What is irritable bowel syndrome?

Irritable Bowel Syndrome (IBS) is a chronic and often debilitating gastrointestinal disorder associated with symptoms that can include abdominal cramping, diarrhea, constipation, bloating, and gas. In the United States, 25 – 45 million people are affected by IBS, and IBS occurs more often in females than males.

IBS can be extremely painful and negatively impact all aspects of a person's life. Repeated bowel movements can interfere with daily activities and leave people feeling trapped and needing to be close to a bathroom.

There are many subtypes of IBS. Symptoms for each of the following occur on days when you have at least one abnormal bowel movement, these include:

  • IBS with constipation (IBS-C):
  • The main symptom of this subtype is constipation. If you have this form of IBS, more than one-quarter of your stools are hard and lumpy, and less than one-quarter are loose .
  • IBS with diarrhea (IBS-D):
  • The main symptom of this subtype is diarrhea. More than one-quarter of your stools are loose , and less than one-quarter are hard and lumpy.
  • IBS with mixed bowel habits (IBS-M):
  • IBS-M is a mix of IBS-C and IBS-D. It is also called irritable bowel syndrome with alternating bowel habits. More than one-quarter of your stools are hard and lumpy, and more than one-quarter are loose .
  • IBS unclassified (IBS-U) :
  • The final IBS subtype may present with a variety of symptoms.  You are diagnosed with IBS-U if you meet the criteria for IBS but your symptoms don’t fall into the IBS-C, IBS-D or IBS-M categories.

What causes IBS, and what are the risk factors?

IBS is complicated, and experts believe that different factors may cause IBS in other people. Some connections in functional gastrointestinal (GI) disorders are associated with the brain-gut axis (BGA), which consists of the bidirectional communication between the central and the enteric nervous system .

Different systems in the body are part of BGA, including:

  • The central nervous system (CNS): The brain and the spinal cord
  • The enteric nervous system (ENS): The gut has a complex system of nerves in its wall. Many nerve cells (neurons) operate in the GI tract to control its functions. There are over 100 million neurons in the human gut.
  • The autonomic nervous system (ANS): ANS is part of the peripheral nervous system, which regulates automatic bodily processes like heart rate, blood pressure, breathing, digestion, and sexual arousal.

Experts believe that alterations in the brain-gut axis may alter how your body works and cause IBS symptoms. Specific problems are more prevalent in people who experience IBS, such as:

  • Stressful events in life, such as sexual or physical abuse
  • Some mental disorders, like depression, anxiety, and somatic symptom disorder
  • Post-Traumatic Stress Disorder (PTSD)
  • Bacterial infections in the digestive tract or bacteria overgrowth in the small intestine
  • People who have experienced infectious gastroenteritis
  • People who have other inflammatory bowel diseases (IBD), like microscopic colitis (MC), Crohn's disease, or ulcerative colitis.

What are hemorrhoids?

Hemorrhoids (piles) are enlarged veins in the lower rectum and anus. Piles can form inside the rectum or under the skin around the anus.

What are the symptoms of hemorrhoids?

External hemorrhoids symptoms:

  • Anal itching and serious irritation
  • One or more firm, painful lumps near your anus
  • Anal discomfort or pain, especially when sitting.

Internal hemorrhoid symptoms:

  • Bright red blood on toilet paper, in the stool or toilet after defecating, or bleeding from the rectum
  • Irritation and pain with defecation

What causes hemorrhoids?

Experts believe that constipation and the straining that happens, as a result, lead to hemorrhoids, but some evidence suggests that diarrhea may also play a role.

Other factors that contribute to the development of hemorrhoids include:

  • Sitting on the toilet for too long
  • Improper posture while defecating
  • Excessive straining
  • Pregnancy
  • Excess weight
  • Low fiber diet

Other causes that may contribute to hemorrhoids may include:

  • Weakened supportive tissues in the anus from natural aging
  • Frequent lifting of heavy objects

How are hemorrhoids treated?

There are several ways to treat hemorrhoids (some are outpatient). Treatment options may include:

  • Rubber band ligation: A rubber band cuts the blood flow to the hemorrhoid which shrinks and falls off, usually around a week after the procedure.
  • Sclerotherapy: A chemical solution is injected into the area around the hemorrhoid causing the tissue to scar and shrink.
  • Infrared photocoagulation: This method uses infrared light to cut off the blood supply to internal hemorrhoids causing them to harden and shrink.

