(Part 1) Irritable Bowel Syndrome: How to Know When you Have It!

Dahlia Marin, RDN, LD

This month (April) is Irritable Bowel Syndrome (IBS) awareness month! Though many may not realize it, approximately 20% of the population struggles with some form of irritable bowel syndrome. The Rome IV criteria for IBS has a general umbrella for symptom diagnosis, and more specific criteria for the 3 major subtypes of IBS and the 4th undetermined type. The diagnostic criteria to be met to have general IBS is recurrent abdominal pain at least one day per week on average in the past 3 months, while simultaneously associated with at least two of these criteria:

  1. Defecation

  2. Change in stool frequency

  3. Change in stool appearance or form

There are three major forms that IBS comes in: IBS-D, IBS-C, and IBS-M. There is also a 4th form called IBS-U that is diagnosed when an individual does not fit into the previous 3 categories.

IBS-D is irritable bowels that have a tendency towards diarrhea. This derivative of IBS is characterized by having a quarter or more stools that are watery and loose, while less than a quarter of them are lumpy, hard, and devoid of water, which is also the criteria for diagnosis.

IBS-C is irritable bowel syndrome with a tendency towards constipation. This kind of IBS is diagnosed when more than one quarter of the stools are lumpy and there is less than a quarter of the stools that are watery.

IBS-M is a mixture of the two. This skew of IBS includes a mixture of both the previous kinds of symptoms, and the diagnosis is characterized by 25% of bowel movements being lumpy and hard (like IBS-C), and 25 % of the bowel movements being diarrhea-like and watery (like in IBS-D).

There is also a diagnosis of IBS-U, which is Irritable Bowel syndrome with no clear categorization of constipation, diarrhea, or a mixture of the two. This is for those patients that meet the diagnostic criteria for IBS, but diarrhea or constipation specifically are rare even if they have abnormal stools and abdominal pain.

It may sound a bit gross to discuss the contents of our toilets when we have to “do our business”, but it is important to know what kind of IBS somebody may have to manage the symptoms and work with a dietitian and care team to come up with the right protocol! If you are really interested in the specific typology of bowel movements and diagnostic criteria of many gastrointestinal issues, check out this website!

What are the symptoms of IBS?

Irritable bowel syndrome is very individual, and it can manifest for different reasons, and with different skews of symptoms; however, there are some general truths that come with this disease. The major symptoms of IBS are pain or discomfort in the lower abdominal region, change in stool frequency or the form of the stool, mucus passed through the rectum, or abdominal pain reduction specifically coinciding with defecation. There may also be the sensation of bloating, gas, or the presence of diarrhea or constipation (depending on the type of IBS). Sometimes, an individual may have a more specific form of IBS called SIBO (Small Intestinal Bacterial Overgrowth) or IMO (Intestinal Microbial Overgrowth). This form of IBS has much more specific causes from the bacteria or other microbes in the large intestine moving into the small intestine and disrupting the delicate ecosystem of our localized gut microbiome. In other words, this form of IBS is caused by the “good microbes” in a place where they should not be, and has a variety of other underlying causes -- more than just the general IBS protocol. It is very important to test and understand if you have SIBO or IMO because the treatment may be different than if you are diagnosed with one of the general forms of IBS. Make sure to consult with your care team to determine what form you may have: 100% of SIBO or IMO is IBS, but NOT all IBS is considered SIBO or IMO!

Want to learn more about causes and treatments for IBS? Stay tuned for the next 2 of this 3 part series we will post throughout the month!

If you are interested in working with an RDN, we would love to support you! You can schedule a personalized visit with us and we would love to collaborate with you on your journey! We see clients from all over the world.

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