What is Irritable Bowel Syndrome IBS – 

also known as irritable colon?

Irritable Bowel Syndrome IBS
Irritable bowel is based on a functional disorder of the intestine. Typical symptoms are abdominal pain, flatulence and diarrhea or constipation. They often intensify during stress. The disease can be very distressing, but it is not dangerous. For a reliable diagnosis, the doctor must rule out other possible causes. Read here everything important about symptoms, triggers and treatment options for irritable bowel syndrome.


  • Irritable bowel

  • Symptoms

  • Causes and risk factors

  • Examinations and diagnosis

  • Treatment

  • Course of the disease and prognosis

Irritable bowel syndrome: Brief overview

  • Most common symptoms: Abdominal pain, diarrhea and/or constipation, bloating

  • Possible causes: Disturbed barrier function of the intestinal wall, disturbed intestinal activity, increased immune activity in the intestinal wall, increased perception of pain

  • Diagnosis: inflammatory bowel diseases, food intolerances, gastrointestinal infections, gynecological causes must be excluded for the diagnosis of irritable bowel syndrome (exclusion diagnoses)

  • Treatment: always an individual treatment concept with medications, herbal remedies, homeopathics, probiotics, dietary changes, stress reduction.

  • Irritable bowel syndrome: What's behind it?

  • Abdominal pain, flatulence and diarrhea - where do the complaints come from and what helps against them?

  • Abdominal pain, flatulence and diarrhea - where do the symptoms come from and what can be done about them? You can see that in this video.

Irritable bowel syndrome: symptoms

In irritable bowel syndrome (irritable colon), intestinal function is disturbed. As a result, the stool changes: patients often suffer from diarrhea or constipation.

In some patients, however, bowel movements are unchanged. They mainly suffer from pain or flatulence, a bloated abdomen and outgoing bowel movements. These symptoms occur in combination with diarrhea and constipation.

Irritable bowel symptoms: The five types of disease

Depending on which symptoms are prominent, irritable bowel syndrome is divided into five disease types:

1. Diarrhea type IBS-D

2. Constipation type IBS-C

3. Mixed Symptoms Type IBS-M

4. Pain type IBS-P

5. Bloating type IBS-P

In addition, one type of disease may also change into another or they may alternate. Diarrhea and constipation, for example, may even occur on the same day.

In all disease types, the following other irritable bowel symptoms are also common:

  • Feeling of fullness

  • Feeling that the bowel does not empty completely during bowel movements

  • Mucus deposits on the stool

Pain with irritable bowel syndrome

Abdominal pain is a major symptom of irritable bowel syndrome. The pain can occur in different parts of the abdomen and can be of different character, for example:

  • burning or stabbing continuous pain

  • more cramp-like pain in waves

  • side stabbing-like pain

  • 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, and on the other hand by the stretching of the intestinal wall due to increased gas formation. The intestinal muscles react to this with contractions.

Diarrhea with irritable bowel

In irritable bowel syndrome patients of the diarrhea type, the stool is very soft to liquid. The number of bowel movements increases to more than three per day. Some irritable bowel patients with diarrhea also suffer from a sudden, strong urge to defecate. They therefore hardly dare to move further away from a toilet.

Constipation in irritable bowel syndrome

Conversely, symptoms of constipation can occur in irritable bowel syndrome. Affected individuals have very hard stools that resemble sheep feces in shape. These patients are often only able to go to the toilet three times a week or even less.

This helps against intestinal complaints!

Irritable bowel syndrome has many faces. Whether you suffer from bloating, diarrhea, constipation or abdominal pain, the following tips will help alleviate the discomfort!

Irritable bowel syndrome is common

Irritable bowel syndrome is one of the most common gastrointestinal complaints. It is a diagnosis of exclusion, which means that all other malaises of the intestine have already been ruled out - such as chronic intestinal inflammation or even an intestinal infection. Nevertheless, sufferers are always plagued by digestive problems.

What disturbs your digestion?

Try to find out if your symptoms have certain triggers. Does your digestion go crazy under stress? Do you not tolerate certain foods or medications? It's best to keep a diary to track down possible connections - so you can better avoid them in the future.

