Irritable bowel syndrome

Symptoms Of Irritable bowel syndrome 

IBS symptoms and their intensity can vary from person to person. Symptoms often occur after eating a large meal or when you are under stress, and they are often temporarily relieved by having a bowel movement.

• Chronic and recurring abdominal pain
• Constipation followed by diarrhea
• Gassiness or bloating
• Abdominal bloating, or the sensation of being full
• Distention, or swelling of the abdomen
• Nausea
• Indigestion
• Heartburn
• Vomiting 
• Worsening of pain with food intake and relief with defecation.
• Mucus in the stool
• The urge to move your bowels without being able to have a bowel movement

Other Symptoms:

• Patients with IBS often complaint of anxiety, depression, and tension headaches
• Some women with IBS notice a link between pain episodes and their menstrual cycle.

Types of IBS:

Irritable bowel syndrome has 3 subtypes:

1. IBS with constipation (IBS-C)

    The perimeters for this include:

• More than a quarter of your stools are hard or lumpy and

• Less than a quarter of your stools are loose or watery

2. IBS with diarrhea (IBS-D)

 The perimeters for this include:

• More than a quarter of your stools are loose or watery and

• Less than a quarter of your stools are hard or lumpy

3. Those whose symptoms include both diarrhea and constipation (IBS-M)

  The perimeters for this include:

• More than a quarter of your stools are hard or lumpy and

• More than a quarter of your stools are loose or watery

Causes Of Irritable bowel syndrome

The exact cause of IBS is not known, however, it is frequently associated with other comorbidities such as:

1. Muscle Contractions in the Intestine:

As the food passes through the digestive tract, muscles lining the intestinal walls contract. Weak intestinal contractions cause slow food passage and hard, dry stools whereas stronger and longer-lasting contractions result in gas, bloating, and diarrhea.

2. Problems in Nerve Signaling:

Poorly coordinated brain-intestine signals can cause your body to overreact to changes in the digestive process, resulting in pain, diarrhea, or constipation.

Note: Reduced plasma serotonin levels (a hormone and neurotransmitter that aids in the regulation of GI motility, sensation, and secretion) may be linked to constipation-predominant IBS, whereas increased serotonin release may be linked to diarrhea-predominant IBS.

3. Severe Infection:

IBS can develop following a severe bout of diarrhea (gastroenteritis) caused by a bacterial or viral infection.

4. Changes in Gut Microbes:

Changes in the bacteria, fungi, or viruses that live in the small intestine are also important in the development of IBS.

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Risk Factors For Irritable bowel syndrome

1. Genetics

Genes may play a role in the development of IBS. Many people who have IBS have a first-degree relative (parent, child, or sibling) who also has the condition.

2. Age

IBS is more common in people under the age of 50 and is rarely diagnosed after that age. Over the age of 50, your symptoms are more likely to be caused by an organic cause rather than IBS.

3. Gender

Females are more likely than males to be diagnosed with IBS. Estrogen therapy, either before or after menopause, is another risk factor for IBS.

4. Stress

People who have faced stressful life events, especially in their childhood, are more prone to develop IBS.

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5. Mental health problems

If you have anxiety or depression, you may be more prone to developing IBS. The opposite is also true: if you have IBS, you may be more prone to anxiety or depression.

Anxiety and depression can exacerbate symptoms in IBD and IBS patients. Consultation with a psychologist or psychiatrist familiar with IBD and IBS can be very helpful in managing these conditions.

Here are 5 effective self-help tips to cope with anxiety.
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5. History of childhood abuse

People with a history of childhood physical or sexual abuse have a higher risk of developing IBS.

6. Other factors

Smoking, frequent alcohol consumption, physical or psychological stress, underlying depression, being exposed to antibiotics, contracting food poisoning, obesity, sleep problems, low exercise level, family history of mental illness, etc. can be the precipitating factors for IBS.

Diagnosis Of Irritable bowel syndrome

Your doctor may be able to diagnose IBS based on your symptoms. They may also take one or more of the following steps to rule out other possible causes of your symptoms:

• Have you adopted a certain diet or cut out specific food groups for a time to rule out any food allergies
• Stool test to rule out infection or presence of any IBD.
• Complete blood tests are done to check for anemia and rule out celiac disease (a serious immune reaction to gluten).
• Perform a colonoscopy (if they suspect any type of Inflammatory Bowel Disease)
• Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) - can show if there is inflammation in the body (which does not occur with IBS).

