Irritable Bowel Syndrome (IBS)

Overview

Irritable Bowel Syndrome or IBS is a common disorder that affects your digestive system, mainly the intestines and stomach, also called gastrointestinal (GI) tract. It is one of the most common GI disorders in people from their late teens up to their 50s. The disease typically affects around 10% to 15% of the world population. It is interesting to note that the prevalence of irritable bowel syndrome is more common in women, with 14% to 24% of females suffering from it while 5% to 19% men suffer from this gastrointestinal disorder.

Symptoms of IBS

Irritable Bowel Syndrome is a chronic condition and people usually learn to manage in the long term. However, only a small number of people with IBS have severe symptoms. Managing diet and lifestyle can help people in controlling the symptoms of IBS. Medication can help in treating more-severe symptoms. Some of the common symptoms are listed below:

• Abdominal pain, bloating and cramping
• Changes in appearance of bowel movement
• Changes in how often you are having a bowel movement
• Diarrhoea and constipation
• Flatulence (gas formed in the stomach)
• Tiredness, backache, feeling nausea

You can go for a checkup to your doctor if you have a constant change in bowel habits or other serious symptoms of IBS. They may indicate a more serious condition, such as colon cancer. However, it is very rare. Other symptoms include the following:

• Weight loss
• Rectal bleeding
• Iron deficiency anaemia
• Unexplained vomiting
• Pain that is not relieved by passing gas or a bowel movement

Causes of IBS

The exact cause of irritable bowel syndrome is still known but health experts classify IBS as neurogastrointestinal disorder (NGI). These conditions have to do with problems with how your gut and brain work together to help your digestive system work without any problems. Communication differences between your gut and brain can lead to the following:
Dysmotility: The way in which your GI muscles contract and the movement of food through your GI tract can cause some problems. Large intestine (colon) muscle tends to contract more in people suffering from IBS, leading to pain and cramps.
Visceral hypersensitivity: Some people may have extra-sensitive nerves in the GI tract. People suffering from IBS tend to have lower pain tolerance than people without the nerves.
Gut bacteria: According to research, people with IBS have different bacteria in their GI tract, resulting in the symptoms of IBS. The amount as well as types of gut bacteria differs in people suffering from the disorder than people without it.
Infections: If you have suffered from an infection that affected your GI tract, there is a possibility that you might get diagnosed with IBS. This suggests that germs may have a potential role to play.
Intolerance to food: If you are allergic to certain food items, then it might contribute to IBS.
There could be some triggers as well which can worsen the symptoms of IBS. Some of these are:
Menstruation: Periods or menstrual cycle may affect IBS and can worsen the symptoms.
Food: Dairy food items or food that contain gluten (wheat) can make you feel gassy.
Stress: Stress is neither good for your mental health nor physical health. According to some of the researchers, IBS is your gut’s response to stress. Therefore, IBS is sometimes also known as nervous stomach or anxious stomach.

Types
There are four main subcategories of IBS. Let’s take a look at them:
IBS-D: Abdominal discomfort and diarrhoea. More than a quarter of stools are loose or watery and less than a quarter of stools are hard or lumpy.
IBS-C: Abdominal discomfort and constipation. More than a quarter of stools are hard or lumpy and less than a quarter of stools are loose or watery.
IBS-M (mixed): Along with abdominal pain, alternating loose stools and constipation. More than a quarter of stools are hard or lumpy and more than a quarter of stools are loose or watery.
IBS-U: It is undefined subtype with varying symptoms
If we talk about the numbers, one can note that there are about an equal number of people with IBS in each of the types. There is also evidence that over time, many people with IBS will alternate between types.

