Apples are high in both sorbitol and fructose (two FODMAPs). Those two sugars rapidly ferment and produce gas, resulting in worsening of your IBS symptoms such as abdominal pain, distension, and bloating. So, they can do more harm than improvement in your IBS-constipation
IBS: how to diagnose it by yourself in 2 minutes [QUIZ INCLUDED]
By Dr. Farahat.
How To Diagnose IBSThe fact is we have no test to diagnose irritable bowel syndrome. Irritable bowel syndrome is a “functional” disorder, which means we -doctors- cannot detect any actual lesion or disease inside your gut causing the IBS. You can diagnose IBS by yourself if you using the ROME IV criteria. This criterion was developed to help doctors to diagnose IBS. and you can use it as well if you are suspecting IBS. The Rome IV criteria can be applied as follows: in simple words, you are IBS sufferer if you have:
- Your first attack of abdominal pain was for 6 or more months.
- Your abdominal pain is occurred 3 days every month in the past 3 months.
- Your abdominal pain improves or worsens when you defecate.
- Your stool frequency changes with the attacks of abdominal pain (have constipation or diarrhea).
- Your attack of abdominal pain is associated with a change in stool appearance.
How IBS symptoms exactly look like?To make it clear for you, I will exactly describe every symptom of IBS.
1- Abdominal pain or discomfort. How it exactly looks like?The gut colics associated with irritable bowel syndrome are usually described as colicy (periods of painful contractions and then relaxations of your gut). It is not constant pain. The abdominal pain is not limited to the upper part of your abdomen (epigastric area), but it occurs all over your abdomen especially the lower part. The abdominal pain is more during your working hours and after meals. it is also more in the morning and least while you are sleeping. The IBS pain usually exacerbates with emotional stress. You may also have a sense of fullness or bloating and excess gas in your abdomen.
2- The pain is related to defecation.The majority of IBS patients report improvement of abdominal pain with the passage of stools. But others report worsening of abdominal pain with defecation. Either way, this relation of abdominal colics or discomfort to defecation aids in the diagnosis of IBS.
3- Irritable bowel syndrome with predominant diarrhea (IBS-D). How it exactly looks?You will have IBS-D when your stools are usually loose during the attacks (more than 25% of bowel movements are diarrhea). The passage of loose stools is usually in the morning, during working hours or after meals. The loose stools usually small or moderate in volume.
If you have a sudden passage of large volumes of loose stools, it is likely an infection, not IBS-D.Also, you may have lower abdominal colics before the attack of diarrhea and a sense of complete evacuation after diarrhea. It is normal to have mucus with stool in the IBS-D attack as it is reported by 50% of people with IBS-D. But is abnormal to find blood in your stool, diarrheal attacks during sleep time or fever with diarrhea. If you find any of this, immediately call your doctor.
4- Irritable bowel syndrome with predominant constipation (IBS-C). How it exactly looks?You will have IBS-C when your stools are usually hard and difficult to pass (in more than 25% of your bowel movements. People with IBS-C usually have what is called “tenesmus”. Tenesmus means the sense of inability or difficulty to evacuate the rectum, even after defecation.
Having constipation alone without abdominal pain is not considered IBS-C but “Chronic Constipation”.
5- Irritable bowel syndrome: the mixed (IBS-M) and unclassified (IBS-U) types.The mixed type of IBS means you have a mixture of both constipation and diarrhea (constipation in more than 25% of the time and also, diarrhea in more than 25% of the time). The unclassified type of IBS is when you have abdominal pain with no specific predominance of constipation or diarrhea.
Why & When You Should Consult Your DoctorMy advice to you, If you have not diagnosed with IBS before you have to consult your doctor. Your doctor will obtain a careful history and examination from you. Your doctor will be more oriented with the details of the disease symptoms more than you and also will prescribe the suitable treatment. If you already have IBS, you should consult your doctor if you experience any symptoms that are not typical. These atypical or warning signs include blackish or reddish blood in the stool, nocturnal diarrhea (diarrhea at night), unexplained weight loss, anemia or progressive abdominal pain (its intensity is increasing over the days). It is extremely important for you to pay attention to any change in the pattern of IBS symptoms. I will explain in detail the warning signs of the IBS below, please read carefully.
When It Is Not IBS (NEVER IGNORE THESE WARNING SIGNS):IBS is often misdiagnosed with other diseases. So, take care of these red flags, if it happens with IBS, it may denote something more dangerous. These red flags include:
1- IBS symptoms start after the age of 50:IBS onset usually starts at a younger age, most commonly in the 20s and 30s of age. It is not typical for IBS to start after the age of 50. If you are 50 years old or more and experiencing some of the symptoms of abdominal pain, constipation, or diarrhea, you should consult your doctor immediately to exclude any other conditions like cancer colon.