The diagnosis of IBS is made by performing a careful review of the patient's symptoms, determining the presence or absence of red flags, performing a thorough physical examination, and utilizing Rome IV criteria. 

The Rome IV diagnostic criteria for irritable bowel syndrome:

Abdominal pain that occurs, on average, at least 1 day/week over the last 3 months, associated with two or more of the following criteria:

• Related to defecation
• Associated with a change in the frequency of stool
• Associated with a change in the form (appearance) of stool

Evaluation of IBS should include a thorough history and identification of any red flags like:

• IBS should not cause rectal bleeding, fever, weight loss, anemia
• Diarrhea that prevents sleep.
• Red flags indicate a colonoscopy

Prevention Of Irritable bowel syndrome

IBS symptoms vary from person to person. Some people suffer from constipation, while others suffer from diarrhea. There are times when symptoms worsen, and other times when they improve or even disappear completely.

Here are a few tips that may help you better manage IBS symptoms:

1. Avoid foods and drinks that trigger IBS.

Foods that may make IBS constipation worse:

• Dairy products, especially cheese
• High-protein diets
• Carbonated drinks
• Caffeine and alcohol
• Processed foods, such as cookies or chips
• Refined grains (think white flour) in bread and cereals

Foods that may make IBS diarrhea worse:

• Dairy foods, especially if you are lactose intolerant
• Foods with wheat if you're gluten-sensitive
• Chocolate
• Carbonated drinks
• Caffeine
• Alcohol
• Too much insoluble fiber, such as from the skin of fruits and vegetables
• Fried foods

2. If you’re not sure what triggers your symptoms, try the elimination approach.

List the foods you believe may be contributing to your symptoms. After that, for 12 weeks, cut out one food at a time to see if it affects how you feel.

3. Avoid or limit processed foods.

Processed foods often contain unexpected or hidden ingredients that cause flare-ups of IBS.

Want to know more about the side effects of processed food?Click Here to Read

4. Avoid having big portions of meals at a time.

You should aim for small meals. Eat multiple small meals throughout the day instead of 3 big meals.

5. Don’t eat too quickly.

Avoid eating quickly, eating with your mouth open or chewing gum. This will minimize

the amount of air you swallow. 

6. Avoid food high in FODMAPs.

Foods containing high FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols - which are short-chain of carbohydrates) aren’t well digested in the intestine. They can cause excess gas production causing pain and diarrhea. 

Try to include low FODMAP foods like lettuces, carrots, crab, lobster, oils, pumpkin seeds, butter, peanuts, quinoa, brown rice etc. in your diet to reduce GI symptoms.

You can consult a dietitian or nutritionist to reduce high FODMAPs in your diet. Book an appointment with a dietician.
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7. Avoid gas-producing foods. 

Avoiding things like carbonated drinks, caffeine, raw fruits, and cruciferous vegetables like cabbage, broccoli, and cauliflower may be helpful if bloating and gas are issues for you.

8. Don’t smoke.

Smoking can irritate the digestive system and worsen IBS symptoms, so it's important to avoid smoking or quit if you are a smoker.

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Specialist To Visit

If you experience any symptoms of IBS-

1. Consult your doctor as soon as possible for a proper diagnosis of the condition.

2. Keep track of your symptoms (for a few weeks) before going to the doctor such as:

• Cramping, abdominal pain, bloating and gas, constipation, diarrhea etc.
• When and for how long the symptoms appear
• Which food helped to ease the symptoms
• Which food flared up the symptoms

3. Take note of any other symptoms such as frequent loose, watery stools, urgent need to have a bowel movement, fullness etc.

4. Seek immediate medical attention if you have a fever, rectal bleeding, weight loss, or any other symptoms in addition to these.

Sometimes IBS is difficult to be diagnosed by a general physician and one might need to see a specialist. In such cases, your doctor might advise you to consult:

• Gastroenterologists
• Nutritionists

Gastroenterologists specialize in the disorders and diseases that affect the digestive system and nutritionists provide guidance on healthy eating habits and lifestyle choices that can improve digestive health.

