Your stomach is at it again. You’re either bloated or in pain these days.

Was it something you ate?

And when you’re not bloated and wishing you’d worn looser pants, you’re having to spend a long time on the toilet. For some reason, your poop is either too soft – or way too hard. What’s that about?

If you think it might be irritable bowel syndrome (IBS), there are 5 IBS facts that gastroenterologists would love you to know about the condition.

#1 The Rome III Criteria for Irritable Bowel Syndrome Is Important

The Rome criteria are named after the original meeting of international gastrointestinal experts in Rome. They agreed on the criteria for the diagnosis of different gastrointestinal diseases, and the Rome III criteria for IBS is the most accepted standard. Although you may find references to Rome IV criteria online, Rome III is what the majority of doctors use.

When a patient presents symptoms that may indicate irritable bowel syndrome, the Rome III criteria aids your doctor in making a diagnosis.

The IBS diagnosis criteria include:

  • Recurring abdominal pain or discomfort for more than 3 days a month for the past 3 months associated with two of the following symptoms –
    • Relief from pain or discomfort with the passing of stools
    • A change in frequency of stool
    • A change in appearance or hardness/softness of stool.

The Rome III criteria also allows for further subcategories of IBS sorted by type of stool (with no medication intervention):

  1. IBS with constipation: at least 25% of the time hard or lumpy stool – and loose, watery stool less than 25% of the time.
  2. IBS with diarrhea: at least 25% of the time loose, watery stool – and hard, lumpy stool less than 25% of the time.
  3. Mixed IBS: at least 25% of the time loose, watery stool – and at least 25% of the time hard, lumpy stool.
  4. Unsubtyped IBS: stool isn’t abnormal enough to be classed as one of the above.

Although taking note of when symptoms began, and how severe they are, is useful, your doctor may need to run some tests.

#2 IBS Symptoms Should Be Discussed with Your Doctor

Although irritable bowel syndrome is a very common complaint, you should still go see your doctor about your symptoms. Many diseases can be mistaken for IBS – some mild, some more serious.

Diseases with similar symptoms to IBS include:

So, some IBS symptoms can indicate a larger medical issue is at play. That’s why it’s important to be checked over by a doctor, who can order blood work to check the status of your blood, liver, kidney, and pancreas. And if you already have a diagnosis of IBS, but you’ve recently experienced a change in your symptoms, book an appointment with your doctor – just to be on the safe side.

If your doctor is satisfied that you have a form of IBS, they can organize some breath tests, colonoscopy and endoscopy to help determine the cause. Although there are known food ‘triggers’, new evidence shows the underlying mechanism of IBS is often caused by small intestine bacterial overgrowth (SIBO). SIBO occurs when the bacteria from your large intestine back-up into your normally bacteria-free small intestine, causing bloating and gas. Knowing the underlying cause allows your gastroenterologist to treat you correctly.

#3 It’s Not all in Your Head

The symptoms of IBS are similar to the more physical symptoms of stress, anxiety, and depression, due to the gut-brain axis. However, irritable bowel syndrome is a very real illness, and it’s not ‘all in your head’. No amount of positive thinking or affirmations are likely to cut down the time you spend in the restroom, or the frequency with which you deal with abdominal pain.

Most doctors understand that IBS is a legitimate condition – although traditionally doctors may have advised otherwise, I’m happy to report that thinking has changed. The only time I would recommend psychologic therapy to a patient with IBS is if their condition is causing acute stress or anxiety that interferes with them going about their everyday life.

#4 The Importance of Keeping a Food Diary

In the lead-up to your appointment with your doctor, it’s worthwhile keeping a food and symptom diary. By tracking the food you eat and the associated symptoms you get, you can help your doctor diagnose you more quickly and find suitable treatment recommendations.

Food triggers for IBS include:

  • Flatulence inducing foods, including alcoholic drinks, apricots, bananas, beans, brussel sprouts, caffeinated drinks, onions and other alliums, prunes, and raisins.
  • Fermentable Oligo-, Di-, and Monosaccharides And Polyols (FODMAPs). FODMAPs occur in a wide range of foods, including dairy, fruits with pits or seeds, fructose, sugar alcohols, wheat, legumes, and the onion family.
  • Lactose and gluten. These can trigger IBS symptoms in susceptible individuals.

Don’t make any dietary changes until your doctor has decided on a course of action. Your food diary should show your typical diet – not your ideal diet – in order to aid your IBS treatment.

#5 IBS Can Be Used as a Trash Can Diagnosis

Unfortunately, some physicians diagnose patients with IBS when they cannot find a cause for their symptoms. Often this results in a trash-can diagnosis, where a label is slapped on the patient and they receive cookie-cutter treatment, with minimal reduction in symptoms.

The practice of sorting similar gastrointestinal symptoms together and passing them off as irritable bowel syndrome occurs because it’s an easy and convenient way to group problem GI sufferers together – even though the underlying cause of the symptoms may be very different, patient to patient. One person may have an underlying SIBO condition, while another may be dealing with food triggers, or yeast overgrowth. A diagnosis of IBS can also limit what the patient can do to help themselves.

Your digestive system is complex, and to view it otherwise means we risk not putting our patients first. Modern medicine is often more focused on treating or masking symptoms, instead of finding and fixing the underlying cause of the disease. I recommend finding a gastroenterologist who understands these nuances to help you find the right treatment.

Have concerns about IBS symptoms or diagnosis? If you’re in the San Antonio, TX area and looking for a board certified gastroenterologist click to request an appointment or call our office at (210) 615-8308.