Irritable Bowel Syndrome

For some, IIrritable Bowel Syndrome, or IBS, is a chronic disorder that characterises daily living. For others, it is a periodically unwelcome visitor. IBS affects 15 to 20% of the general population and is a complex disorder without definitive answers.

Defining IBS

It is rarely one single symptom that qualifies IBS. IBS is a ‘syndrome’, meaning a group of symptoms. Irritable Bowel Syndrome affects predominantly the colon or large bowel. It is the part of the digestive tract that stores stool. It is not a disease but a functional disorder, meaning that the bowel does not work, or function, correctly.

IBS does not damage the colon or other parts of the digestive system. It is not a precursor to other health problems or diseases such as colon cancer.

IBS is not synonymous with inflammatory bowel disease. The main forms of which are Crohn’s Disease and ulcerative colitis. This involves inflammation of the intestines and is more severe than IBS.

IBS is often sub-classified as diarrhoea type or constipation type. This depends on the major symptoms experienced by the individual.

Prevalence

IBS usually begins around age 20 and is more common among women. It is the most common disease diagnosed by gastroenterologists. Also, one of the most common disorders seen by primary care physicians/general practitioners.

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Symptoms

Common Symptoms

Symptoms vary from person to person and may even vary for an individual from day to day. It could fluctuate between extremes such as diarrhoea and constipation. The most common symptoms are abdominal cramping (especially in the lower left side of the abdomen), discomfort and bloating.

Other Symptoms

Incomplete evacuation

Mucus in stool

Flatulence

The sudden need to pass a stool upon waking in the morning or after breakfast or coffee

Another symptom of IBS is bowel movements that are inconsistent with one’s normal patterns. However, with ‘normal’ bowel movements varying significantly from person to person, it is difficult to establish criteria just on one’s frequency of bowel movements. Signs and symptoms often resemble those of other disorders or diseases, making diagnosis that much more difficult.

The following are not symptoms of IBS:

These symptoms could indicate other forms of bowel disease or problems.

Factors That Make It Worse

Hormonal changes (during the menstrual cycle, for example)

Smoking

Food sensitivity (to wheat or lactose, for example)

Processed and smoked foods

Insufficient or excessive fibre

Abnormal intestinal bacteria

Gas-forming foods such as pulses and cabbage

Drinks containing caffeine and/or alcohol as well as carbonated drinks

Sensitivity to artificial additives, colourants, flavourants etc.

Antibiotics

Certain painkillers, antidepressants and antihistamines

Stress, anxiety and depression

It’s clear that IBS is often interlinked with other disorders. This suggests that finding a solution for one ailment (such as stress or hormonal imbalance) could indirectly relieve associated IBS symptoms.

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IBS and Emotional Stress

The stomach area has been referred to in some cultures as the ‘seat of our emotions’. Ample research has been done over the past three decades. The results support theories that there is a close link between IBS and emotions. One of the first references to the concept of an “irritable bowel” appeared in the Rocky Mountain Medical Journal in 1950. The term was used to categorise patients who developed symptoms of diarrhoea, abdominal pain or constipation, but where no well-recognised infective cause could be found.

In 2001, researchers led by Dr Svein Blomhoff of the National Hospital in Oslo, Norway, studied the effects of emotional words on women with IBS. The women’s rectal muscles responded by contracting or relaxing in 70 to 77 percent of cases. The strongest responses were to words that were related to sadness and anxiety. Researchers concluded that when treating IBS, the emotional and mental state of the patient is important in determining a course of treatment.

This psychosomatic link makes IBS even more difficult, particularly for non-sufferers, to understand.

The digestive tract is a highly complex and sensitive system involving several different types of nerve pathways that run between the brain and the digestive organs, which interact with other systems in the body, including higher-order functions such as emotional processing. The intestinal lining hosts an entire network of nerves, known as the enteric nervous system.

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Stress

Stress has a strong impact on the gastrointestinal tract of any person, whether a sufferer of gastrointestinal disorders or not. Symptoms such as abdominal pain and inconsistent passage of faeces are common in anxiety-based disorders. Not only can inner conflict or responses to one’s environment precede gastrointestinal symptoms, but these symptoms are also likely to produce further symptoms of anxiety or depression. In addition to the direct effects that stress has on the digestive system, there may be indirect effects, for example compulsive ‘comfort eating’ or smoking during stressful times, which also affects digestion.

Diagnosis

No specific laboratory test exists to diagnose IBS and diagnosis is rarely immediate. Instead, ongoing processes of elimination are employed, such as the elimination of certain foods in the diet. For example, if dairy products are cut out of the diet but IBS symptoms do not improve within that period, lactose intolerance is ruled out and an elimination of wheat may begin. Diagnosis is also made through the exclusion of other ailments. For example, an evaluation of the patient’s stool might reveal that the cause of symptoms is due to a gastrointestinal infection.

IBS is generally diagnosed on the basis of a complete analysis of medical history that includes a careful description of symptoms and a physical examination. Doctors generally use a set list of specific symptoms, called the Rome criteria and Manning criteria, to make an accurate diagnosis. It is suggested that patients keep a diary to record and supply daily symptoms to their doctor.

Treatment

No cure has been found for IBS but many options are available to treat the symptoms. Your doctor will give you the best treatment for your particular symptoms.

Medication

Medication affects people differently, and no one medication or combination of medications will work for everyone with IBS. You will need to work with your doctor to find the best solution for you.

Antispasmodics are commonly prescribed, which help to control colon muscle spasms and reduce abdominal pain. Probiotics are often recommended to IBS sufferers to restore the natural bacterial balance in the digestive system. Fibre supplements are generally advised for constipation (however, bloatedness and gas can worsen with increased insoluble fibre intake). Dietary and lifestyle changes should always be tried before laxatives or anti-diarrhoea medication is used. Any medication should be used very carefully since some are habit-forming and could impair intestinal functioning even further in the long term.

Diet

As discussed above, fibre may be beneficial to the colon or it may aggravate symptoms. It is suggested that IBS sufferers gradually add foods with fibre to their diet – a sudden influx of fibre can be too harsh on a sensitive digestive system. Large meals can cause cramping and diarrhoea, thus it is best to eat small meals throughout the day. It is also important to keep hydrated and drink between six and eight glasses of water per day. Many IBS sufferers find that spicy foods exacerbate their symptoms.

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Soluble fibre helps both diarrhoea and constipation. It dissolves in water and forms a gel-like substance. Some foods that contain soluble fibre are apples, beans and citrus fruits. Psyllium, a natural vegetable fibre, is also a soluble fibre. Insoluble fibre helps constipation by moving material through your digestive system and adding bulk to your stool. Insoluble fibre is found in wholegrain bread, wheat bran and many vegetables.

Stress Management

The colon, like the heart and the lungs, is partly controlled by the autonomic nervous system, which responds to stress. Thus it is no surprise that the digestive system reacts to stressful situations – when one is nervous or upset during times of conflict, for example. Occasionally, antidepressants are prescribed to alleviate stress-related symptoms – certain types of antidepressants are more suited to a diarrhoea-type IBS and others are more suited to a constipation-type IBS. Lifestyle changes and relaxation techniques such as meditation and exercise should, as far as possible, be the primary source of stress management. More