Tests and treatments for IBS

As there is no test for irritable bowel syndrome, your doctor might initiate the diagnosis by delving into your medical history, physical exams and carrying out other tests to rule out other conditions like disease and inflammatory bowel disease (IBD). After this, your health care provider might use one of these sets of diagnostic criteria for IBS:
Rome criteria: It includes belly pain and discomfort with an average of one day a week for the last months. This condition should accompany at least two of the following- Pain and discomfort related to defecation, change in the defecation frequency, or a change in consistency of stool.
There are some additional tests in cases of extreme symptoms like weight loss, rectal bleeding, anaemia. These tests are:
Stool study: The study is done to check any infection. The study also helps in knowing if the intestine is facing any trouble in absorbing nutrients, a condition called malabsorption.
Colonoscopy: A small, flexible tube is used to examine the entire length of the colon.
CT scan: It produces images of abdomen and pelvis that might rule out other causes of symptoms, especially if you have belly pain.
Upper endoscopy: A flexible, long tube is inserted all the way down to the throat which reaches oesophagus (tube connecting mouth and stomach). The tube consists of a camera which helps doctors to take a look at the upper digestive tract. A tissue sample might also be collected during the procedure. To check any overgrowth of bacteria, a sample of fluid can also be collected.
There are some laboratory tests as well:
Lactose intolerance test: Lactase is an enzyme which helps in the digestion of milk sugar or lactose. Absence of lactase may generate problems similar to those of IBS like belly pain, diarrhoea and gas. Doctors might suggest you to refrain from milk and milk products for several weeks.
Breath test: The test helps to figure out the presence of any bacterial overgrowth in the small intestine (SIBO or Small Intestinal Bacterial Growth). It is estimated that 80% of people suffering from IBS have SIBO.
The treatment focuses on relieving symptoms so that one can love life without any pain or discomfort. Some medications can be useful for the same:
Supplements: Taking fibre supplements like psyllium (Metamucil) along with fluids can help in easing constipation.
Laxatives: In case the fibre is not able to provide you relief, over-the-counter laxatives, such as magnesium hydroxide oral (Phillips' Milk of Magnesia) or polyethylene glycol (Miralax) can become your saviour
Anti-diarrheal medications: Over-the-counter medications, such as loperamide (Imodium A-D), can help control diarrhoea. Bile acid binder, such as cholestyramine (Prevalite), colestipol (Colestid) or colesevelam (Welchol) can also be used but they can cause bloating.
Anticholinergic medications: Medications like dicyclomine (Bentyl) can help with painful bowel spasms. Generally safe, these medications can have mild side-effects like constipation, dry mouth and blurred vision.
Tricyclic antidepressants: This may help reduce pain but it also inhibits the activity of neurons that control the intestines. If you have diarrhoea and abdominal pain without depression, a doctor may suggest a lower than typical dose of imipramine (Tofranil), desipramine (Norpramin) or nortriptyline (Pamelor). Side effects include drowsiness, blurred vision, dizziness and dry mouth but they can be diminished if taken before sleep.
Pain medications: Severe pain or bloating can be eased through Pregabalin (Lyrica) or gabapentin (Neurontin).
Approved medications for people with IBS are as follows:
Alosetron (Lotronex): Helps in relaxing the colon and easing the movement of waste through the lower bowel. It is prescribed only in severe cases of IBS-D in women on which other treatments didn't work out.
Rifaximin (Xifaxan): Helps in reducing the bacterial overgrowth and diarrhoea. This is used for treating IBS-D.
Lubiprostone (Amitiza): Helps in smooth passage of stool by increasing the fluid secretion in the small intestine. It is prescribed only in severe cases of IBS-C in women on which other treatments didn't work out.
Linaclotide (Linzess): Just like Lubiprostone, it also helps in increasing fluid secretion resulting in passage of stool. It can cause diarrhoea but taking the medicine 30 minutes-60 minutes prior to eating can help.
Probiotics: Some studies suggest that probiotics may help in relieving IBS symptoms like abdominal pain, diarrhoea and constipation. Probiotics are good bacteria living in your intestine and found in food items like yoghurt.

Prevention for IBS

IBS can be prevented by making healthy eating choices and changing your lifestyle. For example, food items like bread and cereals made with refined grains, processed foods (chips), dairy products like cheese are known to make IBS-C worse, So it’s better to avoid such foods. Other changes that you can incorporate in your life can be:

• Boosting fibre intake by 2 grams to 3 grams per day in case of constipation. Women should have 25 grams of fibre per day. For men, it should be 38 grams.
• Drinking lots and lots of water. Avoid food that can lead to increase in gas like carbonated and alcoholic beverages. Also, avoid delaying or skipping your meals.
• Stress can worsen IBS symptoms. Try to manage it by indulging in your favourite activities, get regular exercise and sleep, and try to maintain balance between personal and professional life.
• FODMAPs or fermentable oligosaccharides, disaccharides, monosaccharides and polyols are sugars that are poorly absorbed by the small intestine. Some people can be sensitive to fructose, fructans, lactose and others and can experience cramps, diarrhoea, constipation, bloating and other problems.