Heat against cramps

Make yourself a hot water bottle - the heat has a relaxing effect on the muscles and thus calms the intestines. A warm body wrap or a relaxing bath with lavender or lemon balm oil can also bring relief.

Eat in a relaxed way

Don't put too much on your plate and take your time when eating. A hectic pace, discussions about conflicts and deadlines should have no place at the table during mealtimes - this prevents stress and thus digestive problems.

Goodbye stimulants!

Even in healthy people, stimulants have a strong effect on digestion. Therefore, avoid the stressors for the stomach and intestines. So keep your hands off coffee, black tea, caffeinated drinks, alcohol and cigarettes.

Good against diarrhea

If diarrhea is one of your problems, you should eat little fiber and dairy products. Grated apples, carrots or healing clay can help against it - they bind the water.

Good against constipation

In some patients with irritable bowel syndrome, nothing works at all - constipation occurs. To reduce constipation in the intestines, eat plenty of fiber, i.e. fruits and vegetables. You should also drink plenty of fluids so that the fiber can swell - otherwise it will only make the situation worse. Also: don't skip breakfast, which you can enrich with bran or flaxseed, for example.

Good against flatulence

The situation is different if you are struggling with flatulence. In that case, you should only eat a small amount of dietary fiber. In particular, avoid vegetables that cause flatulence, such as beans, onions, nuts, unripe fruit or cabbage. Caraway seeds can be helpful, either as a tea or as an oil. An abdominal massage while lying down also provides relief - for this purpose, massage the abdomen in a clockwise circular motion.

Exercise helps the intestines

Some sufferers notice an improvement in their symptoms when they are regularly active. Try to incorporate exercise into your daily routine, go for a walk, cycle or do gymnastics.

Prevent stress

Try to manage stress better. It can help to learn a few relaxation techniques or to start doing yoga. Also, always take enough time to go to the bathroom.

Symptoms often improve

If sufferers can find out what triggers their symptoms, they have a good chance of getting rid of their complaints: About 34 percent of irritable bowel sufferers can alleviate their symptoms or even become completely symptom-free through targeted behavioral changes and therapeutic measures. However, if the condition becomes chronic, the prognosis is worse. There is no reliable cure as yet.

Flatulence and bloating in irritable bowel syndrome

Every healthy digestive system produces gases in the intestines. In irritable bowel syndrome, however, they can form in excess due to disturbed intestinal movements and food utilization. This is particularly unpleasant for patients because their intestinal wall reacts more strongly than usual to the stretching stimulus caused by the gas bubbles. Cramp-like abdominal pain is often the result.

If the intestinal gas bubbles cannot escape sufficiently, a bloated abdomen forms, which can be distended like a drum and is painful.

Other changes in bowel movements

Although the various symptoms usually improve after bowel movements, some irritable bowel patients find the bowel movements themselves painful.

In addition, many sufferers have the feeling that the bowels could not be emptied properly. This tempts some to use laxatives. However, such drugs then do not help and can aggravate the irritable condition. If laxatives are really necessary, they should be considered as a short-term solution because of the possible side effects.

Also common with irritable bowel syndrome is mucus buildup on the stool.

Regardless of whether patients with irritable bowel syndrome have diarrhea or constipation, they often suffer from a permanent feeling of fullness. This usually improves after bowel movements, but can also occur when those affected have not eaten any food at all and the bowel is relatively empty.

Risk of confusion with other diseases

The symptoms of irritable bowel syndrome are non-specific. That is, they also occur in a variety of other diseases. Before the diagnosis of irritable bowel syndrome is made, these must therefore be ruled out. Possible other causes for the complaints are

· Food intolerances, including to lactose, fructose, sorbitol or gluten

· Inflammatory bowel diseases 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. Rapid medical clarification is necessary in case of them, as potentially dangerous diseases may be behind them.

  • Diarrhea that occurs mainly at night

  • Fever (acute or chronic-recurring)

  • Blood in the stool

  • Severe unwanted weight loss

Irritable bowel syndrome: Tracking down the causes

Irritable bowel syndrome (IBS)

Irritable bowel syndrome: causes and risk factors

There are numerous hypotheses on the development of irritable bowel syndrome, but so far there is little reliable evidence.

