Irritable bowel syndrome (IBS) is a chronic condition that affects the large intestine. It requires long-term management and is the most common functional gastrointestinal disease condition with a global prevalence estimated to be 11.2%( PubMed)
Though IBS is not life-threatening, the condition impacts an individual’s quality of life, affecting the socio-economic and other day to day activities (PubMed). Not only that, the disease significantly burdens the healthcare system in economic terms. In the U.S. the direct annual cost of diagnosing and treating IBS is estimated to be $1.7 to $10 billion (PubMed). This is besides the indirect cost caused by employee absenteeism and workdays lost.
So what is this condition that burdens individuals and nations? Read on to know its signs, symptoms, and management and treatment protocols.
What Is Irritable Bowel Syndrome?
The other names for IBS include spastic colon, irritable colon, mucous colitis, and spastic colitis; These names are sometimes used interchangeably with inflammatory bowel disease (IBD), which is not technically correct. The syndrome has no connection with inflammatory or other bowel disorders.
About 3% to 20% of American adults suffer from IBS, which experience a variety in the severity of signs and symptoms. The prevalence of IBS is higher in women than in men. A patient suffering from IBS may experience minor symptoms that last for a few days. In contrast, the severe form of disease disrupts one’s life schedules entirely and can last for months at a stretch.
It is important to note that IBS may cause damage to the mucosal wall of the large intestine. Yet, it does not increase one’s risk of colon cancer in any way.
What Are The Signs And Symptoms Of IBS?
Irritable bowel syndrome causes a group of symptoms affecting the large intestine. They are undoubtedly uncomfortable and sometimes embarrassing for the patient. The typical signs and symptoms include:
- Abdominal pain and cramping: pain in the abdomen may range in severity from minor discomfort to severe pain and cramps. They often start after meal consumption and ease away after one passes a stool. The pain is due to the abnormal processing of the pain signals from the bowel. Experts suggest that the gut lining nerves become extra sensitive and relay a hyper response, which alleviates after a bowel movement.
- Bloating: patients with IBS experience abdominal bloating and swelling. The patient may complain of abdominal tightening and a feeling of fullness. The belly area may be visibly swollen in severe cases.
- Gas: Inflammatory bowel syndrome is almost often accompanied by flatulence or gas. The symptom may get worse after eating certain cruciferous foods like cabbage, broccoli. beans, milk and milk products, foods high in fat, fried food items, and drinks containing caffeine, alcohol, or artificial sweeteners may also induce flatulence. Fibrous foods tend to cause gas in IBS. Ironically, fiber also relieves constipation faced in this condition. So if you are prescribed to increase the intake of fibrous food in your diet, gradually increase the dose.
- Constipation and diarrhea: IBS disturbs bowel movement and stool consistency. The patient may complain of alternating diarrhea and constipation or one of the conditions at one time. On examination, the stool may also contain mucus. Usually, bowel movements follow a pattern of three times or less per day to three times or more per weekIt is important to note that not passing stool every day does not constitute constipation, as most people believe.
However, less than three bowel movements per week define constipation. And more than three bowel movements per day constitutes diarrhea.
In IBS-related constipation or IBS-C:
- There is a need to strain to pass stool
- The patient has less than four bowel movements per week
- The consistency of the stool is hard, lumpy, and dry
Sometimes, constipation becomes chronic enough to rise to complications like fissures, hemorrhoids and fecal impaction in the large intestine. The frequency of bowel movements (more than four per day) with urgency defines IBS-related diarrhea or IBS-D. Sometimes, mucus is passed with stools, which is a clear indication of irritable bowel syndrome.
IBS Symptoms In Women
It is interesting to note that signs of IBS are more pronounced in women who are menstruating as compared to menopausal women. Women with IBS are observed to report more gynecologic disorders (for example, endometriosis) and are generally diagnosed with IBS during their reproductive years. Pregnant women with IBS experience more heartburn, nausea, and disturbance in bowel movements. However, extensive research is required to establish a link in this regard. Women report experiencing more pronounced symptoms of IBS when they are nearing their period date or while menstruating. However, variations and exceptions are not ruled out. Clinically, women describe having diarrhea and abdominal discomfort just before starting their periods and during menstruation as well. After about the middle of the cycle, women report constipation and bloating.
Some other women-specific IBS complaints include:
- Fatigue
- Insomnia
- Food sensitivity
- Backache
- Painful menstruation
- Cramping
- Premenstrual syndrome (PMS)
- Decreased sex drive or libido
- Pain or discomfort during sexual intercourse
IBS Symptoms In Men
According to the International Foundation for Functional Gastrointestinal Disorders, men do not report signs and symptoms of IBS, so there is a lack of data showing the prevalent signs and symptoms of IBS in men.
In addition to the signs as mentioned earlier, some additional signs include:
- A feeling of incomplete emptying of stools
- Feeling uncomfortable or nauseous after regular meal consumption
- Increased frequency and urgency of bathroom visits
- Lower backache
- Heartburn and other symptoms that get worse after meals
- Complications like weight loss, nutritional deficiencies and loss of bowel control in IBS-D
What Causes Irritable Bowel Syndrome?
The exact cause of IBS is not known. Some suggest the condition arises due to hypersensitivity of colonic mucosa or the body’s immune system. Some suggest a previous bacterial infection in the gut may initiate the condition, mostly post-infectious variety.
