Irritable Bowel Syndrome with Diarrhea (IBS-D)

Welcome to our Patient Education page!

Our team of specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your digestive system. Please use the search field below to browse our website. You'll find a wide array of information about our office, your digestive health, and treatments available. If you have questions or need to schedule an appointment, contact our office.

Screening or Diagnostic Colonoscopy?

All colonoscopies, whether diagnostic or screening, are billed under the CPT/Procedure code 45378.  The diagnosis or reason for the colonoscopy is what determines if the procedure is diagnostic/surveillance or preventative/screening. 
 

Diagnostic/Surveillance Colonoscopy: 

The patient has past and/or present gastrointestinal symptoms, polyps, GI disease, iron deficiency anemia and/or any other abnormal tests OR the patient is currently asymptomatic (no gastrointestinal symptoms either past or present) but has a personal history of GI disease, personal and/or family history of colon polyps and/or colon cancer.  Patients in this category are required to undergo colonoscopy surveillance at shortened intervals (e.g. every 2-5 years). 

Insurance plans process these claims subject to the individuals deductible and co-insurance requirements.

Preventative Screening Colonoscopy:

The patient is asymptomatic (no gastrointestinal symptoms either past or present), age 50 or greater, has no personal or family history of GI disease, colon polyps, and/or cancer.  The patient has not undergone a colonoscopy within the last 10 years.

Insurance plans usually process these claims under the wellness benefit, payable at 100% if it is a benefit of the individual’s health insurance plan.

Frequently asked questions:

Who will bill me?

You may receive bills for your procedure from the physician, the facility, anesthesia, pathologist and/or laboratory. 

Can the physician change, add, or delete my diagnosis so that my procedure can be considered a preventative/wellness/routine screening?

NO!  The patient encounter is documented as a medical record from the information you have provided, as well as what is obtained during our pre-procedure history and assessment.  It is a binding legal document that cannot be changed to facilitate better insurance coverage.

What if my insurance company tells me that the doctor can change, add or delete a CPT or diagnosis code?

This happens a lot. Often the representative will tell the patient that if the “doctor had coded this as a screening, it would be paid at 100%."  A member services representative should never suggest a physician alter a medical record for billing purposes. 


FAQS - Frequently Asked Questions

Q: How long will my procedure take?
A: Plan to spend 2- 2 1/2 hours with us from the time you arrive until when you are released to go home. The procedures themselves are relatively quick.
- An upper endoscopy takes 8-10 minutes, depending on what is found and the need for biopsies.
- A colonoscopy usually takes about 20-25 minutes, again depending on the findings and need for polyp removal, biopsies, etc.
The rest of your stay involves going over the consent prior to the procedure, a physical assessment, taking vital signs, placing an IV and attaching you to a continuous monitor. After the procedure, you will stay under our observation until you are deemed ready to be driven home.
 
Q: Can I drive myself home after the procedure?
A: No. The anesthesia and sedation we use, while relatively short-acting, can have subtle effects for hours after your procedure. Possible drowsiness and delayed reaction times make driving potentially dangerous. Therefore, having someone drive you home is necessary. You may drive and return to normal activities the following day.
 
Q: How soon can I eat and drink after my procedure?
A: Usually immediately after you leave the office, unless you are told otherwise. It is best to avoid heavy meals for that day.
 
Q: Can I take routine medications the day of the procedure?
A: Please do not take any of your medications except those for blood pressure, heart and seizures unless otherwise instructed by your physician.
 
Q: Do I need antibiotics prior to my procedure for an artificial joint?
A: No. The American Society for Gastrointestinal Endoscopy has concluded that antibiotic use for a patient with an artificial joint is not necessary.
 
Q: What happens if I begin to vomit during my prep?
A: Wait 1-2 hours to allow your stomach to settle. Start to drink the solution at a slower pace- every 20-30 minutes. This will take longer but should keep you from vomiting the rest of the solution.
 
Q: I have my period. Can I still have my colonoscopy?
A: Yes. This will not interfere with your procedure. You may use a tampon during the procedure.
 
Q: Do I have to drink all of my prep?
A: Yes. You want your colon completely cleaned out. This allows the physician to find and treat the smallest and flattest polyps.
 
Q: I’m diabetic. What precautions should I take?
A: If you are diabetic, we will give you special instructions. You will need to let us know ALL of your medications and doses. You should check your blood sugars periodically throughout the day of the prep and the procedure. Since you are on clear liquids, your blood sugar will tend to drop faster than normal. To avoid this, be sure to include some liquids with sugar.
 