However, scientists have been able to identify a whole series of typical changes in the intestines of those affected. These changes do not only occur in irritable bowel syndrome, but also in chronic inflammatory bowel diseases. These include:

Disturbed intestinal peristalsis (motility disorder).

It is thought that in irritable bowel syndrome, the natural movement of the bowel is disturbed. This means that the movements to transport the digested food do not run optimally.

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 intestine and stretches the wall. Together with the neurotransmitter serotonin, the gut nervous system controls digestion. It stimulates the intestinal muscles to tense and relax alternately.

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 extracted 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 spasms, on the other hand, occur, among other things, when the muscles contract too strongly and for too long or do not relax properly at all.

Increased permeability of the intestinal mucosa

An unnaturally high permeability of the intestinal mucosa (leaky gut) can also trigger irritable bowel symptoms. In the intestinal mucosa, neighboring cells are normally closely connected to each other via a kind of adhesive bridge (tight junction). They tightly seal the junction between the cells so that no foreign substances or pathogens can pass between the cells.

As long as these tight junctions between the cells are intact, the intestinal mucosa cells as a whole form an effective barrier. It prevents foreign substances from entering the body uncontrollably from the intestinal tract.

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

Increased immune activity in the intestinal mucosa

In tissue samples of the intestinal mucosa of affected individuals, there is increased immune activity. For example, increased immune system defense cells and their messenger substances can be detected in the mucosa. It is not yet known why this 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 then occurs with severe diarrhea. Certain bacteria such as Campylobacter jejuni may be more frequently responsible for this than other types. However, only about one in ten cases of irritable bowel 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 mixture of beneficial bacteria in the intestine is out of balance, this can impair intestinal function and promote increased gas formation. Causes of disturbed intestinal flora can include medications such as antibiotics, but also gastrointestinal infections.

Disturbed serotonin balance

The serotonin balance could also be disturbed in irritable bowel syndrome. The neurotransmitter serotonin is responsible, among other things, for how pain is perceived. If the nervous system of the intestine is activated in irritable bowel syndrome, it cannot optimally regulate how much messenger substance it releases. As a result, sufferers may perceive their intestines more strongly than usual and experience pain.

Stress as a trigger and amplifier

Whether anxiety, nervousness, anger, grief or work stress: Irritable bowel symptoms often worsen under psychological stress. If the stress subsides again or if one relaxes specifically, the symptoms usually improve as well.

Acute stress has been shown to lead to changes in the gastrointestinal tract. Gastric juice production increases, intestinal movements increase and the local immune response in the intestines changes.

However, people react highly differently to stress. While some sufferers have developed methods to deal with stress, others suffer enormously from the mental and physical consequences. Persistent life stress is important for the prognosis of the disease: patients with life stress show no improvement in their symptoms after six months. In contrast, 44 percent of patients without life stress show an improvement. The longer the medical history, the lower the chance of improvement.

Irritable bowel syndrome and its triggers

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

Connection with diseases occurring at the same time

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

· Depression

· Anxiety disorders

· Chronic fatigue syndrome

 Fibromyalgia· Fatigue syndrome

· Chronic (head) pain

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Irritable bowel: examinations and diagnosis

Irritable Bowel Syndrome
The diagnosis of irritable bowel syndrome is a so-called diagnosis of exclusion. This means that the doctor must first rule out other possible causes for the complaints before an irritable bowel syndrome can be assumed.

The right person to contact when irritable bowel syndrome is suspected is an internal medicine specialist who specializes in diseases of the digestive tract: a gastroenterologist. At your appointment, the doctor will first inquire about your current symptoms and any previous illnesses (medical history).

The doctor might ask you the following questions, for example:

· Where exactly do you have pain and in what 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 circumstances?

· Have you noticed blood in your stool, do you have a fever, and have you lost weight unintentionally?

These would all be atypical of irritable bowel syndrome.

It is also useful to keep a 2-week stool diary (with at least one abnormal bowel movement) / food log and discuss the results with your doctor. In particular, this can often reveal a connection between certain foods and the symptoms. There are also special questionnaires for IBS.

