Irritable Bowel Syndrome (IBS) is a common 'functional' disorder of the gut. The gut includes the bowels. A functional disorder means there is a problem with the function of a part of the body, but there is no abnormality in the structure. So, in IBS, the function of the gut is upset, but all parts of the gut look normal, even under a microscope.
IBS causes various symptoms and can affect anyone at any age, but it commonly first develops in young adults and teenagers. IBS is twice as common in women as in men.
What are the symptoms of
irritable bowel syndrome?
- Pain and discomfort may occur in different parts of the abdomen. Pain usually 'comes and goes'. The length of each bout of pain can vary greatly. The pain often eases when you pass stools (motions or faeces) or wind. Many
people with IBS describe the pain as a 'spasm' or 'colic'. The severity of the pain can vary from mild to severe, both from person to person, and from time to time in the same person.
- Bloating and swelling of your abdomen may develop from time to time. One may pass more wind than usual.
- Stools (sometimes called motions or faeces)
- Some people have bouts of diarrhoea, and some have bouts of constipation.
- Some people have bouts of diarrhoea that alternate with bouts of constipation.
- Sometimes the stools become small and pellet like. Sometimes the stools become watery or ribbony. At times, mucus may be mixed with the stools.
- You may have a feeling of not emptying your rectum after going to the toilet.
- Some people have urgency, which means you have to get to the toilet quickly. A 'morning rush' is common. That is, you feel an urgent need to go to the toilet several times shortly after getting up. This is often during and after breakfast.
- Other symptoms sometimes occur and include: nausea (feeling sick), headache, belching, poor appetite, tiredness, backache, muscle pains, feeling quickly 'full' after eating, heartburn, and bladder symptoms (an associated 'irritable bladder').
However, passing blood is not a symptom of IBS. You should tell a doctor if you pass blood.
What causes irritable bowel
syndrome?
The cause is not clear. It may have something to do with overactivity of part or parts of the gut. The gut is a long muscular tube that goes from the mouth to the anus. The small and large bowel (also called the small and large intestine) are parts of the gut inside the abdomen. Food is passed along by regular contractions (squeezes) of the muscles in the wall of the gut. Pain and other symptoms may develop if the contractions become abnormal or overactive.
The cause of overactivity in parts of the gut is not clear. One or more of the following may play a part:
Overactivity of the nerves or muscles of the gut. It is not known why this may occur. It may have something to do with overactivity of messages sent from the brain to the gut. Stress or emotional upset may play a role. About half of people with IBS can relate the start of symptoms to a stressful event in their life. Symptoms tend to become worse during times of stress or anxiety.
Intolerance to certain foods may play a part in some cases. However, this is thought to be only in a small number of cases.
Infection and bacteria in the gut. IBS is not caused by an ongoing gut infection.
However, in about 1 in 6 cases, the onset of symptoms seems to follow a bout of gastroenteritis (a gut infection which can cause diarrhoea and vomiting). So, perhaps a virus or other germ may 'sensitise' or 'trigger' the gut in some way to cause persisting symptoms of IBS.
Also, in some cases, symptoms get worse after taking a course of antibiotics. Antibiotics kill certain harmless or ‘good' bacteria in the gut which changes the balance of bacteria types in the gut.
What are the treatments for irritable bowel syndrome?
Many people are reassured that their condition is IBS, and not something more serious such as colitis. Simply understanding about IBS may help you to be less anxious about the condition, which may ease the severity of symptoms. Symptoms often settle for long periods without any treatment. In some cases, symptoms are mild and do not require treatment.
If symptoms are more troublesome or frequent, one or more of the following treatment options may be advised:
Fibre
The advice about fibre in treating IBS has changed somewhat over the years. Fibre (roughage) is the part of the food which is not absorbed into the body. It remains in your gut, and is a main part of faeces (stools). There is a lot of fibre in fruit, vegetables, cereals, wholemeal bread, etc. It used to be said that eating a high fibre diet was good at easing IBS symptoms. However in some individuals a high fibre diet can make IBS worse.
What seems to be the case is that the type of fibre is probably important. There are two main types of fibre - soluble fibre (which dissolves in water) and insoluble fibre. It is soluble fibre rather than insoluble fibre that seems to help ease symptoms in some cases. So, if you increase fibre, have more soluble
fibre than insoluble fibre.
- Dietary sources of soluble fibre include oats, ispaghula (psyllium), nuts and seeds, some fruit and vegetables and pectins. A fibre supplement called ispaghula powder is also available from pharmacies and health food shops. The recent review of treatments for IBS mentioned earlier mentions ispaghula as the fibre supplement that seems to be the most beneficial.
- Insoluble fibre is chiefly found in corn (maize) bran, wheat bran and some fruit and vegetables.
Food, drinks and lifestyle
A healthy diet is important for all of us. However, some people with IBS find certain food of a normal healthy diet can trigger symptoms or make symptoms worse. Current guidelines about IBS include the following points about diet which may help to minimise symptoms:
- Have regular meals and take time to eat at a leisurely pace.
- Avoid missing meals or leaving long gaps between eating.
- Drink at least eight cups of fluid per day, especially water or other non-caffeinated drinks. This helps to keep the faeces (stools) soft and easy to pass along the gut.
- Restrict tea and coffee to three cups per day (as caffeine may be a factor in some people).
