Irritable Bowel Syndrome

Symptoms

While IBS symptoms differ, they normally persist over a long period. The most prevalent ones are:

• Abdominal cramping, pain, or bloating associated with bowel movements
• Changes in how bowel movements appear
• Alterations in bowel movement frequency

Other commonly related symptoms are the feeling of incomplete emptying and an increase ingasor the presence of mucus in the stool.

Causes

The actual cause of irritable bowel syndrome remains unidentified; however,some of the factors that might contribute to its occurrence are:

• Intestinal muscle contractions: Muscle layers that line the intestinal walls normally contract to help food pass through the digestive tract. However, stronger and prolonged contractions than usual can lead to bloating, gas and diarrhea, while weaker contractions result in hard, dry stools by slowing food passage.
• Nervous system: Nerve issues in the digestive system can lead to discomfort when the abdomen expands due to gas or stool. Poor coordination of signals sent from the brain to the intestines can result in overreaction to normal changes occurring in the digestive process. This may cause diarrhea, pain, or constipation.
• Severe infection: IBS may develop following a serious episode of diarrhea resulting from bacterial or viral infection known as gastroenteritis. It might as well be linked to bacterial overgrowth (excess bacteria in the intestines).
• Early life stress: Exposure to stressful life events, particularly during childhood, increases the possibility of more IBS symptoms in some people.
• Changes in gut microbes: This involves variations in the bacteria, viruses, and fungi living in the intestines and are essential for good health. Studies show that microorganisms in persons with IBS vary from those in individuals without the condition.

Triggers

The possible triggers of IBS symptoms are:

• Food: Scientists do not completely understand the connection between food allergies or intolerances in irritable bowel syndrome. Rarely, true food allergies lead to IBS, but most people experience worsened symptoms after consuming certain foods or drinks. These triggers include dairy products, wheat, citrus fruits, cabbage, beans, milk, and carbonated beverages.
• Stress: The majority of individuals with IBS notice that their symptoms worsen or become more common when they are too stressed. Although stress can exacerbate symptoms, it usually doesn’t trigger them.

Risk factors

Many individuals experience occasional IBS symptoms. However, the likelihood of developing the syndrome increases due to factors such as:

• Age: IBS is more common in people below the age of 50.
• Gender: In the US, IBS is more prevalent in females. Also, oestrogen therapy done before or after menopause is a contributing risk factor.
• Family history: A family history of IBS may indicate a genetic predisposition as well as shared environmental factors within the family, or a combination of both.
• Mental health problems: Depression, anxiety, and other psychological health conditions, along with a history of physical, sexual, or emotional abuse, may increase the risk of IBS.

Complications

Chronic diarrhea or constipation related to IBS can lead to haemorrhoids. Moreover, IBS is linked to:

• Reduced quality of life: Individuals experiencing moderate to serious IBS often report a lower quality of life. Studies show that those with the syndrome miss up to three times as many workdays compared to persons who don’t have the symptoms.
• Mood disorders: The symptoms of irritable bowel syndrome can contribute to depression or anxiety. These mood disorders can, eventually, worsen the symptoms.

Diagnosis

There is no definitive test for diagnosing irritable bowel syndrome. However, the doctor will probably conduct a physical examination, a thorough medical history, and some diagnostic tests to rule out disorders like inflammatory bowel disease (IBD) and celiac disease.

Once other conditions are sidelined, the doctor may use any of the following diagnostic criteria sets for IBS:

• Rome criteria: These entail experiencing abdominal pain and discomfort for at least a day in a week during the past 3 months. It should also be accompanied by at least two occurrences including pain associated with defecation, frequency of defecation changes, or stool consistency changes.
• Type of IBS: For treatment purposes, IBS can be grouped into four categories depending on symptoms. They include constipation-predominant, diarrhea-predominant, mixed, and unclassified.

In addition, the provider can as well check for other symptoms that could indicate a more severe problem. Examples are:

• Start of symptoms after 50 years
• Weight loss
• Fever
• Rectal bleeding
• Nausea or repeated vomiting
• Abdominal pain, particularly if not connected with bowel movements or happens at night
• Persistent diarrhea or diarrhea that wakes you up from sleep
• Anaemia due to low iron

If you exhibit these symptoms or if the first IBS treatment is not effective, more tests may be necessary.

Additional tests

The practitioner can order a number of tests, such as stool studies, to examine infections. In addition, stool studies can be used to determine if the intestine has difficulty absorbing nutrients, a disorder called malabsorption. Other tests may be suggested to help rule out different causes of the symptoms.

The diagnostic procedures that can be performed include:

• Colonoscopy: A small, flexible tube is used to assess the whole dimension of the colon.
• CT scan: This imaging test provides detailed pictures of the abdomen and pelvis, which can help rule out other symptoms and causes of abdominal pain.
• Upper endoscopy: This involves inserting a long, flexible tube through the throat into the oesophagus (a tube that connects the stomach and mouth). The small camera attached to the tube’s tip enables the doctor to see the upper digestive tract. A sample of the tissue may be removed (biopsy) for analysis, or a fluid sample is taken to check for bacteria overgrowth during the procedure. The provider can recommend endoscopy if there is a possibility of celiac disease.

