There’s no test to definitively diagnose IBS. Your doctor will probably commence with an entire medical history, physical exam and tests to rule out other conditions. If you’ve IBS with diarrhea, you probably will be tested for gluten intolerance (celiac disease).
After other conditions happen to be ruled out, your medical professional will probably use one of the groups of diagnostic criteria for IBS:
- Rome criteria. These criteria include abdominal discomfort and pain lasting on average at least one day every week within the last 3 months, related to a minimum of two of the factors: Pain and discomfort are based on defecation, how often of defecation is altered, or stool consistency is altered.
- Manning criteria. These criteria concentrate on pain relieved by passing stool and on having incomplete going number 2, mucus inside stool and modifications in stool consistency. The more symptoms you have, the more the likelihood of IBS.
- Type of IBS. For the purpose of treatment, IBS may be separated into three types, determined by your symptoms: constipation-predominant, diarrhea-predominant or mixed.
Your doctor will also likely assess whether you might have other signs or symptoms that may suggest another, more severe, condition. These indicators include:
- Onset of signs and symptoms after age 5
- Weight lost
- Rectal bleeding
- Nausea or recurrent vomiting
- Abdominal pain, in particular when it isn’t really completely relieved by a bowel movement, or occurs at night
- Diarrhea which is persistent or awakens you sleep
- Anemia associated with low iron
If you might have these indicators, or if an initial treatment for IBS fails, you will likely need additional tests.
Your doctor may recommend several tests, including stool studies to test for infection or difficulty with your intestine’s capability to take inside the nutrients from food (malabsorption). You might also have numerous other tests to rule out other causes to your symptoms.
Imaging tests range from:
- Flexible sigmoidoscopy. Your doctor examines the low area of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope).
- Colonoscopy. Your doctor uses a small, flexible tube to analyze your entire length with the colon.
- X-ray or CT scan. These tests produce images of your respective abdomen and pelvis that may allow a medical expert to rule out other causes of your respective symptoms, especially if you’ve abdominal pain. Your doctor might fill your large intestine with a liquid (barium) to produce any problems more visible on X-ray. This barium test is oftentimes referred to as a lower GI series.
Laboratory tests normally include:
- Lactose intolerance tests. Lactase is an enzyme you have to digest the sugar found in milk products. If you don’t produce lactase, maybe you have problems much like those a result of IBS, including abdominal pain, gas and diarrhea. Your doctor may order a breath test or ask you to remove milk and dairy food from your diet for a lot of weeks.
- Breath test for bacterial overgrowth. A breath test also can determine whether you’ve bacterial overgrowth within your small intestine. Bacterial overgrowth is much more common among folks who suffer from had bowel surgical procedures or who may have diabetes or some other disease that slows digestion.
- Upper endoscopy. A long, flexible tube is inserted down your throat and to the tube connecting orally and stomach (esophagus). A camera about the end in the tube allows the doctor to inspect your upper digestive system and acquire a tissue sample (biopsy) out of your small intestine and fluid to look for overgrowth of bacteria. Your doctor might recommend endoscopy if celiac disease is suspected.
- Stool tests. Your stool may be examined for bacteria or parasites, or a digestive liquid produced with your liver (bile acid), if you’ve got chronic diarrhea.
Treatment of IBS is targeted on relieving symptoms to help you live as normally as you possibly can.
Mild signs or symptoms is frequently controlled by managing stress by making modifications in your diet plan and lifestyle. Try to:
- Avoid foods that trigger your symptoms
- Eat high-fiber foods
- Drink a good amount of fluids
- Exercise regularly
- Get enough sleep
Your doctor might declare that you eliminate from the diet:
- High-gas foods. If you experience bloating or gas, you might avoid items such as carbonated and alcohol consumption, caffeine, raw fruit, and certain vegetables, for example cabbage, broccoli and cauliflower.
- Gluten. Research shows that many people with IBS report improvement in diarrhea symptoms if they stop eating gluten (wheat, barley and rye) even if they don’t have celiac disease.