Q: What if I forget to stop my blood thinners?
A: Please contact the office.
 
Q: Can I take over the counter medications with my prep?
A: Most over the counter medications are acceptable except fish oil, aspirin, Motrin, Advil, ibuprofen, Aleve, naprosyn, naproxen or iron supplements. Tylenol will not interfere with your procedure.
 
Q: Is it OK to drink alcohol?
A: NO! We strongly suggest that you avoid all alcohol before your procedure as it can cause dehydration and may thin your blood.
 
Q: Can I brush my teeth?
A: Yes.
 
Q: Can I chew gum or suck on hard candy?
A: Yes, but no red candy or candy with soft centers. Nothing after midnight.
 
Q: What can I take for a headache?
A: Tylenol or Extra-Strength Tylenol only.

 

Who gets IBS-D?

IBS-D can affect any gender and any age group, but young females are more commonly affected than males or older people.

What causes IBS-D?

The cause of IBS-D is not known. There likely are multiple factors. Some of the different possibilities are discussed here.

In some patients, rapid contractions of the intestine can cause both pain and faster movement of stool. This gives the intestine less time to absorb water from the digested matter, which leads to loose or watery stools.

For unclear reasons, some patients develop IBS-D from a prior infection in the gut. When this occurs, it is called post-infectious IBS. It can last for weeks, months, or even years following a gut infection.

It is also possible that sensitivity or allergy to certain foods may play a role for some people with IBS-D. Many patients have symptoms after eating certain food ingredients, such as gluten or lactose. In these cases, avoiding foods containing those ingredients can improve symptoms. Unfortunately, routine allergy testing is not a reliable way to tell if particular foods are causing IBS symptoms.

Some IBS patients have a more sensitive gut, and they feel pain or discomfort from gas or intestinal contractions more than most people do.

Recent research has suggested that changes in the type or number of normal bacteria living in the gut may contribute to IBS-D symptoms.

Lastly, while stress and anxiety are not thought to cause IBS-D, they can play an important role in making the symptoms worse.

What are the symptoms of IBS-D?

Frequent abdominal pain or discomfort along with changed bowel habits are typical in IBS. People with IBS often report that these symptoms have been present, to some degree, for many months or years. The pain is usually described as abdominal cramps that come and go, which often improve after having a bowel movement. In IBS-D, stools are usually loose and frequent, sometimes include mucus, and happen during the day while the patient is awake.

Diarrhea that frequently awakens a person from sleep is not typical for IBS-D and should be mentioned to your doctor.

Abdominal bloating also is common in people with IBS-D. Symptoms unrelated to the gut can also occur as part of this syndrome, such as difficulty with sexual function, irregular menstrual periods, increased or more urgent need to pass urine, or pain in other parts of the body.

Triggers for pain and diarrhea vary from patient to patient, and may include eating or stress.

How do doctors diagnose IBS-D?

The diagnosis is based on a thorough medical history and physical exam. Doctors use a tool called the Rome criteria, a list of specific symptoms and factors that can help determine if someone has IBS-D. The most important of these criteria include the presence of abdominal pain or discomfort and change in bowel habits. There are no lab tests or imaging studies that can confirm a diagnosis of IBS-D. But limited testing (such as blood work or imaging studies) may be necessary to be sure the symptoms are not being caused by some other condition.

What is the treatment for IBS-D?

IBS-D is not life-threatening. It can, however, affect a person’s quality of life. There is no cure, so the goal of treatment is to reduce symptoms as much as possible. Some treatments may be aimed at improving the uncomfortable symptoms of IBS-D – such as abdominal pain, discomfort or bloating. Other treatments may focus on improving bowel function. Treatments include lifestyle modifications, dietary changes, psychosocial therapy, and medications.

Dietary therapy: In some patients with mild IBS-D, lifestyle and dietary changes can control symptoms completely. Specific foods that cause symptoms vary widely from patient to patient. There are no reliable tests to identify which foods may trigger symptoms, but some foods containing lactose or gluten are common problem foods for people with IBS-D. For those people, avoiding these foods can improve symptoms.