Physical examination

The complaints of irritable bowel syndrome primarily affect the digestive tract. That is why the abdominal cavity is the focus of the physical examination. The physician first listens to the abdomen with a stethoscope (auscultation). In doing so, he can hear the intestinal activity, but also determine if the intestine moves little or not at all. In irritable bowel syndrome, the bowel often moves excessively.The doctor then gently taps the abdominal wall with his fingers. The sound differs depending on whether the bowel is filled with stool or air. Since the intestine is filled with more air in cases of flatulence, a characteristic resonance is produced when tapping.Finally, the doctor palpates 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 pain is caused by the examination.

Abdominal ultrasound

Ultrasound is of limited value in assessing the intestines in irritable bowel syndrome because intestinal gases interfere with the ultrasound image. However, it can detect other causes of the symptoms, such as diseases of the gallbladder, bile ducts, liver, kidneys and pancreas. In addition, the doctor can see in the ultrasound whether the intestinal wall is thickened. This would indicate inflammation.

Laboratory tests

The laboratory can be used to search for various substances in the blood, urine and stool. They provide indications of inflammations or infections, for example. In irritable bowel syndrome, however, the laboratory values are usually unremarkable.

Gastroscopy and colonoscopy

In many cases, a gastroscopy and colonoscopy must be performed if the symptoms of the digestive tract are unclear. During the examination, the physician may also take a small sample (biopsy) of the mucosa. In the case of irritable bowel syndrome, certain changes in the intestinal mucosa are apparent These, however, also occur in chronic inflammatory bowel diseases (Crohn's disease, ulcerative colitis).

Tests for food intolerances

Food intolerances such as lactose, fructose or sorbitol intolerance as well as celiac disease (gluten intolerance) cause symptoms similar to those of IBS. They can be confirmed or ruled out by simple tests.

The H2 breath test (also calles SIBO Breath Test) can be used to identify various carbohydrate intolerances.

To diagnose celiac disease, the blood is tested for certain antibodies and a tissue sample of the mucosa of the small intestine is analyzed under the microscope.

With the help of the Test, one can find out whether the barrier function of the intestine is disturbed (leaky gut syndrome).

Diagnostic criteria: Irritable bowel

According to the Rome Criteria, irritable bowel syndrome is present when the following three points are met in a patient:
  • The patient suffers from chronic, i.e. at least one day per week, intestine-related complaints such as abdominal pain or flatulence, which are usually accompanied by changes in bowel movements such as diarrhea or constipation.
  • Due to the complaints, the quality of life is significantly impaired.
  • There are no changes characteristic of other clinical pictures that could explain the complaint
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Irritable bowel syndrome: Treatment

IBS Irritable bowel syndrome

There is no generally valid therapeutic approach for the treatment of irritable bowel syndrome. What improves the symptoms depends on the different symptoms, but also on the different triggers and the individual patient.

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

Always make changes to the 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

Diarrhea in irritable bowel syndrome can be treated with various medications. The most commonly used are tanning agents, 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. They can also be bought as capsules in pharmacies. They counteract inflammatory processes in the intestine, reduce secretion and slow down intestinal movement.

Loperamide is a synthetically produced substance distantly related to opium, but it acts almost exclusively locally on the intestine and immobilizes the overexcited intestinal muscles. As a result, the stool lingers longer in the colon, allowing more fluid to be extracted from it and making it firmer again. However, loperamide should only be taken for short periods of time and strictly according to dosage instructions, as the drug would otherwise lead to pronounced constipation.

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

Water-soluble dietary fibers such as psyllium, locust bean gum and pectin can also stop diarrhea. To compensate for fluid loss, increase fluid intake accordingly. In cases 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

If irritable bowel syndrome causes constipation, physical exercise can sometimes help to get the bowels moving again. In addition, those affected should drink two to three liters of fluid daily. Since this alone is usually not enough, additional dietary fibers such as psyllium husks and water-absorbing substances such as macrogol can be used.Laxatives from the pharmacy include active ingredients such as bisacodyl and sodium picosulfate. They are usually used as suppositories or mini enemas.

Irritable bowel syndrome: treatment of cramps and pain

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

If herbal medicines are not enough, the antispasmodic active ingredient butylscopolamine has proven effective. It is often used in combination with the painkiller paracetamol. Other active ingredients with antispasmodic effects are mebeverine or trospium chloride. Unlike the herbal preparations mentioned, however, these must not be used permanently.