2- Passage of reddish or blackish stools:bleeding with stools may be:
- Reddish blood: which may be due to bleeding from the last part of the colon (rectum or anal canal) or large amounts of bleeding from any part of the colon (no enough time for blood to be digested and turn black).
- Blackish blood: digested blood appears black or “tarry”. This occurs when blood stays sufficient time in the colon to be digested.
Passage of blood is not a symptom of IBS. if you see any blood in stools, you must consult your doctor immediately.Blood in the stool can occur due to multiple conditions, some are benign conditions like piles and dysentery. Others are malignant like colon or rectal cancer. Read this article about IBS and colon cancer if you want to learn more.
3- Diarrhea awakens you from sleep:IBS diarrhea usually occurs in the morning or during working hours. IBS usually doesn’t cause diarrhea during sleeping hours. If you wake up at night because you have diarrhea you should consult your doctor to figure out the cause.
4- You have abdominal pain that is increasing over the days.The abdominal pain of the IBS is typically intermittent and recurrent in nature. This means you will have hours or days of abdominal pain and other days you are free from pain. If you have abdominal pain that is present all the time or increasing in intensity over the days you should again consult your doctor.
5- You are progressively losing weight.Chronic infections of bowel with microbes or helminths, colorectal cancer, and inflammatory bowel disorders can cause significant weight loss while IBS can’t. A significant weight loss means loss of 4.5 Kg (10 Pounds) or more than 5% of your body weight within 6 to 12 months.
6- If you have a family history of IBD or colorectal cancer.IBD or Inflammatory bowel disorders include Ulcerative colitis and Crohn’s disease. These diseases cause inflammation of the wall of your colon and intestine. People who have one of their families with colon cancer or inflammatory bowel disorder have a higher risk to develop these diseases. And these disorders have similar symptoms to IBS. So… If you have a family history of these diseases you should tell your doctor about that. Your doctor will request some investigations for you to exclude any possibility of these diseases.
7- If you have anemia without a definite cause.We know that one of the most common causes of unexplained anemia is hidden blood loss from the gut. You may not see blood in stools if the amount of bleeding is small. But blood loss can continuously happen every day causing anemia. So if you have both anemia and IBS symptoms you should tell your doctor about that.
Common Questions Asked By My patients; Answered.Q: How long do IBS attacks last? A: the typical IBS attack lasts from 2-4 days (it may last shorter if you received the suitable treatment). But this is highly variable, some experience the attack for only a few hours, and others may have an IBS Flare-up for more than a week. Q: How does IBS pain feel like? A: I explained how IBS pain exactly feels like before but I can summarize it as:
- Colicy (contraction followed by relaxations of your intestine) and not constant.
- Site: usually all over the abdomen, most people feel it more at the lower part of the abdomen.
- Time: usually during working hours and in the morning. Least while you are sleeping.
- Increased by: certain triggering foods like FODMAPs, gas-producing foods and also, by emotional stress.
- Related to defecation: theIBS pain usually decreases when you defecate. But this is not a rule as some IBS Patients reports worsening the IBS Pain with defecation.
- Post-infectious IBS: in 10% of cases of IBS, the onset is associated with an attack of intestinal infection (gastroenteritis). The IBS symptoms develop with the infection and continue after the gastroenteritis is resolved.
- Major stressful events: some people suddenly develop IBS after exposure to major psychic trauma (like the death of a beloved one).
- Complete blood picture: a blood test to assess the presence of any infections or inflammations inside your body.
- ESR (Erythrocyte Sedimentation Rate): also, a blood test to detect any inflammation, infection or cancer that may present.
- Stool analysis
- Blood tests to exclude celiac disease
- Colonoscopy: a camera goes inside your colon to detect any abnormality.
- No specific test to diagnose IBS, doctors diagnose it by asking for a certain pattern of symptoms obtained from you.
- You can diagnose IBS by yourself by applying ROME IV criteria or taking this QUIZ.
- If you want to accurately diagnose yourself with IBS, you have to read the details of the symptoms mentioned in this post.
- This article is not a substitution for your own doctor. If you feel you have IBS after reading this article, you should head to your doctor.
- Never ignore the red signs of IBS like bloody stools, fever, anemia, weight loss, and nocturnal diarrhea.
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