Irritable Bowel Syndrome

Maher A. Abbas, MD
Compassion, Excellence, Integrity

Diplomate, American Board of Surgery

Diplomate, American Board of Colon and Rectal Surgery

Fellow, American College of Surgeons

Fellow, American Society of Colon and Rectal Surgeons

Honorary Fellow, Philippine Society of Colon and Rectal Surgeons

Honorary Member, Surgical Section Serbian Medical Association

“The best interest of the patient is the only interest to be considered…”W.J. Mayo, MD (Founder of the Mayo Clinic)


Dr. Maher Abbas is an American Board Certified Colon and Rectal Surgeon who performs the latest and most advanced procedures to treat conditions affecting the small intestine, colon, rectum, and anus.  He is a leader in minimally invasive and endoscopic surgery. With over 18,000 operations and procedures experience, he provides state of the art treatment to his patients.


What is irritable bowel syndrome?

Irritable bowel syndrome, known as IBS, is a common gastrointestinal disorder which predominantly affects the large bowel [Figure 1].   The spectrum of symptoms in patients with IBS can vary significantly in nature, severity, and frequency.  It is important to note that IBS is a diagnosis of exclusion, which means other gastrointestinal conditions need to be excluded before assigning an individual patient the diagnosis of IBS.   IBS affects approximately 15% of the population.  Although it is more common in women, it occurs in men as well.   All age groups from childhood to elderly age suffer from IBS but most patients are young under the age of 50 years.  Although IBS negatively impacts the quality of life, it is not dangerous and there is no increased risk for colorectal cancer in patients with IBS.  IBS can lead to depression and anxiety and can contribute to the development of proctologic disorders such as hemorrhoids.

Figure 1 – The large bowel


What causes irritable bowel syndrome?

Despite extensive scientific research, we still have a limited understanding of the causes of IBS.   Abnormal sensitivity of the large bowel with irregular contraction of the muscles and nerves in the bowel wall have been implicated as plausible mechanisms.   Weak intestinal contractions lead to constipation and bloating pain while strong fast contractions lead to diarrhea and spasm.  Factors which trigger symptoms include environmental elements, bacterial overgrowth in the gut, food intolerance or sensitivity, emotional or physical stress, or prior gut inflammation or infection.  Women can experience worse symptoms around their menstrual periods.


What are the symptoms of irritable bowel syndrome?

The spectrum of IBS symptoms varies from patient to patient in nature, severity, and frequency.  Patients have 1 or more of the following symptoms:

  • Abdominal pain (with complete or partial relief with a bowel movement)
  • Cramping and/or bloating
  • Constipation
  • Excess gas
  • Diarrhea
  • Mixed bowel pattern alternating between constipation and diarrhea
  • Mucous in the stool


Can other disorders mimic the symptoms of irritable bowel syndrome?

It is important to note that the symptoms of IBS are non-specific and many other types of gastrointestinal disorders can present with similar symptoms.  Therefore, it is important to seek care to exclude other conditions such as:

  • Bacterial overgrowth
  • Cancer and tumors of the stomach, small bowel, or colon
  • Celiac disease and/or gluten allergy
  • Constipation related to endocrine disorders such as hypothyroidism
  • Dietary causes (excessive intake of gas producing foods)
  • Diverticulitis
  • Food allergies
  • Fructose, glucose, or lactose intolerance
  • Gut motility issues
  • Inflammatory bowel disease such as Crohn’s disease
  • Intestinal blockage
  • Intestinal infections
  • Helicobacter pylori bacterial infection of the stomach
  • Slow emptying of the stomach (gastroparesis)


When should you be concerned?

Patients with a presumed history of IBS should seek immediate medical attention if any of the following symptoms is present:

  • Anemia
  • Bloody stools
  • Distended, bloated abdomen that is sensitive to the touch
  • Fever
  • Inability to pass gas with severe constipation
  • Onset of symptoms after age of 50 years
  • Pain that is worse with coughing or moving around
  • Persistent nausea with vomiting and inability to keep food down
  • Sudden onset of new severe abdominal pain
  • Weight loss
  • Pain that does not go away and is present on most days


What tests are needed to evaluate irritable bowel syndrome?

The history and physical examination are the first step in evaluating patients with irritable syndrome.  As other more serious gastrointestinal conditions can present with IBS like symptoms, several tests are conducted to exclude such conditions.  Dr. Maher Abbas individualizes the care of his patients based on a variety of factors.  Several of the following tests may be recommended after the initial evaluation:

  • Blood tests: CBC (complete blood count to assess for anemia or infection), liver function test, renal (kidney) function test, CRP (C reactive protein) and/or ESR (erythrocyte sedimentation rate) to check for inflammation, thyroid test, calcium level, celiac disease serology, helicobacter pylori bacteria serology, pregnancy test in women of reproductive age

  • Breath tests: urea breath test for helicobacter pylori bacteria, lactose intolerance test, fructose and lactose intolerance test (inability to digest some sugars including dairy products). In addition, a test for bacterial overgrowth can be helpful in some patients

  • Colonic transit study to check for colon function in patients with severe constipation (bowel movement frequency less than once a week). In this procedure, you swallow a capsule that contains small ring markers which travel through the intestine.  XRAY films are obtained 3 and 5 days later to assess how fast these markers travel through the colon

  • Endoscopic procedures: Colonoscopy and Gastroscopy to check inside the colon and stomach

  • Radiologic examinations: CT scan (computed tomography), MRI (magnetic resonance imaging scan), or ultrasound of the abdomen

  • Stool tests: useful tests include ova and parasites, Calprotectin level (to check for inflammation), guaiac or the FIT test (fecal immunochemical test) to check for blood in the stool, helicobacter pylori bacteria toxin for bacterial infection, stool cultures, Gastrointestinal Multiplex panel (to test for various infection), clostridium difficile toxin

  • Other tests: in rare cases, other types of tests are available to evaluate your condition



No surgical intervention is indicated for patients with IBS.  After the initial evaluation and documentation of IBS, Dr. Maher Abbas will provide you with some general recommendations and he will refer you to a gastroenterology colleague (medical doctor) who will assist in managing your condition long-term.   Medical management of IBS include the following:

  • Acupuncture
  • Avoid gas producing foods (Gas Reduction Instructions)
  • Consider a low-FODMAP diet. Certain carbohydrates (sugars) such as fructose, lactose, and others known as FODMAPs (fermentable oligo/di/and monosaccharides and polyols).  You can visit with a dietician for further guidance or check various online resources on this topic
  • Decrease gluten intake in your diet (wheat, barley, and rye)
  • Drink plenty of fluids
  • Eat at regular times every day
  • Maintain a food diary and record daily bowel symptoms for 2 months. Identify potential food triggers you need to avoid
  • Regular exercise
  • Sleep an adequate amount to avoid daily fatigue
  • Stress reduction techniques including yoga, meditation, hypnosis

In addition to the above interventions, the gastroenterologist will determine which medication can be helpful for your specific condition.  Depending on your symptoms, medications to relieve constipation or control the diarrhea are prescribed.   Anti-spasmodic medications decrease intestinal spasm and pain.   A course of one of the specific anti-depressant medications for several months can get the symptoms under control.   Some patients can benefit from antibiotics or probiotics to alter the bacterial composition of the gut.  Peppermint oil can provide relief in some patients.

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