome: homeopathy & Co.

There are a number of homeopathic preparations that are believed to have a soothing or preventive effect. The following means, among others, are used:

Bismuth oxide nitrate (Bismutum subnitricum)
Cerium oxalicum
Citwer blossom (Cina artemisia)
Cyclamen
ginseng
Also: Schüssler salt potassium sulfuricum

Irritable bowel syndrome: therapy with probiotics

Probiotics are viable intestinal bacteria that can be taken as dietary supplements. They should bring a disturbed intestinal flora back into balance. Whether and, if so, which probiotics help with irritable bowel syndrome has not yet been fully clarified. However, there is evidence that various bacteria such as Bifidobacterium bifidum MIMBb75 could actually help.

Experts suspect that the effectiveness depends on the respective form of the disease. For example, there is evidence that probiotic treatment is particularly effective if the irritable bowel syndrome was preceded by a gastrointestinal infection.

Irritable bowel: help through relaxation

Irritable bowel syndrome is often triggered or worsened by stress and acute or chronic overload. Sufferers should observe whether psychological or physical stressful situations aggravate the symptoms of irritation syndrome. Here, too, a diary can help to identify such connections.

As far as possible, the known stressors should be avoided. But that is not always possible. It is therefore important to learn to deal with stressful situations and to actively reduce stress. Targeted stress management as well as procedures such as autogenic training, progressive muscle relaxation or yoga can help prevent or alleviate the symptoms.

Antidepressants and psychotherapy

Irritable bowel syndrome is also often associated with psychological complaints such as depression or anxiety disorders. They are associated with stress and can thus promote and worsen irritable bowel syndrome. If the psychological complaints are treated as part of psychotherapy or with antidepressants, the irritable bowel symptoms often improve too.

In addition, antidepressants partially affect the muscles of the gastrointestinal tract and can have a pain-relieving effect.

Irritable bowel: diet

In patients with irritable bowel syndrome, the bowel reacts much more sensitively to all influences. This also applies to nutrition. Foods that are difficult to digest can overwhelm them more easily than a healthy intestine.

However, there is no general recommendation for diet for irritable bowel syndrome: the rules for diarrhea are different from those for constipation. In addition, each person affected reacts differently to different foods.

Fiber

When it comes to fiber, too, not every irritable bowel patient responds well to it. But they seem to help especially with constipation. Liquid fiber may also benefit patients with diarrhea or gas as the main symptom.

Diet tips for irritable bowel syndrome

The following basic dietary rules have been found to be helpful for some IBS sufferers:

Eat slowly.
Do not swallow too much air unnecessarily.
Many small portions are better than a few large ones.
Drink enough. For example, non-carbonated mineral water is good.
Fatty foods, legumes, strong spices, sometimes coffee, alcohol, nicotine or dairy products can cause symptoms.
Some people also react sensitively to white flour products, finished products and various sugar substitutes.
Pay attention to the composition of the food and what time of day you eat.
Eat regularly and always at set times.
Don't overeat, especially in the evening.
Make time for your meals, try to eat them in a calm atmosphere.

Warmth for the stressed stomach

Placing a hot water bottle on your stomach can relieve pain and cramps, and soothe the bowels.

Irritable bowel syndrome: disease course and prognosis

Irritable bowel syndrome (IBS) or irritable colon is one of the most common gastrointestinal diseases in Europe. The disease often occurs for the first time between the ages of 20 and 30. Women are affected about twice as often as men.

Irritable bowel syndrome can develop very differently from person to person. The symptoms can also increase and decrease again, stop completely, but also recur. In some patients with irritable bowel syndrome, diarrhea, constipation, pain, and gas alternate. Often the disease has a significant impact on the quality of life.

If people can find out what is causing their symptoms, they have a better prognosis. About 34 percent of patients manage to alleviate their symptoms through specific behavioral changes and therapeutic measures or they even become completely symptom-free.

However, if irritable bowel syndrome persists for a long time, the prognosis is usually worse. About one in two people will develop chronic irritable bowel syndrome and have the symptoms for many years or even their entire life. There is currently no treatment that can completely cure the disease. But there is also no evidence that the irritable bowel causes other serious diseases.