For other people, it is not easy to figure out what foods may be “triggering” their symptoms. In these cases, symptoms may improve with a diet low in FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) or foods low in a type of sugar called fructose (which is found in many types of fruit). Avoiding foods that are known to cause increased gas production, such as onions, celery, carrots, beans, prunes, wheat, alcohol or caffeine, can help.

These diets are not easy to follow. When attempting diets that exclude entire types or groups of food, it is often helpful to work with a dietitian to be sure the restricted diet is both safe and nutritious.

Medical therapy: If a person’s symptoms do not improve despite dietary changes, there are several kinds of medication that can help.

Medications for abdominal discomfort:

Antispasmodics are a group of medicines thought to relax smooth muscle in the intestine. They are commonly used to treat IBS. These medications may reduce pain, bloating and the urgent need to go to the bathroom. Commonly prescribed anti-spasmodics include dicyclomine and hyoscyamine. Over-the-counter preparations of peppermint oil also have been found to have similar benefits.

Medications to improve bowel function:

For people whose main symptom is diarrhea, fiber supplements often are the first treatment recommended. Fiber can add form to stool and make it less loose or watery. Anti-diarrheal products, such as loperamide, also work to decrease diarrhea. These medications slow down the contractions of the gut, giving the intestine more time to absorb water from the digested food. This lessens the stool volume and frequency and makes the stool more solid.

Bile, a substance produced by the liver, enters the upper part of the small intestine. Most of the bile is reabsorbed as it moves further down in the small intestine. If not enough bile gets reabsorbed before it reaches the large intestine (colon), it can cause diarrhea. In some IBS-D patients, a medication that binds the extra bile can be used to reduce diarrhea.

For people with IBS-D who keep having symptoms despite trying some of the above-mentioned treatments, there are other medical options, including antibiotics and a medication to block pain specifically in the intestine.

Probiotics

Bacteria are naturally present in the intestines or “gut” of humans, and they play an important role in normal bowel health and function. “Probiotic” products are foods or pills that contain live bacteria that may promote gut health. They are sometimes recommended with the goal of changing the types of gut bacteria in the intestine. This can sometimes reduce abdominal discomfort, bloating and gas from IBS-D. Experts are not sure of the overall benefit of probiotics for people with IBS; the most beneficial types and amounts of probiotic foods or supplements also is not known.

Antibiotics are another way to change the population of bacteria in the gut. While antibiotics sometimes provide relief of IBS symptoms, there are potential risks associated with frequent use. If antibiotics are used too often, they can become less effective, and the risk for developing serious infections increases. These risks are reduced when a non-absorbable antibiotic such as rifaximin is used, which has shown some benefit in the treatment of IBS-D.

Lastly, stress and anxiety play a major role in some cases of IBS-D. If these are a known trigger of symptoms, it is best to discuss these openly with your healthcare provider and other caregivers to find ways to reduce stress and anxiety. Doctors might also suggest antidepressant medications to lessen symptoms.

When Should I See a Doctor?

If you have chronic symptoms of diarrhea and discomfort, see your doctor for a diagnosis and treatment plan to help reduce and manage symptoms, improve bowel function and increase comfort. Such a plan can improve your quality of life.

In addition, if you use over-the-counter medications regularly to reduce symptoms, you should consult a doctor to determine the best course of treatment.

Also report abdominal discomfort or symptoms that come with weight loss, bleeding, iron deficiency (low levels of iron based on blood tests) or symptoms that start after age 50. Tell your doctor about any personal or family history of gastrointestinal diseases such as cancer or inflammatory bowel disease or celiac disease.

To find a doctor near you who is a member of the American Society for Gastrointestinal Endoscopy, use the ASGE Find a Doctor tool at www.asge.org..

What is Irritable Bowel Syndrome with Diarrhea (IBS-D)?

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder affecting 7-21% of the general population. It is associated with abdominal pain or discomfort, bloating, and changing stool frequency and/or form. IBS-D is a type of IBS in which abdominal pain or bloating symptoms happen along with stools that are often loose or more frequent than usual.

Since its founding in 1941, ASGE has been dedicated to advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. This information is the opinion of and provided by the American Society for Gastrointestinal Endoscopy.

Gastrointestinal endoscopy helps patients through screening, diagnosis and treatment of digestive diseases. Visit www.asge.org to learn how you can support GI endoscopic research, education and public outreach through a donation to the ASGE Foundation.

For more information, visit www.asge.org or www.screen4coloncancer.org

Copyright © 2018 American Society for Gastrointestinal Endoscopy Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.