Surgical Procedures are only necessary in a small percentage of cases. If surgery is needed, procedures may include:

  • Hemorrhoid removal (hemorrhoidectomy): A surgeon removes excess tissue causing bleeding.
  • Hemorrhoid stapling (stapled hemorrhoidopexy): This surgical procedure stops blood flow to the hemorrhoid tissue.

Are there any complications associated with hemorrhoids?

If not treated, hemorrhoids may create other problems, such as a prolapsed hemorrhoid that cuts off blood flow or anemia due to heavy bleeding.

What are the symptoms of irritable bowel syndrome?

Irritable bowel syndrome symptoms can vary from person to person, but common symptoms include the following:

  • Cramps or abdominal pain when attempting to pass a stool
  • Changes in the way your stools appear
  • Increases in the number of times you need to defecate

Other symptoms can include:

  • Feeling like you weren't able to complete your bowel movement
  • Increased gas or mucus in the stool

If you experience consistent changes in bowel habits other than your IBS symptoms, consult your doctor. They might signify something more severe, such as colon cancer.

Severe signs and symptoms include:

  • Weight loss
  • Nighttime diarrhea
  • Rectal bleeding
  • Iron deficiency anemia
  • Pain that persists even after passing stool or gas
  • Unexplained vomiting

Are IBS and Hemorrhoids Connected?

There appears to be some connection between IBS, Chronic gastritis, Hemorrhoids, and Urolithiasis.

One study of 51 patients with IBS and 70 without IBS found chronic gastritis in 40 IBS cases (78.4%) versus 35 cases (50%) without IBS. Hemorrhoids were diagnosed in 17 IBS cases (33.3%) but only 11 cases (15.7%) without IBS. Urolithiasis occurred in 9 (17.6%) of IBS cases and 4 (5.7%) without IBS.

IBS treatments.

Some of the best treatments for IBS are appropriate and safe methods, such as maintaining a healthy lifestyle, reducing alcohol consumption, avoiding or limiting caffeinated beverages, and avoiding foods that can trigger and worsen symptoms.

  • Mind-body therapy: Cognitive Behavioral Therapy (CBT), multi-component psychological therapy, dynamic psychotherapy, hypnotherapy, and yoga are commonly used and effective mind-body therapies. Furthermore, yoga may help improve GI symptoms, anxiety, and quality of life.
  • Diet modification: Patients with IBS are more likely to experience reactions to food, such as dietary intolerance to gluten, wheat, and lactose (dairy products). Gluten-free diets have been studied and associated with improvements in anxiety, depression, fatigue, and quality of life.
  • Your health provider may recommend a low FODMAP diet to help reduce and eliminate certain foods that are known to trigger IBS. Foods high in fiber, like whole grains, vegetables, and fruits, are healthy and may help improve IBS symptoms.
  • Exercise: Studies have shown that physically active people have less symptoms than non-physically active people.
  • A 102 patient 12-week trial revealed increased physical activity reduced IBS symptom severity.
  • Thirty-nine trial participants reported long-term improvements from the increased exercise regimen.
  • Alternative approaches: Alternative medicine, like Traditional Chinese Medicine (TCM): TCM treatments, such as acupuncture, electroacupuncture (EA), and moxibustion, have been studied and have been found to improve symptoms in some people.
  • Acupuncture: A trained practitioner inserts thin needles to target acupuncture points in the body. Heat is applied to acupuncture points when a trained acupuncture practitioner uses moxibustion.
  • Medications: If you experience abdominal pain, your physician may prescribe medicines, depending on your symptoms, such as fiber supplements or over-the-counter (OTC) laxatives.
  • Naturopathy: Peppermint oil, aloe, or probiotic supplements can help reduce IBS symptoms in some people.

Possible complications of inflammatory bowel disease.

Diarrhea can cause dehydration. Diarrhea and constipation can worsen haemorrhoids. Constipation can cause intestinal obstruction, rectal ulcers, and anal fissures.

When should I contact my healthcare provider?

Call your healthcare provider if you have new or worsening symptoms such as increased pain, or  bleeding when you use the bathroom.