Irritable bowel syndrome: What helps against flatulence?

In irritable bowel syndrome, excessive gas can build up due to impaired food utilization and altered intestinal movement. In people with irritable bowel syndrome, these often do not go away spontaneously and can also trigger cramp-like discomfort and distend the abdomen.Herbal remedies for flatulence such as caraway and peppermint oil, fennel or aniseed not only have an acute effect, but can also be taken preventively and in the long term. If they are not enough, defoaming medications such as simethicone and dimethicone alleviate the discomfort.

Fennel against flatulence

Fennel can help with acute flatulence and also prevent it. Anise as well as caraway and peppermint oil also soothe the intestines.

Irritable bowel: Homeopathy & Co.

There are a number of homeopathic preparations that are believed to have a soothing or preventive effect. Among others, the following remedies are used:

· Bismuth oxide nitrate (Bismutum subnitricum).

· Cerium oxalicum· citron flower (Cina artemisia)

· Cyclamen (Cyclamen)

· Ginseng

· In addition: So called "Schuessler salt" - Kalium sulfuricum

The concept of homeopathy and its specific effectiveness are controversial in science and not clearly proven by studies.

Irritable bowel: Therapy with probiotics

Probiotics made from viable intestinal bacteria are supposed to bring a disturbed intestinal flora back into balance. Whether and which probiotics are suitable for irritable bowel syndrome has not yet been fully clarified. However, there are indications that various bifidobacteria, lactobacilli and other probiotics may actually help.

Irritable bowel syndrome: help through relaxation

Irritable bowel syndrome is often triggered or exacerbated by stress and acute or chronic overwork. Sufferers should observe whether psychological or physical stressful situations aggravate the irritable bowel syndrome symptoms. Here, too, a diary can help to identify such correlations.

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

Antidepressants and psychotherapy

Irritable bowel syndrome is also frequently accompanied by psychological complaints such as depression or anxiety disorders. These are associated with stress and can thus promote and intensify irritable bowel syndrome. If the psychological complaints are treated in the context of psychotherapy or with antidepressants, the irritable bowel symptoms often improve as well.In addition, antidepressants partially influence the musculature of the gastrointestinal tract and can have a pain-relieving effect.

Irritable bowel syndrome: diet

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

However, there is no universal recommendation for the diet of irritable bowel syndrome: different rules apply to diarrhea than to constipation. In addition, each affected person reacts differently to different foods.

Dietary fiber

Fiber is another food that not every irritable bowel patient responds well to. However, they do seem to help with constipation in particular. Liquid dietary fiber may also benefit patients with diarrhea or bloating as the main symptom.

Dietary tips for irritable bowel syndromeThe following basic dietary rules have proven helpful for some irritable bowel patients:

· Eat slowly.

· Don't gulp down a lot of air unnecessarily.

· Many small portions are better than a few large ones.

· Drink enough. Mineral water without carbonic acid, for example, is good.

· Fatty foods, legumes, strong spices, sometimes also coffee, alcohol, nicotine or dairy products can cause discomfort.

· Some people are also sensitive to white flour products, convenience foods and various sugar substitutes.

· Pay attention to how the food is composed and at what time of day you eat.

· Eat regularly and always at fixed times.· Do not eat too much, especially in the evening.

· Take your time for your meals, try to eat them in a calm atmosphere.

Warmth for the stressed belly

A hot water bottle on the belly can relieve pain and cramps and soothe the intestines.

Abdominal massage

Irritable bowel syndrome: course of the disease and prognosis

Irritable bowel syndrome

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

Irritable bowel syndrome can vary greatly from person to person. The symptoms can also wax and wane, stop altogether, or recur. In some patients with irritable bowel syndrome, diarrhea, constipation, pain and flatulence alternate. Often, the disease significantly affects the quality of life.

If sufferers can find out what triggers their symptoms, they have a better prognosis. About 34 percent of patients succeed in alleviating their symptoms through targeted 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 every second person affected develops chronic irritable bowel syndrome and suffers from the symptoms for many years or even their entire life. There is as yet no treatment that can completely cure the disease. However, there is also no evidence that irritable bowel syndrome causes other serious diseases.

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