Michael DeSimone, MD, of Concord Gastroenterology Associates sat down for an episode of Emerson’s Health Works Here podcast series to provide insights on irritable bowel syndrome (IBS). Continue reading for his answers to common questions about IBS or listen to the podcast below.
Irritable bowel syndrome is a term that is not often well understood. “Basically, IBS is a situation where your bowel movements are not where you want them to be, and maybe you have some uncomfortable symptoms that are associated with that irregularity,” states Dr. DeSimone.
What Causes IBS?
Many IBS sufferers describe feelings of bloating, cramping, discomfort, urgency, or nausea. Others will say, “I have a flare of my IBS” or “Things are really inflamed.” Dr. DeSimone provides some clarity surrounding statements like this, explaining that IBS falls under the umbrella of a group of conditions fairly common in the gastroenterology world called functional disorders.
“IBS is not an infection, and it’s not an inflammatory condition. Inflammation means that the immune system is very active in an area, and that is not something we see with irritable bowel syndrome. IBS is also not something we typically see under a microscope, on an endoscopy, or on a CAT scan. But things are not functioning the way they should.”
A lot of the symptoms of IBS relate to the muscles and nerves that control movement through the gastrointestinal (GI) tract and give us feedback about what is happening there. In a healthy gut, that movement is nicely coordinated and those nerves are fairly quiet.
“We are not, on an average day, given too much information about what our GI tract is up to. And we like it that way. In general, if we are being told a lot of information about the inner workings of our gut, that is often uncomfortable,” explains Dr. DeSimone.
Another potential cause of IBS relates to the gut’s microbiome — a burgeoning area of investigation and study in the GI world. “All of the bacteria and other organisms that live inside of us, we are chock full of them, and they need to be in a certain state of balance. We have to have certain healthy bacteria and organisms that keep away the ‘bad’ ones that cause illness, disease, or discomfort symptoms in the case of IBS,” he adds.
How is IBS Diagnosed?
There is no definitive diagnostic test to identify IBS. It often falls in the realm of “diagnosis of exclusion,” meaning other conditions are ruled out. To more clearly diagnose IBS, gastroenterologists routinely use a set of diagnostic criteria called the Rome IV criteria, which were developed by a panel of international experts in the field of functional gastrointestinal disorders. These criteria have undergone several revisions, with the intent of making them clinically useful and relevant.
Some of the Rome criteria for IBS include:
Recurrent abdominal pain on average at least one day/week in the last three months, associated with two or more of the following criteria:
- Related to defecation
- Associated with a change in frequency of stool
- Associated with a change in form (appearance) of stool
Then there are additional criteria defining IBS with diarrhea and constipation.
Some symptoms are not associated with the condition, such as blood in one’s stool and unexplained weight loss. “We do not expect to see bleeding from the GI tract as a result of irritable bowel syndrome. So, if you have blood in your stool, that is something you should get checked out by your doctor,” cautions Dr. DeSimone.
Treatment for IBS typically begins by getting the patient’s bowel movements back on a healthy track. For example, if diarrhea is the issue, the goal is to slow down the digestive system. If bowel movements are not occurring frequently enough, the aim is to speed them up.
Sometimes, the solution is as simple as an over-the-counter stool softener or laxative, or, on the other end of the spectrum, an over-the-counter diarrhea medicine. There are also prescription medications Dr. DeSimone will prescribe for certain scenarios.
Once a level of regularity is restored, the next step is to optimize bowel function via diet and lifestyle. Functional GI disorders tend to flare up in times of stress. They are often associated with conditions like anxiety or depression. In the same way a healthy lifestyle can help ease mental health issues, it can similarly ease IBS symptoms as well.
Diet is a key piece in the management of gastrointestinal symptoms. The diet topics Dr. DeSimone and other GI specialists focus on most in IBS patients revolve around gluten and dairy.
“Gluten bothers a lot of people, yet it is everywhere. The western diet, the American diet, is very gluten heavy and very dairy heavy,” he notes. “A lot of the foods we think of as staples or comfort foods are a combination of gluten and dairy. It's pizza, it's pastas that have cheese. About every sandwich we eat is made on wheat-based bread and may have some cheese in it.”
Fiber is another food that is routinely involved in conversations about IBS. In some cases, more fiber is recommended in the form of a high-fiber diet or fiber supplement. Other patients need less fiber or different forms of fiber in their diets.
“An important component of a lot of people's IBS symptoms is bloating or gas — some of which does come from ingesting fiber. “We try to control it or give people guidance on how to balance out different sources of fiber, how to add or subtract sources of fiber in order to control some of their symptoms,” shares Dr. DeSimone.
Is It Time to See a GI Doctor?
If you or someone you know is suffering from IBS-like symptoms, Dr. DeSimone urges scheduling a visit with a GI physician — and sooner rather than later.
“I can't tell you how many times I see patients who have been walking around with some form of these symptoms their whole lives, or at least for their whole adult lives. The sooner you come in, the sooner we can figure out if there is something we can do. If it is possible to improve your quality of life with a little bit of guidance, some advice about a diet or a medication with very few side effects, I think that is a great opportunity to try to feel better.”
Listen to the Podcast
Holistic Approach to Managing IBS
Dr. Michael DeSimone discusses IBS and ways to manage IBS through lifestyle and holistic methods.
Subscribe to the Health Works Here Podcast on Apple Podcasts, Spotify, Google Podcasts and wherever podcasts can be heard.
About Dr. Michael DeSimone
Dr. Michael DeSimone is a board-certified gastroenterologist at Emerson’s Concord Gastroenterology Associates in Concord, Mass. A graduate of Brown University’s Warren Alpert Medical School, Dr. DeSimone specializes in colorectal cancer screenings and prevention, inflammatory bowel disease including Crohn’s disease and ulcerative colitis, and liver disease.
Visit Dr. DeSimone’s physician profile to learn more and request an appointment, or call Concord Gastroenterology Associates at 978-287-3835.