The on-spot physical causes of IBS in the gut include:
- Slow and spastic movements of the colon, which causes painful abdominal cramps
- Disturbed serotonin levels in the colon, which affects the colonic motility and bowel movements
- Sometimes, a mild case of celiac disease may initiate IBS symptoms by damaging the intestinal mucosa
- Certain IBS triggers may initiate the disease process as specific foods, chronic stress, anxiety and hyperactive immune system
How Is IBS Diagnosed?
The different diagnostic tests for IBS are primarily used to rule out other gastrointestinal conditions (GIT) like celiac disease. Since IBS produces a collection of symptoms that often overlap with other GIT conditions, it is difficult to confidently claim a spot-on diagnosis.
The doctor usually starts with taking a complete history of:
- Life stressors experienced
- History of infections or any current infections
- Family history of the condition
- Probable intake of certain medications or food items that make your symptoms worse
The patient’s responsibility is to give all relevant details so the doctor can link the disease pattern with your behavior because the disease severity varies between person to person.. If a patient experiences one or more of the signs and symptoms described earlier at least three times a month for a period of three months or longer, a possible diagnosis for IBS is made. The doctor may also ask the patient to undergo a physical examination.
The physical examination could include these tests: ·
- Stool examination to rule out any infections
- Blood complete picture to diagnose anemia and rule out celiac disease (wheat allergy)
- Prescribing a specific diet that cuts down some food items to rule out food allergies (for example, cut back on milk and dairy to rule out lactose intolerance)
- Colonoscopy to rule out inflammatory bowel disease, colitis, or colon cancer
- X-ray of the lower gastrointestinal tract to check for any blockages of the intestine
- A CT-scan to find any other causes of abdominal discomfort as gallbladder or pancreatic disease
Recently, doctors have also started using MRI scans to diagnose and treat IBS. Scientists at the University of Nottingham’s Digestive Diseases Centre in the U.K. are striving in this direction via different studies.
Our large intestine is divided into three parts; the ascending, transverse and descending colon. MRI scans help the scientists measure the volumes of these three colon regions in patients with IBS. It allows for comparative studies of the motility of the colon’s different parts with a normal healthy gut.
It is observed that in IBS patients, the problem lies in the ascending colon. This part of the colon does not relax enough to make room for digested food compared to a healthy colon.
Another part of the research involved the volunteers ingesting specially designed markers that are visible on MRI scans. This helped measure the time taken by ingested food to travel through the large intestine. Series of images were taken over 24 hours to note the movement of the markers along the colon. This exercise showed whether the patient has normal or delayed gut movements. This method is preferred in pregnant women and children where unnecessary exposure to X-ray radiation may be harmful.
MRI scans are also essential tools to map out a treatment plan for IBS patients. It is suggested that diets that limit fructose, a type of sugar present in fruits, help improve IBS symptoms. MRI scans help identify the mode of action needed.
Fructose, being difficult to absorb, gets passed into the gut and ferments there. The fermentation causes gas and bloating. Researchers are trying to determine if the same reasons cause the bloating, gas and abdominal symptoms in IBS.
Similarly, MRI scans may help determine if a gluten-free diet can help improve IBS symptoms.
MRI scans help identify our body’s response to different food items, which is vital in managing IBS symptoms.
What Treatment Is Available For Irritable Bowel Syndrome?
There is no cure for IBS; however, the signs and symptoms are certainly manageable. Before your doctor prescribes you medicine for IBS, certain lifestyle modifications need to be adopted because they play an essential role in easing away IBS flare-ups.
- Lifestyle modifications for IBS
These include:
- Moderate yet regular physical exercise
- Cutting back on certain foods like caffeinated drinks, veggies like broccoli, onion, garlic, cauliflower, and cabbage, raw fruits that irritate the intestines
- Consuming frequent meals but in smaller portions
- Alleviating stress via talk therapy, meditation, yoga, group sessions, adopting a hobby and so on
- Integrating probiotic-rich foods and probiotic supplements
- Cutting back deep-fried or spicy foods
- Adopting a low FODMAP diet (fermentable oligo-, di-, and monosaccharides and polyols) decreases mucosal irritation in the gut. These food items include asparagus, apples, kidney beans, split peas, grapefruit, processed meats, raisins, and wheat-containing products
- Taking moderate fiber in the diet to alleviate constipation
- Quitting smoking
The International Foundation for Functional Gastrointestinal Disorders has stated three relaxation techniques. These are said to help with managing symptoms of IBS. These include:
- Diaphragmatic or abdominal breathing
- Progressive muscle relaxation
- Visualization or positive imagery
- FDA Approved medications for IBS
The FDA approves certain IBS-specific medications to manage IBS. These are prescribed according to the severity of the symptoms and include:
· Alosetron hydrochloride (Lotronex): For IBS associated with diarrhea (IBS-D)
· Eluxadoline (Viberzi): It reduces bowel contractions that cause diarrhea
· Lubiprostone (Amitiza): For IBS with constipation (IBS-C)
· Rifaximin (Xifaxan): An antibiotic to be taken three times a day for 14 days to reduce IBS-D symptoms. It affects the bacterial colony in the gut
- General medications for IBS
Since IBS is associated with multiple symptoms, certain other drugs may also be prescribed, when required, to help ease the condition of a patient. These include:
· Anti-diarrheal
· Probiotics
· Fiber supplements
· Antidepressants
· Antispasmodics
· Bile acid sequestrants
Irritable bowel syndrome is an uncomfortable condition that disrupts the sufferers’ daily life immensely. Since each patient may have different symptoms with varying severity, it is essential to know what works for you, so customize your treatment plan in consultation with your physician.
References
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