Irritable Bowel Syndrome and Fibromyalgia

Irritable bowel syndrome, often simplified to IBS, is frequently linked to other syndromes such as fibromyalgia or chronic fatigue syndrome. Like with all other syndromes, there are no specific tests that can identify the condition. There is no blood test, no current metabolic test and no genetic marker discovered that can positively identify that an individual is at risk for the development of irritable bowel syndrome. However, with the significant presentation of the symptoms, this syndrome seems to be easier to identify for medical professionals and is more readily diagnosed.

General Symptoms of IBS

As the name of the syndrome implies, IBS is directly related to an irritation or dysfunction in the abdominal area and the bowels. This includes extreme bloating after eating, nausea, excessive gas, pains in the stomach and bowels, and problems with diarrhea, constipation or both. Many people find that they have an uncontrollable need to use the restroom that is difficult to predict and may come on suddenly after eating or during the next few hours. The abdominal pain and cramping may be significant and extremely debilitating. These symptoms can come and go, but they are much more frequent than simple digestive disturbances that may be a result of illness, overeating or just an upset stomach.

In the most recent studies, the role of hypersensitivity to pain in the bowels in people with IBS has been clearly demonstrated. This is combined with overreaction of the muscles that control the contractions of the intestines that move the waste material through the digestive system. These two factors alone may account for the painful symptoms, but the specific reasons why they occur is not understood at this time.1

The symptoms of IBS are relieved after a bowel movement, which is one reason why people may fail to recognize the symptoms as a medical problem. During a bout with IBS the stool will look different than normal, and you will go to the bathroom more often. When constipation is present you will feel the need to try to relieve yourself frequently and there may be large amounts of mucous in the stool when you finally do have a bowel movement.

Since IBS symptoms may come and go in some people and get progressively worse in others, the syndrome makes planning your life, eating out or even going out in public extremely difficult. You may find you cannot continue to work if you are in a job that does not have immediate access to a restroom. Eating out and socializing with friends may not be possible since the pains and urgency in using the restroom cause stress and mental discomfort.

Who Gets IBS?

Anyone at any age can develop IBS but the greatest number of people, approximately half of those diagnosed, have the symptoms before the age of 35. Women are more likely to have symptoms and be diagnosed than men and those with other chronic pain and stress disorders are at greater risk. The link between stress, IBS and fibromyalgia is not clearly understood, but researchers believe there are several ways in which these syndromes may be associated with high chronic or very intense stress levels.

It is estimated that as many as 20% of the adult population of the United States has symptoms of irritable bowel syndrome at some time in their life.  In addition worldwide prevalence of IBS is estimated at between 10 to 15% of the total population. 2 However, in the population of people diagnosed with fibromyalgia it is estimated that as many as 30 to 70% also have IBS.

People that are under emotional or physical stress, such as the chronic pain experienced by fibromyalgia, have changes in their brain chemistry. This includes changes in the neurotransmitters, particularly serotonin, which in turn is essential in the management and control of the autonomic nervous system. This is the system that kicks in when pain or stress is present to shut off systems that don’t need to work and engage systems that do. When levels of neurotransmitters remain at heightened levels the colon can begin to spasm, leading to abdominal pain and cramping and the frequent need to have a bowel movement.

Controlling IBS

Some medications used to control pain or to provide muscle relaxation that are used with fibromyalgia can lead to increased problems in regular bowel movements. If IBS is present it is essential to avoid these medications or to use an alternate type of treatment to control the symptoms of fibromyalgia that doesn’t create more complications with IBS.

Adding high levels of fiber to the diet may be helpful for people with IBS that suffer with constipation. Increasing water intake will help with both constipation and diarrhea and will prevent dehydration, which is an important consideration. Individuals should also carefully keep records of foods consumed and any adverse effects. Some people find that eating a bland diet or avoiding specific foods, particularly those containing gluten, may help in controlling symptoms of IBS. This can also help with fibromyalgia if there is sensitivity to gluten which may be triggering changes in the immune response of the body.

Stress reduction is also seen as a major factor in controlling both IBS and fibromyalgia. As with fibromyalgia, IBS is linked to changes in the HPA axis, the hypothalamic-pituitary-adrenal axis, as well as an increase in proinflammatory cytokines that trigger hypersensitivity to pain.3 Controlling stress, both physical and mental, will help to limit the release of cortisol and proinflammatory cytokines and also prevent related symptoms.

Relaxation exercises, counseling, regular exercise and ensuring that sleep problems are addressed and corrected are also key in reducing stress and limiting the pain and discomfort from fibromyalgia and IBS. Women should be aware that hormones can play a major factor in the severity of symptoms, with increasing pain and digestive problems occurring most frequently during menstruation. Talking to your doctor and working on a comprehensive approach to treating both fibromyalgia and irritable bowel syndrome concurrently is the only way to ensure that the pain and stress of both syndromes are minimized and managed.

References

1 Posserud, I., Ersryd, A., & Simten, M. (2006). Functional findings in irritable bowel syndrome. World Journal of Gastroenterology , 2830-2838.

2 Mayer, E. A. (2008). Irritable Bowel Syndrome. New England Journal of Medicine , 1692-1699.

3 Dinan, T. G., Quigley, E. M., Ahmed, S. M., & et al. (2006). Hypothalamic-Pituitary-Gut Axis Dysregulation in Irritable Bowel Syndrome: Plasma Cytokines as a Potential Biomarker? Gastroenterology , 304-311

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015