Laboratory tests that can be conducted are:

• Lactose intolerance tests: The enzyme required to break down sugars present in dairy products is known as lactase. A deficiency in lactase can cause symptoms similar to IBS, such as abdominal pain, diarrhea, and gas. Therefore, the doctor can recommend a breath test or suggest eliminating milk and dairy products from your diet for a few weeks.
• Breath test for bacterial overgrowth: The test can help detect bacterial overgrowth in the small intestine. This condition is common in individuals who have undergone bowel surgery or those with diabetes or other disorders slowing digestion.
• Stool tests: The doctor can examine stool for parasites, bacteria, or bile acid, a digestive liquid that the liver produces.

Treatment and Management

Irritable bowel syndrome treatment aims to relieve symptoms to help you lead a symptom-free life. You can manage mild symptoms through stress management, diet changes, and lifestyle adjustment. Also, consider these tips:

• Refrain from foods triggering your symptoms
• Consume fibre-rich foods
• Take a lot of fluids.
• Exercise frequently
• Get adequate sleep

Your doctor can also recommend eliminating particular foods from your diet including:

• High-gas foods: To prevent symptoms like bloating or gas, avoid things like carbonated and alcoholic drinks, plus other foods that can increase gas.
• Gluten: According to studies, some individuals with IBS find that their diarrhea symptoms get better when they eliminate gluten (barley, wheat, and rye) from their diet, even without celiac disease.
• FODMAPs: Some individuals are sensitive to specific carbohydrates, like lactose, fructose and fructans, called FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). These are present in particular grains, fruits, vegetables, and milk products.

Consulting with a dietitian is essential in implementing these dietary changes. If your symptoms range from moderate to severe, the doctors might recommend counselling, particularly if you are depressed or if stress worsens your symptoms.

Medications

Depending on the symptoms, the provider can suggest the following medications:

• Fibre supplements: A fibre supplement, including psyllium (Metamucil) taken with fluids, can help manage constipation.
• Laxatives: If fibre alone doesn’t relieve constipation, the physician may suggest over-the-counter laxatives, like magnesium hydroxide oral (Phillips’ Milk of Magnesia) or polyethylene glycol (Miralax).
• Anti-diarrheal medications: Over-the-counter drugs like loperamide (Imodium A-D) might assist in controlling diarrhea. Bile acid binders, including colestipol (Colestid), cholestyramine (Prevalite), or colesevelam (Welchol), may also be prescribed, although these can lead to bloating.
• Anticholinergic medications: Drugs like dicyclomine (Bentyl) help ease painful bowel spasms and are, at times, recommended for those with bouts of diarrhea. While these medications are usually safe, they can lead to dry mouth, constipation, and blurry vision.
• Tricyclic antidepressants: These drugs can help alleviate depression and prevent the activity of neurons regulating the intestines, potentially reducing pain. For those with diarrhea and abdominal pain but with no depression, a lower dose of imipramine (Tofranil), nortriptyline (Pamelor), or desipramine (Norpramin) might be recommended. The possible side effects, which are drowsiness, dizziness, blurry vision and dry mouth, can be minimised by taking the medicine at bedtime.
• SSRI antidepressants: Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (Prozac) or paroxetine (Paxil), can be helpful if you experience depression along with discomfort and constipation.
• Pain medicines: Medications such as gabapentin (Neurontin) or pregabalin (Lyrica) may relieve severe discomfort or bloating.

Activity changes

In addition, adjusting daily activities might help manage IBS symptoms. In such cases, the doctor can recommend the following:

• Regular exercise: At least 150 minutes of moderate exercise each week is advisable. This is around 30 minutes per day for five days a week. Engaging in moderate exercises is all about raising the heart rate.
• Try relaxation techniques: Engage in yoga, meditation, or other de-stressing methods everyday to calm an overstrained nervous system as well as the“nervous gut.” A behavioural therapist can sometimes assist with these techniques.
• Get adequate sleep: Strive for at least 7 to 9 hours of quality sleep every night and try to maintain a consistent bedtime. Quality sleep is a great de-stressor that is often recommended. It’s also important to consult a practitioner if you have trouble sleeping.
• Have an activity diary: It’s advisable to keep a record of all activities that are helpful in managing IBS symptoms and share your notes with the doctor.

Therapy

Consulting a therapist is often beneficial for most individuals with IBS. A therapy helps one manage stress and related conditions, including depression and anxiety. Furthermore, these approaches can also provide relief:

• Cognitive Behavioural Therapy (CBT)
• Biofeedback
• Hypnotherapy

Living With

When should I see a doctor?

You should visit your healthcare provider if the symptoms persist for over 3 months or if they tend to worsen. Even if the symptoms are less frequent but disrupt daily activities, seeing a primary caregiver is also advisable.

Sometimes, certain symptoms point to a more severe issue. Therefore, it’s essential to contact your doctor right away if you experience common signs of IBS along with:

• Vomiting
• Fever
• Rectal bleeding
• Unexplainable weight loss
• A severe diarrhea that awakens you at night
• A serious abdominal pain, particularly if it doesn’t get better after bowel movement or passing gas

What questions should I ask my healthcare provider?

Consider asking your provider the following questions if you have symptoms of IBS:

• What medications are helpful?
• Which types of foods should I stay away from?
• What lifestyle adjustments should I make?
• When will my symptoms improve?