- FODMAPs. Some people are understanding of certain carbohydrates such as fructose, fructans, lactose yet others, known as FODMAPs – fermentable oligo-, di-, and monosaccharides and polyols. FODMAPs are within certain grains, vegetables, fruits and dairy products. Your IBS symptoms might ease should you have a strict low-FODMAP diet and then reintroduce foods one-by-one.
A dietitian may help you with your diet changes.
If your complaints are moderate or severe, your doctor might suggest counseling – particularly when you’ve depression or if stress will worsen your symptoms.
In addition, according to your symptoms a medical expert might suggest medications like:
- Fiber supplements. Taking a supplement for example psyllium (Metamucil) with fluids may help control constipation.
- Laxatives. If fiber doesn’t help symptoms, your physician may prescribe magnesium hydroxide oral (Phillips’ Milk of Magnesia) or polyethylene glycol (Miralax).
- Anti-diarrheal medications. Over-the-counter medications, including loperamide (Imodium), might help control diarrhea. Your doctor might additionally advise a bile acid binder, like cholestyramine (Prevalite), colestipol (Colestid) or colesevelam (Welchol). Bile acid binders might cause bloating.
- Anticholinergic medications. Medications like dicyclomine (Bentyl) may help relieve painful bowel spasms. They are sometimes prescribed for people who have bouts of diarrhea. These medications are generally safe but can cause constipation, dry mouth and blurred vision.
- Tricyclic antidepressants. This type of medication can help relieve depression along with inhibit the experience of neurons that control the intestines in lessening pain. If you’ve diarrhea and abdominal pain without depression, your physician may suggest less than normal dose of imipramine (Tofranil), desipramine (Norpramine) or nortriptyline (Pamelor). Side effects – which could possibly be reduced should you take the medication at night – normally include drowsiness, blurred vision, dizziness and dry mouth.
- SSRI antidepressants. Selective serotonin reuptake inhibitor (SSRI) antidepressants, like fluoxetine (Prozac, Sarafem) or paroxetine (Paxil), could help if you’re depressed and possess pain and constipation.Pain medications
Medications specifically for IBS
Medications approved for sure those with IBS include:
- Alosetron (Lotronex). Alosetron is designed to relax the colon and slow the movement of waste through the low bowel. Alosetron might be prescribed only by doctors signed up for a particular program, is meant for severe cases of diarrhea-predominant IBS in ladies who haven’t answered other treatments, and isn’t approved to be used by men. It has been associated with rare but important unwanted effects, so it should just be considered when other treatments aren’t successfull
- Eluxadoline (Viberzi). Eluxadoline can ease diarrhea by reducing muscle contractions and fluid secretion inside intestine, and increasing muscle inside the rectum. Side effects can include nausea, abdominal pain and mild constipation. Eluxadoline has been linked to pancreatitis, which might be serious plus much more common in some individuals.
- Rifaximin (Xifaxan). This antibiotic can decrease bacterial overgrowth and diarrhea.
- Lubiprostone (Amitiza). Lubiprostone can increase fluid secretion in your small intestine to assist while using passage of stool. It’s approved for ladies who may have IBS with constipation, and it is generally prescribed only for women with severe symptoms that haven’t answered other treatments.
- Linaclotide (Linzess). Linaclotide may also increase fluid secretion with your small intestine to help you pass stool. Linaclotide might cause diarrhea, but using medication 30 to sixty minutes before eating may help.
Potential future treatments
Researchers are investigating new treating IBS. Serum-derived bovine immunoglobulin/protein isolate (SBI), a nutritional therapy, has demonstrated some promise as being a answer to IBS with diarrhea.
Studies also reveal that, in people who have IBS with diarrhea, a specially coated tablet that slowly releases peppermint oil within the small intestine (enteric-coated peppermint oil) eases bloating, urgency, abdominal pain and pain while passing stool. It isn’t clear how enteric-coated peppermint oil might affect IBS, so ask your doctor before utilizing it.
Lifestyle and home remedies
Simple alterations in your diet and lifestyle often provide relief from IBS. Your body will need time for it to reply to these changes. Try to:
- Experiment with fiber. Fiber helps reduce constipation but could also worsen gas and cramping. Try slowly increasing the level of fiber inside your diet during a period of weeks with foods including whole grain products, fruits, vegetables and beans. A fiber supplement could cause less gas and bloating than fiber-rich foods.