- Restrict the amount of fizzy drinks that you have to a minimum.
- Some people report an improvement in symptoms when they cut down from drinking a lot of alcohol, or stop smoking if they smoke.
Individual food
intolerance
Some people with IBS find that one or more individual foods can trigger symptoms, or make symptoms worse ('food intolerance or sensitivity'). If you are not sure if a food is causing symptoms, it may be worth discussing this with a doctor who may refer you to a dietician.
A dietician may be able to advise on an 'exclusion diet'. For example, one fish/meat, one fruit, and one vegetable. Then, advise on adding in different foods gradually to your diet to see if any cause the symptoms.
It may be possible to identify one or more foods that cause symptoms. This can be a tedious process, and often no problem food is found. However, some people say that they have identified one or more foods that cause symptoms, and then can control symptoms by not eating them.
Probiotics
Probiotics are nutritional supplements that contain 'good' bacteria. That is, bacteria that normally live in the gut and seem to be beneficial. Taking probiotics may increase the 'good' bacteria in the gut which may help to ward off 'bad' bacteria that may have some effect on causing IBS symptoms. You can buy probiotic capsules (various brands) from pharmacies.
The dose is on the product label. You can also buy foods that contain probiotic bacteria. These include certain milk drinks, yoghurts, cheeses, frozen yoghurts, and ice creams. They may be labelled as 'probiotic', 'containing bacterial cultures', or 'containing live bacteria'.
There is some evidence that taking probiotics may help ease symptoms in some people with IBS. At present, there are various bacteria that are used in probiotic products. Further research is needed to clarify the role of probiotics and which one or ones are most helpful. In the meantime, if you want to try probiotics, you should keep to the same brand of probiotic containing product for at least four weeks to monitor the effect. Perhaps try a different probiotic for at least a further four weeks if the first one made no difference.
Other lifestyle factors
Regular exercise may also help to ease symptoms. Stress and other emotional factors may trigger symptoms in some people. So, anything that can reduce your level of stress or emotional upset may help.
It may help to keep a food and lifestyle diary for 2-4 weeks to monitor symptoms and activities. Note everything that you eat and drink, times that you were stressed, and when you took any formal exercise. This may identify triggers, such as a food, alcohol, or emotional stresses, and may show if exercise helps to ease or prevent symptoms.
Antispasmodic medicines
These are medicines that relax the muscles in the wall of the gut. Your doctor may advise one if you have spasm-type pains. There are several types of antispasmodics. If one is found to help, then you can take it 'as required' when pain symptoms flare-up. Many people take an antispasmodic medicine for a week or so at a time to control pain when bouts of pain flare-up. Some people take a dose before meals if pains tend to develop after eating.
Treating constipation
Constipation is sometimes a main symptom of IBS. If so, it may help if you increase your fibre as discussed earlier. Sometimes laxatives are advised for short periods if increasing fibre is not enough to ease a troublesome bout of constipation.
Treating diarrhoea
An antidiarrhoea medicine may be useful if diarrhoea is a main symptom.
Antidepressant medicines
An antidepressant medicine in the 'tricyclic' group is sometimes used to treat IBS. In particular, it tends to work best if pain and diarrhoea are the main symptoms. (Tricyclic antidepressants have other actions separate to their action on depression. They are used in a variety of painful conditions, including IBS.) Unlike antispasmodics, you need to take an antidepressant regularly rather than 'as required'.
Therefore, an antidepressant is usually only advised if you have persistent symptoms, or frequent bad flare-ups that have not been helped by other treatments.
Psychological treatments (talking treatments)
Situations such as family problems, work stress, exams, recurring thoughts of previous abuse, etc, may trigger symptoms of IBS in some people. People with anxious personalities may find symptoms difficult to control.
The relationship between the mind, brain, nervous impulses, and overactivity of internal organs such as the gut is complex. Some people have found such things as relaxation techniques, stress counselling, cognitive behaviour therapy, psychotherapy, hypnotherapy, and similar therapies useful.
Psychological treatments are generally mainly considered in people with moderate to severe IBS, when other treatments have failed. Or, when it seems that stress or psychological factors are contributing to causing symptoms.
Other treatments
Various alternative and complimentary therapies are sometimes used. Newer medicines that affect certain functions of the gut are also being developed and may become useful treatments in the future.
Assess your symptoms - perhaps keep a diary
If you are advised to try a particular treatment, it may be sensible is to keep a symptom diary 'before and after' the start of the treatment. For example, before changing the amount of fibre that you eat, or taking a probiotic, or starting medication. You may wish to jot down in the diary the type and severity of symptoms that you get each day for a week or so. Keep the diary going and you can then assess whether it has improved the symptoms or not. Treatment can often ease symptoms and improve your quality of life.
What of the future?
In most people with IBS, the condition tends to persist long-term. However, the severity of symptoms tends to 'wax and wane' and you may have long spells without any symptoms, or with only mild symptoms. Treatment can often help to ease symptoms when they flare-up. In some cases, symptoms clear for good at some stage.
IBS does not shorten your expected life span, it does not lead to cancer of the bowel, and does not cause blockages of the gut or other serious conditions.
(The writer is a Consultant Physician & Gastroenterologist at the Sri Lanka Police Hospital & Lanka Hospital, Colombo)
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