CONDITIONS
Irritable Bowel Syndrome (IBS)
What is irritable bowel syndrome (IBS)?
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that commonly results in abdominal discomfort, spasms, bloating, excessive gas, and changes in bowel movements. Individuals may experience constipation, diarrhoea, or a sense of urgency. The symptoms can differ from one individual to another.
The syndrome refers to a collection of symptoms, and IBS is classified as a syndrome due to the variety of symptoms it can present. IBS is not classified as a disease but rather as a functional disorder, indicating that the bowel is not functioning as it should. Individuals with IBS may have heightened sensitivity in the nerves and muscles of the bowel. This sensitivity can lead to excessive muscle contractions after eating, resulting in cramping and diarrhoea. Additionally, the nerves may be overly sensitive to bowel stretching, causing discomfort or pain. While IBS can be painful, it does not cause damage to the bowel.
What causes IBS?
The exact cause of IBS has not yet been determined by researchers, but it is classified as a neurogastrointestinal disorder. These disorders, also known as gut-brain interaction disorders, involve problems with the coordination between the gut and brain, affecting the digestive system’s functioning.
When there are difficulties in communication between the brain and gut, it can lead to the following issues:
- Dysmotility: This refers to problems with the contraction and movement of the muscles in the gastrointestinal tract. In individuals with IBS, the muscles in the colon (large intestine) tend to contract more frequently, resulting in cramps and pain.
- Visceral hypersensitivity: People with IBS may have more sensitive nerves in their gastrointestinal tract than those without the condition. As a result, individuals with IBS often have a lower pain tolerance. Their digestive tract may be sensitive to abdominal pain or discomfort.
Other potential factors that may contribute to IBS include:
- Gut bacteria: Research suggests that people with IBS may have an altered bacteria in their digestive system, which could be connected to the onset of symptoms. Studies have found differences in the types and amounts of gut bacteria with and without IBS.
- Previous episodes of severe infections: In some instances, the individual is diagnosed with IBS after experiencing a severe infection that has affected their gastrointestinal tract, indicating a possible involvement of pathogens in developing the condition.
- Food intolerances: Allergies or sensitivities to specific foods could potentially worsen IBS symptoms.
- Childhood stress: Those who have undergone significant stress during their childhood, such as physical, sexual, or emotional abuse, have a higher likelihood of developing IBS.
What are the risk factors for IBS?
The risk factors for IBS include:
- IBS can occur at any age, but it often first appears in young adulthood (late teens to early 40s).
- Women are more likely to develop IBS than men.
- Conditions such as anxiety, depression, and post-traumatic stress disorder (PTSD).
- Certain dietary habits, such as a high intake of fatty foods, spicy foods, alcohol, caffeine, and low fiber intake, may increase the risk of IBS or worsen symptoms in susceptible individuals.
- Severe gastrointestinal infections, particularly bacterial or viral gastroenteritis, can increase the risk of developing IBS.
- Fluctuations in hormone levels, particularly during menstruation or hormonal therapies, can influence bowel function and contribute to IBS symptoms.
- Certain chronic medical conditions, such as fibromyalgia, chronic fatigue syndrome, and chronic pelvic pain, are associated with an increased risk of IBS.
What are the types of IBS?
There are four types of IBS:
- IBS with constipation (IBS-C): Mostly constipation and abdominal discomfort.
- IBS with diarrhoea (IBS-D): Mostly diarrhoea and abdominal discomfort.
- IBS with mixed bowel habits (IBS-M): Alternating loose stools and constipation with abdominal discomfort
- IBS undefined (IBS-U): Symptoms vary.
What are the symptoms of IBS?
The main symptom of IBS is abdominal pain or discomfort associated with alterations in bowel movements. Individuals suffering from IBS may describe abdominal discomfort in different ways, such as sharp pain, cramping, bloating, fullness, or a burning sensation. Other symptoms of IBS include:
- mucus in the stool
- a feeling of urgency
- a sensation of incomplete bowel movements
Individuals with IBS may also experience symptoms that are not directly related to the intestines, such as:
- Migraine headaches
- Disturbances in sleep patterns
- Feelings of anxiety or depression
- Fibromyalgia
- Chronic pelvic pain
Stress is often associated with the onset of symptoms, which typically improve once the stress is relieved. While some people may experience occasional episodes of IBS without clear triggers, others may have prolonged periods of symptoms followed by symptom-free periods.