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Treatment Of Irritable bowel syndrome

Drug therapy may be initiated when IBS symptoms start to diminish the patient’s quality of life.

1. Drug treatments for IBS with diarrhea

Antidiarrheal Medications-

• Losetron
• Atropine 
• Eluxadoline
• Loperamide
• Diphenoxylate
• Loperamide

Antibiotics like Rifaximin amongst others are prescribed to treat bacterial infections.

2. Drug treatments for IBS with constipation

• Lubiprostone 
• Linaclotide 
• Plecanatide
• Fiber supplements with psyllium, in case dietary fiber intake is insufficient
  

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3. Medication to treat abdominal pain in people with IBS.

• Antispasmodics- which relax the smooth muscle in the small and large intestines, thereby reducing abdominal spasms and cramps.
  Examples- Hyoscyamine, dicyclomine, pinaverium, peppermint oil, trimebutine
• Low-dose tricyclic antidepressants- Diazepam, lorazepam, clonazepam 
• Low-dose selective serotonin reuptake inhibitors (SSRIs)-  tegaserod
• Coated peppermint oil capsules

4. Bloating/ Gas

It requires probiotics, dietary changes and medications such as fluoxetine.

Probiotics contain good bacteria such as bifidobacteria and lactobacilli which help maintain the health of the digestive tract and aid in proper digestion.

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Home-care For Irritable bowel syndrome

1. Be careful with fiber- Adding fiber to your diet can help deal with constipation. Increase the amount of fiber in your diet gradually over a few weeks. Whole grains, fruits, and vegetables are high in fiber. Avoid eating too much fiber if you have diarrhea.

2. Avoid trigger foods- If certain foods aggravate your signs and symptoms, avoid them. Avoid beans, cabbage, milk, cauliflower, and broccoli if you suffer from gas.

3. Eat at regular times- To help regulate bowel function, don't skip meals and try to eat at the same time every day.

4. Be mindful of dairy products- If you’re lactose intolerant, try replacing milk with curd. Consuming milk products in small amounts or combining them with other foods is also beneficial.

5. Drink plenty of liquids- Try to include plenty of fluids in your diet. Drink 8-10 glasses of water daily.

6. Have Gluten free food- The gluten-free diet is very helpful for sufferers of IBS. Gluten is a group of proteins found in grains including rye, wheat, and barley, which may cause problems for some people with IBS.

7. Probiotics- Probiotics are live microorganisms that are similar to the good bacteria that live in the digestive tract. Taking them in the form of food or supplements helps to relieve gas and bloating.

Note: In a 2022 study, IBS patients who took a probiotic called Bifidobacterium longum for 1 month, observed a significant decrease in symptom severity compared to baseline measurements.

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8. Keep a food and symptom diary- Record the foods you eat as well as the symptoms you experience to determine which foods help or worsen your symptoms.

9. Exercise regularly- Exercise relieves depression and stress, stimulates normal bowel contractions, and can make you feel better about yourself.

10. Manage stress- Your gut and bowel habits can be affected by your mood and stress levels. Spend some time during the day doing something that helps you relax or de-stress. For example, meditating, going for a walk outside or reading a book.

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Complications Of Irritable bowel syndrome

IBS can lead to both physical and mental health complications such as:

1.  Diarrhea or Constipation

Diarrhea occurs when you have three or more liquid bowel movements per day. Constipation occurs when stools are frequently hard and pellet-shaped. Even when the rectum is completely empty, patients may experience a sense of incomplete evacuation.

2. Anal fissures/ Tears

These can occur as a result of pushing too hard during a bowel movement. During constipation, these small tears are difficult to heal.

3. Hemorrhoids

It can cause rectal bleeding and develop from constipation-related straining.

4. Fecal impaction

It happens when stool gets stuck in the rectum. In addition, healthcare workers will have to manually remove the impacted stool.

5. Rectal prolapse

It happens when the rectum exits the anus, causing mucus to leak out. Chronic constipation can be the reason for this.

6. Cramping

Cramping is usually caused by eating too much food. Both cramping and diarrhea may be avoided by cutting down on food consumption or eating smaller-sized meals.

7. Malnourishment

It can develop as a result of avoiding certain nutritious, healthy foods that aggravate IBS symptoms.

