IBS: What if test results are normal but abdominal pain and diarrhea recur?

If your test results are normal but you frequently experience abdominal pain, diarrhea, or constipation, you may suspect 'IBS'. According to a video from the health and medical specialty channel HiDoc, IBS is common enough that 1 in 10 adults experiences it, appearing frequently especially in young adults and women. While it is not a life-threatening disease, it is characterized by lowering the quality of life by causing significant interference with outings and social life.

If abdominal pain is accompanied by these symptoms, you must visit a hospital

Not all abdominal pain is IBS. IBS can be suspected when recurrent abdominal pain is accompanied by bowel-related symptoms such as constipation or diarrhea for several months or more. However, caution is required as there are 'warning symptoms' that necessitate differentiating from other diseases.

In the video, Choi Young-sun, a department head and surgeon at Hansol Hospital, emphasizes that if bloody stools appear, or if there is unexplained weight loss, severe pain that wakes you up at night, or accompanying fever, active testing is necessary as there is a possibility of other diseases such as inflammatory bowel disease or colorectal cancer. Additionally, if the first symptoms appear in one's 40s or 50s, it is important to receive an accurate diagnosis rather than dismissing it as simple IBS.

From intestinal motility abnormalities to the Gut-Brain Axis, complex causes of onset

The cause of IBS is not clearly defined as a single factor, but rather multiple factors act in combination. The main causes are as follows:

• Intestinal motility abnormalities: If intestinal motility is too fast, diarrhea occurs; if it is too slow, constipation occurs.
• Visceral hypersensitivity: IBS patients sensitively feel gas or food stimuli as pain or discomfort, which healthy people do not feel.
• Abnormalities in the Gut-Brain Axis: When stress or anxiety intensifies, abnormalities occur in the mechanism through which the gut and brain communicate via nerves and hormones, affecting intestinal motility and pain control. A representative example is the experience of sudden abdominal pain before an important exam or interview.
• Changes in gut microbiota: According to recent studies, changes in the composition or diversity of gut microbiota are known to trigger symptoms.
• Occurrence after enteritis: In some cases, symptoms appear when inflammation fails to recover after suffering from diseases such as acute enteritis or food poisoning.

The key to dietary management is finding 'foods that do not suit me'

There are no foods that are absolutely bad for IBS patients, but there are foods that exacerbate symptoms. Since the foods that the gut reacts sensitively to differ for each person, a process of finding foods that suit oneself is necessary. The foods to be cautious of mentioned in the video are as follows:

• Greasy foods: Foods with high fat content, such as fried foods, pizza, and pork belly, can stimulate intestinal motility and cause diarrhea.
• High FODMAP foods: These are carbohydrates such as onions, garlic, wheat, legumes, and milk that are not easily absorbed in the gut and are prone to fermentation. They can form gas by gut microbiota and draw in water, causing abdominal pain or diarrhea.
• Other irritants: Spicy and irritating foods, alcohol, and beverages containing high amounts of caffeine can also exacerbate symptoms.

A 'Low FODMAP diet' was suggested as an effective dietary management method. This is a method of limiting carbohydrates that are not well absorbed in the gut. However, rather than restricting them for a lifetime, one usually goes through a restriction period of about 2 to 6 weeks, and once symptoms are relieved, goes through a process of selectively avoiding only the foods that cause problems by re-trying foods one by one. Since indiscriminate restriction can lead to imbalances in gut microbiota or nutritional imbalances, it is good to proceed while consulting with medical professionals.

Choi advised, "The key is to keep a food diary to record which foods cause symptoms to worsen when eaten." This is not a process of unconditionally avoiding foods that others say are bad, but a process of finding one's own aggravating factors.

Integrated lifestyle management including drug treatment and exercise

The goal of treatment is not simply to stop diarrhea, but to improve the patient's quality of life by improving bowel habits. Treatment methods vary depending on the symptom type.

• Constipation-type: Medications that promote intestinal motility are used.
• Diarrhea-type: Medications that regulate intestinal motility or antidiarrheals are used. Especially for diarrhea-type patients, drugs such as 'Ramosetron (selective 5-HT3 receptor antagonist)' are used to improve abdominal pain and bowel abnormalities by regulating excessive intestinal motility and visceral hypersensitivity.
• When accompanied by abdominal pain: If the pain is severe, antispasmodics are used.

Probiotics may be helpful to some patients, but this is an auxiliary treatment that must be accompanied by dietary control, lifestyle improvement, and drug treatment. The effectiveness may be limited depending on the patient's symptom type.

In terms of lifestyle, regular meals and sufficient sleep are essential. Since eating a large amount at once can burden the gut, it is good to eat an appropriate amount at regular times. For exercise, consistently performing aerobic exercises such as brisk walking or swimming for more than 30 minutes, 3 to 5 times a week, helps in regulating intestinal motility and relieving stress. Relaxation exercises such as yoga, stretching, and meditation are also positive. However, caution is needed as excessively high-intensity exercise can excessively stimulate intestinal motility.

Choi Young-sun stated, "IBS is not a disease that is cured overnight, but a chronic disease that must be managed steadily," adding, "If symptoms recur, it is important to consult a specialist to find a treatment plan that suits you rather than relying on folk remedies."