Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a group of symptoms or disorder that a patient may have, which consists of symptoms that include, though are not limited to: abdominal pain and cramping, changes in bowel movements, gas, bloating, indigestion, heartburn, reflux, Gastro-oesophagial reflux disease, diarrhea, constipation, alternating diarrhea/constipation, abnormal bowel frequency or urgency, pain, spasms, vomiting and/or hemorrhoids.

Causes

IBS can occur at any age, but it often begins in the teen years or early adulthood. It is twice as common in women as in men. About 1 in 6 -10 people have symptoms of IBS. It is a very common reason for referral to bowel specialist and sometimes incorrectly to a gynaecologist, as the symptoms often resemble and can be associated with that of gynaecological conditions causing pelvic pain.

It is not clear why patients develop IBS. Sometimes it occurs after an infection or inflammation of the intestines, or in some cases when reduced stomach acid, causes malfunctioning of the bowels; and there may also be abnormalities in the gut flora (good germs versus bad germs) or the immune system . Also the intestine is connected to the brain. Signals go back and forth between the bowel and brain. These signals affect bowel function and symptoms. The nerves can become more active during stress, causing the intestines to be more sensitive and contract, which causes the spasms that can be associated with IBS – hypersensitive stress response.

There are some research evidences that suggest that people with IBS may have some difficulties in metabolizing serotonin, a neurotransmitter most commonly associated with quality sleep and positive mood, but which is also critical for peristalsis (intestinal muscle contractions that move food through the GI tract). An estimated 95% of the body’s serotonin receptors are located in the intestinal tract! IBS sufferers may have extra sensitive pain receptors in their gut , which may be directly related to low levels of serotonin. So while it’s helpful to make lifestyle changes to reduce overall stress levels, to combat potentially low serotonin uptake, it can also be worthwhile supplementing to promote increased serotonin production!

Symptoms

Symptoms range from mild to severe, but most people have mild symptoms. Symptoms vary from person to person. The main symptoms of IBS are abdominal pain, fullness, gas, and bloating that have been present for at least 3 days a month for the last 3 months. The pain and other symptoms will often be reduced or go away after a bowel movement, or it may occur when there is a change in how often there are bowel movements. People with IBS may switch between constipation and diarrhea, or mostly have one or the other. There may be loss of appetite and the symptoms may get worse for a few weeks or a month, and then decrease for a while. For some, symptoms are present most of the time

• People with diarrhea will have frequent, loose, watery stools. They will often have an urgent need to have a bowel movement, which may be hard to control.
• Those with constipation will have a hard time passing stool, as well as fewer bowel movements. They will often need to strain and will feel cramps with a bowel movement. Often, they do not release any stool, or only a small amount.

Signs and tests

There is no specific test to diagnose IBS. Most of the time, your doctor can diagnose IBS based on your symptoms, with few or no test. . Tests may be done to rule out other problems, for example;

• Eating a lactose-free diet for 2 weeks may help the doctor check for a possible lactase deficiency, or blood tests to see if you have celiac disease or a low blood count (anemia)
• Stool cultures to check for an infection.
• Colonoscopy (camera view of the lower portion of the bowel) can be done if you have other symptoms such as weight loss or bloody stools, or anaemia.

Treatment

The goal of treatment is to relieve symptoms. Lifestyle changes can help in some cases of IBS. For example, regular exercise and improved sleep habits may reduce anxiety and help relieve bowel symptoms. Dietary changes can be helpful. However, no specific diet can be recommended for IBS, because the condition differs from one person to another. It may help to:

• Avoid foods and drinks that stimulate the intestines (such as caffeine, tea, or colas)
• Avoid large meals
• Increase fiber in the diet (this may improve constipation but make bloating worse)

It is important to realise that no one medication will work for everyone.  Your doctor may try:

• Anticholinergic medications (dicyclomine, propantheline, belladonna, and hyoscyamine) taken about a half-hour before eating to control intestine muscle spasms
• Bisacodyl to treat constipation
• Loperamide to treat diarrhea
• Low doses of tricyclic antidepressants to help relieve intestinal pain
• Lubiprostone for constipation symptoms
• Rifaximin, an antibiotic

Outlook

Irritable bowel syndrome may be a lifelong condition. For some people, symptoms are disabling and reduce the ability to work, travel, and attend social events. Symptoms can often be improved or relieved through treatment.