How is IBS diagnosed?
The first step in diagnosing IBS involves a thorough medical history review and assessment of symptoms. The doctor will inquire about the nature, frequency, and duration of gastrointestinal symptoms such as abdominal pain or discomfort, bloating, gas, diarrhoea, and constipation. They may also ask about factors that exacerbate or alleviate symptoms, as well as any associated symptoms like fatigue or changes in bowel habits.
Physical examination: During a physical examination, the doctor examines for abdominal distention, auscultates the sounds coming from the abdomen using a stethoscope, and taps on the abdomen to assess for tenderness or discomfort.
Laboratory tests: While there is no specific test to diagnose IBS, laboratory tests may be ordered to rule out other conditions that can mimic IBS symptoms. These tests may include blood tests to check for signs of inflammation or infection, stool tests to rule out infections or malabsorption disorders, and tests for celiac disease if gluten intolerance is suspected.
In some cases, a colonoscopy or flexible sigmoidoscopy may be recommended to examine the colon and rectum for signs of inflammation, polyps, or other abnormalities. Upper GI endoscopy with a biopsy is recommended to check for celiac disease or other GI conditions.
What is treatment for IBS?
The doctor can help manage IBS by suggesting dietary and lifestyle changes, prescribing medications, recommending probiotics, and referring for psychological therapies. It may be necessary to try different treatments to find the most effective approach. A doctor can assist in finding the right treatment plan.
Dietary and lifestyle changes
- Identifying and avoiding trigger foods like spicy foods, fatty foods, caffeine, and alcohol. Opt for a gluten-free diet. Limit dairy products like milk and cheese.
- Increase fiber in the diet: Include fiber-rich food like fruits, vegetables, and whole grains. Introduce fiber slowly in the diet to give the gut time to adjust.
- Consuming regular, smaller meals and chewing food slowly can aid digestion and prevent discomfort.
- Practicing stress-reducing techniques like meditation or yoga can help manage stress, which can worsen IBS symptoms.
- Physical activities like walking or yoga can regulate bowel function and reduce stress levels.
- Get enough sleep.
Medication
- Antispasmodic medication: Medications that can ease abdominal cramping by relaxing intestinal muscles.
- Antidiarrheal medications: Medications may be used to reduce diarrhoea frequency in individuals with diarrhoea-predominant IBS.
- Fiber supplements: Soluble fiber supplements can help regulate bowel movements and relieve constipation.
- Probiotics: Supplements containing beneficial bacteria may restore gut balance and alleviate symptoms.
- Antidepressant medications: Low doses of tricyclic antidepressants and selective serotonin reuptake inhibitors for anxiety associated with the disease.
Psychological therapies
Various stress-inducing situations such as family issues, job-related stress, or exams can lead to the manifestation of IBS symptoms in certain individuals. Psychological therapies such as cognitive behavioural therapy (CBT), hypnotherapy, and psychotherapy have proven to be highly effective in managing IBS symptoms for some individuals.
Conclusively, IBS is a gastrointestinal disorder characterized by abdominal pain or discomfort, bloating, and changes in bowel habits. It affects millions worldwide, with symptoms varying in severity and duration. Though its exact cause remains unclear, factors such as abnormal gut motility, visceral hypersensitivity, and dietary triggers play a role. Diagnosis relies on symptom assessment and exclusion of other conditions through medical history and tests. Treatment involves a multifaceted approach, including dietary modifications, medications, and behavioural therapies aimed at symptom management and improving quality of life.
References
- National Institute of Diabetes and Digestive and Kidney Disease. Irritable Bowel Syndrome (IBS). Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome . Accessed on May 9th, 2024
- Johns Hopkins Medicine. Irritable Bowel Syndrome (IBS). Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/irritable-bowel-syndrome-ibs . Accessed on May 9th, 2024
- Cleveland Clinic. Irritable Bowel Syndrome (IBS). Available from: https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs . Accessed on May 9th, 2024
- National Institute of Diabetes and Digestive and Kidney Disease. Treatment for Irritable Bowel Syndrome. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/treatment. Accessed on May 9th, 2024
Irritable bowel syndrome. Available from: https://patient.info/digestive-health/irritable-bowel-syndrome-leaflet#what-causes-ibs. Accessed on May 9th, 2024