- Avoid problem foods. Eliminate foods that trigger your symptoms.
- Eat at regular times. Don’t skip meals, and then try to get your meals at comparable time on a daily basis to help you regulate bowel function. If you have diarrhea, you will probably find that eating small, frequent meals makes you feel better. But should you’re constipated, eating larger numbers of high-fiber foods could help move food through your intestines.
- Exercise regularly. Exercise helps relieve depression and stress, stimulates normal contractions of your intestines, and will help you feel good about yourself. Ask your medical professional about an workout program.
The role of alternative therapies in relieving IBS symptoms is unclear. Ask your doctor before commencing any of these treatments. Alternative therapies include:
- Hypnosis. A trained professional teaches you the best way to enter a relaxed state then walks you in relaxing your abdominal muscles. Hypnosis may reduce abdominal pain and bloating. Several studies secure the long-term effectiveness of hypnosis for IBS.
- Mindfulness training. Mindfulness is the act of being intensely alert to the pain you are sensing and feeling each and every moment, without interpretation or judgment. Research indicates that mindfulness can ease symptoms of IBS.
- Acupuncture. Researchers have discovered that acupuncture may help improve symptoms for people who have IBS.
- Peppermint. Peppermint is really a natural antispasmodic that relaxes smooth muscles in the intestines. It might provide short-term relief of IBS symptoms, but study results have been inconsistent.
- Probiotics. Probiotics are “good” bacteria that normally live with your intestines and are found in food items, for example yogurt, plus dietary supplements. Recent studies advise that certain probiotics may relieve IBS symptoms, like abdominal pain, bloating and diarrhea.
- Stress reduction. Yoga or meditation can help relieve stress. You can take classes or practice in the home using books or videos.
Preparing for your appointment
You may be referred to a doctor who specializes in the digestive tract (gastroenterologist).
What it is possible to do
- Be aware of any pre-appointment restrictions, such as restricting what you eat before your appointment.
- Write down your symptoms, including any which could seem unrelated on the reasons why you scheduled the appointment.
- Write down any triggers for your symptoms, including specific foods.
- Make a summary of your medications, vitamins and supplements.
- Write down your key medical information, including other concerns.
- Write down key personal information, including any recent changes or stressors with your life.
- Write down questions to ask your doctor.
- Ask a family member or friend to accompany you, to assist you remember what the physician says.
Questions to ask your medical professional
- What’s probably the most likely cause of my symptoms?
- What tests do I need? Is there any special preparation for the kids?
- What treatment approach would you recommend? Are there any side effects linked to these treatments?
- Should I change my diet?
- Are there other change in lifestyle that you just recommend?
- Do you advise that I talk having a counselor?
- I have other health problems. How can I best manage these conditions together?
- If I have IBS, how long can it take for me to view improvement in the therapy you might have prescribed?
In addition towards the questions that you’ve prepared to ask your physician, don’t hesitate to ask questions in your appointment when you don’t understand something.
What to expect from your physician
Your doctor probably will ask a quantity of questions. Being willing to respond may leave time for it to review points you want to spend more time on. You could possibly be asked:What are your symptoms, and when did they begin?
- How severe are the symptoms? Are they continuous or occasional?
- Does anything manage to trigger your symptoms, including foods, stress or – in ladies – your menstrual period
- Have you dropped excess weight without trying?
- Have you had fever, vomiting or blood with your stools?
- Have you recently experienced significant stress, emotional difficulty or loss?
- What will be your typical diet?
- Have you ever been diagnosed using a food allergy or with lactose intolerance?
- Do you might have any family history of bowel disorders or colon cancer?
- How much would you say your symptoms are affecting your total well being, together with your personal relationships as well as your power to function in class or work?
What it is possible to do in the meantime
While waiting to your appointment:
- Ask members of the family if any relatives are actually clinically determined to have inflammatory bowel disease or colon cancer.
- Start noting how many times your symptoms occur as well as any factors that apparently trigger them.