8. Bladder issues

Pressure on the bladder can cause irregular urination and irritation.

9. Problems in sex life

You may have difficulty enjoying your sex life. People who have IBS may experience increased urgency to use the restroom or other symptoms.

10. Agoraphobia

It is a fear of going out in public. Anxiety about finding a restroom in unfamiliar places can lead to agoraphobia symptoms.

11. Anxiety and depression

It could arise as a result of coping with IBS symptoms. IBS symptoms can cause anxiety, and anxiety can exacerbate the symptoms. It is frequently a vicious circle.

12. Sleeping disturbances

Sleeping problems are common with IBS because abdominal pain and other cramps can keep you awake at night.

Alternative Therapies For Irritable bowel syndrome

1. Herbal therapies

Herbal remedies have been shown to have a significant effect on the management of IBS symptoms. Such as turmeric extract, peppermint oil extract, artichoke (beet)leaf extract etc.

Learn more about herbs that help in managing IBS?Click here
2. Mind-body therapies

Any stressful situation (for example, family problems, work stress, or examinations) may trigger symptoms of IBS in some people. 

• Hypnotherapy- Hypnotherapy for IBS can help you to learn relaxation techniques, as well as learn new ways to manage stress. 
  
  
• Cognitive behavioral therapy-  CBT can help patients learn coping strategies to control the symptoms brought on by anxiety. The aim of this therapy is to help the patient identify their stressors and come up with healthier responses to reduce the impact of their triggers.  Click here to know more
• Relaxation techniques- Specific exercises focused on promoting relaxation in the body, such as breathing exercises, are particularly helpful in fighting anxiety. This boosts the person’s confidence in battling negative thoughts as well as helps improve behavioral responses.
  
  
• Gut-directed hypnotherapy- It is one of the most successful treatment approaches for chronic IBS. In addition to decreasing pain perception at the level of the brain, hypnosis may improve immune function in IBD and IBS, increase relaxation, reduce stress, and ease feelings of anxiety.

3. Acupuncture

 Acupuncture can help IBS by stimulating your nervous system in a way that releases chemicals and hormones that relieve pain, stress, and other symptoms.

4. Moxibustion

It is a type of traditional Chinese medicine therapy that is typically administered in conjunction with acupuncture. The two approaches are thought to complement each other best. It is similar to heat therapy. Dry herbs are burned close to your skin, often near acupuncture points. Moxibustion combined with acupuncture may help with IBS symptoms.

Living With Irritable bowel syndrome

1. Sociological impact- IBS has a significant negative impact on patients' personal and professional lives, including a decreased tendency to travel, reduced socializing, and a loss of earnings.

IBS makes it difficult to carry out daily tasks outside of the home, where access to a bathroom is a concern. This can eventually lead to social isolation. 

There are several ways to manage the sociological impact of IBS:

• Join a support group for individuals with IBS or seek professional counselling to address the emotional impact of IBS on your life.
• Try to communicate with others about your condition, needs and limitations. This can help reduce anxiety and make social interactions more comfortable.

2. Psychological impact- According to some studies, having IBS might increase your risk of depression, anxiety, sleep disorder, or bipolar disorder. Depression and anxiety can also make IBS worse.

Here are some tips to help manage the psychological impact of IBS:

• Practice stress-reducing activities such as meditation, yoga, deep breathing etc.
• Talking to loved ones
• Consider consulting with a mental health professional who can help you develop coping strategies for managing anxiety, depression, and stress.
• Stay physically active as it helps in reducing stress.
• Track your symptoms. This can help you avoid foods that trigger your symptoms, which can reduce stress and anxiety.

3. Financial burden- IBS can be financially draining as well in the aspect of hospitalizations, physician services, prescription drugs, over-the-counter drugs, skilled nursing care etc.

This can be managed through: 

• Understanding the cost of therapy well in advance. 
• Communicating any financial issues with the doctor's team. This will help doctors to look for affordable alternatives.
• Finding financial support resources through doctors, or online. 
• Taking help through your health insurance partners.

4. Role of caregivers- Caregivers play a very important role in the overall disease outcome of the patient diagnosed with IBS. The important role of caregivers are:  

• Making decisions about diseases management options
• Participating in doctor appointments
• Giving the medicines to the patient on time
• Helping with meals