Amelia Grant

Irritable bowel syndrome (IBS) is difficult to diagnose because there are no visible signs or symptoms that specialists can detect through physical exams, imaging scans, or lab testing.

People with IBS are frequently misdiagnosed because their symptoms coincide with those of a variety of other digestive illnesses. Diverticulitis, colon cancer, intestinal blockage, ulcerative colitis, Crohn's disease, gastrointestinal infection, celiac disease, and lactose intolerance are all common causes of IBS.

Because IBS is more typically diagnosed in those under the age of 50, older people must first rule out the possibility that another disease that affects the elderly is causing their symptoms. A doctor will gather information about your medical history, do a physical examination, and request blood tests.

A colonoscopy or sigmoidoscopy should be performed on older people to rule out the risk of colorectal polyps, cancer, or colitis. If your IBS symptoms include primarily diarrhea or an alternating pattern of diarrhea and constipation, you should also have a blood test for celiac disease. If your symptoms increase when you eat dairy products, your doctor may order a lactose intolerance breath test.

To diagnose IBS, two of the following three criteria must be met once your doctor establishes that your abdomen pain is not caused by a physical abnormality:

- Regular bowel motions help to relieve pain.

- Constipation or diarrhea accompany the pain.

- Pain is linked to a change in stool consistency (watery, loose, or pellet-like).

For at least three months, these symptoms must be have been present all of the time or on occasion.

IBS Treatment 

IBS treatment focuses on alleviating the most unpleasant symptoms once it has been diagnosed:

Constipation-predominant IBS

The Food and Drug Administration of the United States approved a new type of prescription drug for constipation-predominant IBS in 2012. In clinical trials, people who took the medicine linaclotide (Linzess) on a daily basis had more spontaneous bowel movements and less abdominal pain than those who took a placebo.

Linaclotide induces the colon to produce higher levels of an enzyme called guanylate cyclase-C, which is thought to speed up gastrointestinal transit and reduce the activity of pain-sensing neurons. Linzess should be taken at least 30 minutes before eating once a day. Diarrhea was the most common side effect documented throughout clinical studies. Patients under the age of 17 should not be given this medication.

The prescription laxative lubiprostone is another option for people suffering from constipation-related IBS (Amitiza). This selective C-2 chloride-channel activator was approved in 2008 and helps increase bowel motions by initiating chloride secretion into the intestine. Nausea, diarrhea, and headaches are major adverse effects of Amitiza, which are taken twice a day.

Antidepressants known as selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), can help with abdominal pain and other symptoms associated with constipation-predominant IBS. Food transit speed via the gastrointestinal tract is hypothesized to be increased by SSRIs.

Tegaserod (Zelnorm), a previously approved prescription medicine for women with constipation-predominant IBS, was pulled off the market in 2007 due to dangerous cardiovascular adverse effects and is now only available in emergency cases.

Diarrhea-predominant IBS

Loperamide (Imodium), an over-the-counter antidiarrheal drug, is an effective treatment for reducing stool frequency and improving regularity. On the other hand, it has no effect on abdominal pain or bloating.

By slowing food transit through the gastrointestinal system, low-dose tricyclic antidepressants (TCAs) like desipramine (Norpramin) alleviate pain and symptoms of diarrhea-predominant IBS.

Alosetron (Lotronex), a prescription medicine, has been demonstrated to alleviate symptoms in women with diarrhea-predominant IBS, but it comes with a risk of major side effects, such as severe constipation and decreased blood supply to the colon. It is only given to women with severe diarrhea-predominant IBS who have failed to respond to more standard medications through a unique prescription program.

Constipation/diarrhea-predominant IBS

Psychological therapies, such as cognitive-behavioral therapy, dynamic psychotherapy, and hypnosis, have also been shown to provide some relief with IBS symptoms, whether they are constipation- or diarrhea-predominant.

Mindfulness training, a type of meditation defined by the nonjudgmental observation of thoughts, feelings, and sensations, has been shown to help persons with IBS reduce symptom severity and enhance the quality of life.