In digestive health communities, I have seen dozens of stories: a person has tests, an ultrasound, a gastroscopy — and hears "everything is normal." Yet the abdominal pain, bloating, and fluctuating bowel movements do not go away. Very often, this picture is caused by irritable bowel syndrome (IBS).
What it is and what it is not
IBS is a functional bowel disorder: abdominal pain arises from functional changes in the nerve plexuses of the bowel and impaired peristalsis, even though clinical tests show no abnormalities. There is also general abdominal discomfort that is relieved by defecation.
Let us clarify right away what it is not: it is not an organic lesion — clinical tests show no abnormalities, and there is no direct link to the development of serious organic diseases or to increased mortality. People with IBS have a noticeably high level of general anxiety, and chronic stress sustains the onset and further development of the syndrome.
How common is it?
IBS accounts for 20–50% of visits to gastroenterologists and affects 7–11% of the population in many countries. It is observed more often in women, with first manifestations usually appearing at age 30–40. If left untreated at a young age, the syndrome is also seen in older age groups. There is evidence that it has a noticeable negative impact on the quality of life and social functioning of many patients. In some countries, particularly Italy and Mexico, it is more common.
What does it look like in practice?
Diarrhea usually occurs after eating, most often after breakfast, with a strong urge and copious watery stools. If constipation predominates, the stool resembles pellets or ribbons.
- Pain around the navel or in the iliac regions that eases after defecation or passing gas
- Alternating diarrhea and constipation
- Bloating, flatulence, rumbling in the abdomen
- Weakness, rapid fatigue, decreased appetite, nausea
- Frequent urination, a feeling of incomplete bladder emptying
Often, people with a long course develop thoughts about a malignant bowel tumor, which lowers mood and creates anxiety. Sometimes manifestations reach the level of depression.
Based on the nature of the stool, doctors distinguish subtypes: diarrhea-predominant, constipation-predominant, and mixed, when it is difficult to determine which predominates. In some patients, the stool quickly shifts from one subtype to another within a few months.
How does stress affect the bowel?
In simple terms: in susceptible people, the nervous system responds to stimuli more strongly than it should, and this excessive response returns to the bowel — hence the symptoms. The body's response to external stimuli is mediated through the hypothalamic-pituitary-adrenal axis and the sympathetic branch of the autonomic nervous system together with the immune system. In some patients, according to sources, the response to stress is stronger due to the endocrine component.
I will separately mention a common myth: that IBS is "just from nerves." In fact, according to sources, in some patients the syndrome began after an intestinal infection, and the role of visceral hypersensitivity — increased sensitivity of both the peripheral and central nervous systems — is also being discussed.
Why are tests normal?
Precisely because tests are "normal," IBS is diagnosed by excluding other causes. The doctor usually assesses complaints and history, including cases of the syndrome in the family, and orders examinations to rule out organic diseases. Here I want to remind you what a test result means: normal tests do not mean the pain is imagined: they help rule out other causes and look at the picture as a whole.
When to see a doctor immediately?
Severe bleeding, vomiting blood, loss of consciousness, severe chest pain — call 103 or 112.
Who to turn to: for typical pain and changes in bowel movements — see your family doctor, who will refer you to a gastroenterologist if needed. If anxiety and mood are troubling you alongside the symptoms, tell your doctor.
This material is for reference and does not replace a doctor's consultation.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer