Irritable Bowel Syndrome (IBS) is a condition where the person experiences abdominal pain, discomfort, and bloating that is far from the perceived normal bowel functions, and runs for more than six months. It is a chronic disorder, characterized from acute, traveler and stress diarrhea which inflicts an individual for several days. It is usually termed irritable bowel syndrome if the symptoms, such as bloating and abdominal pain, that comes with either diarrhea or constipation runs for more than six months continuously. The cause of it is still unknown to medical researchers, although they speculate that either the immune system of the gastrointestinal tract (GI) becomes sensitive to some foods, stress or the normal motility of the GI tract is disturbed by undiscovered bacteria and protozoas or hormonal imbalances. IBS does not progress into more serious diseases, although it is present as a symptom of a disease of the digestive tract and often strikes after a GI tract infection. It is not to be confused with Inflammatory Bowel Disease (IBD) which is the inflammation and swelling of the intestinal tract. It is not contagious, hereditary, malignant or cancerous, but because it is chronic, it can affect the daily activities and quality of life of an individual, as they often suffer from stomach discomfort or long bathroom sessions most of the day. There are many marketed products aimed to relieve symptoms, but some of them may relieve or not relieve the condition which adds to the confusion to the sufferer.
IBS is one of the most misdiagnosed disorders by doctors, and as many as 2 in every 10 Americans have IBS. It is more common in women, of which most of them get infected from traveling abroad and have the condition persist after they have returned home. In the United Kingdom, the cases of Irritable Bowel Syndrome have increased in the span of 30 years. In Pakistan, the cases were as high as 34%, and it mostly affect college students. Higher rates of 43% have been reported in people of Brazil, and 46% in Mexico. In the capital Mexico City, 35% of the residents have IBS, where it is attributed to stressful living in a densely populated city.
The main cause of irritable bowel syndrome remains unclear to doctors, but they speculate a number of factors that can trigger this condition to individuals. Some researchers believe that IBS is caused by having a larger lumen of the GI tract. This larger passageway can have a significant effect on the passage of food; a food bolus can move too quickly or slowly that contributes to long-term symptoms and emotional distress.
Others speculate that irritable bowel syndrome is caused by faulty gastrointestinal movement rhythm caused by a miscommunication between the brain and the intestines, or even the brain itself is sending the wrong signals that are responsible for the erratic peristalsis. The peristalsis can move too fast, too slowly or stop temporarily as seen in some patients.
Some suspect the cause lies in the immune system. The immune system in the gastrointestinal tract, particularly in the small intestines, normally has a strong active immune system which helps destroy harmful microorganisms that enter the system with the food that is ingested. But the immune system of a person with IBS is principally sensitive and reactive to certain types of food which immediately triggers massive immune response that may stop or speed the peristalsis rhythm resulting in either constipation or diarrhea.
Another suggestion is that hormones may play a role in IBS; a reason why more women than men have IBS. But many women who have IBS do experience a worsening of symptoms during periods of stress and menses. Others insist that IBS is caused by an undiscovered bacteria, virus, or protozoan that causes irritation and disturbance of normal peristalsis. It is also suggested that the same action is caused by an overgrowth of the number of intestinal flora.
The symptoms of Irritable Bowel Syndrome or IBS can differ from person-to-person, but most of the common symptoms that one may experience are:
- Increased flatulence
- Presence of mucus in stool
- Diarrhea that comes first thing in the morning or after the first meal.
- Alternating episodes of the above two symptoms.
- Urgency to go to the bathroom, with a strong urge to defecate, just after you left the bathroom.
- Feeling that you have not eliminated completely after a bowel movement.
- Abdominal pain and cramping, which sometimes it disappears after having a bowel movement.
- The symptoms can vary in each person, with some having either diarrhea or constipation only, while others experience both.
Diagnosis starts by going to the doctor for an appointment. Most doctors diagnose IBS by asking specific questions to the individual about their symptoms and duration. Each symptom must be carefully described in detail by the patient, which makes it necessary to have a strong patient-doctor relationship, so the doctor can more easily understand the condition of the patient.
There are no existing specific tests for IBS yet, but diagnostic tests are done to eliminate other potential diagnoses. If the symptom does not appear to be caused by other diseases, irritable bowel syndrome is likely suggested. The differences in symptoms among different patients, as well as the presence of other comorbid diseases and severe symptoms, makes IBS easily misdiagnosed by doctors.
Stool exams are done to look for intestinal bleeding and parasites. Blood tests are used to look for hormonal imbalances, antigen titers to detect any presence of infections as well as a blood count. Abdominal x-rays are also used to look inside the GI tract, sometimes in conjunction with barium swallowing or an enema to look for polyps, inflamed structures, strictures and foreign objects.
If the patient has long-standing symptoms, endoscopy or colonoscopy procedures are performed. Those involve inserting a small tube, equipped with a miniature camera, through the mouth or anus. The position and direction of the tube is manipulated by the doctor to view the intestinal structures and what condition they are in. It is often used as the last resort, if other tests failed to present a probable cause, since the procedure is invasive.
Currently, there is no scientifically tested cure for irritable bowel syndrome. To date, no drugs, surgeries, or procedures have been approved by a reputed medical association or the FDA. Treatment is focused on reducing the occurrence and gravity of the symptoms.
Treatment starts with food. A strict diet is followed to relieve symptoms of diarrhea and constipation. The approach is usually a trial-and-error method, because an individualized approved diet of a patient may worsen the symptoms of another. Working with your physician is important to work out a helpful diet plan.
If diarrhea is dominant in a patient, soluble fiber is added into the diet. Soluble fiber is helpful in diarrhea and constipation as well, since it dissolves in water to form a gel that binds food particles. For sufferers of constipation, insoluble fiber is added to the diet. It is insoluble because it remains unchanged after digestion and works by sticking to food particles, and it turn, prevents too many food particles from clumping together. This eliminates hard and dry stools of constipation. It can cause bloating unless it is introduced gradually in the diet.
Foods and beverages that worsen the condition are identified by the patient and eliminated in the diet. The ideal outcome is to have soft, but not liquid or hard stools which are eliminated at regular intervals. Water intake is also important, at least eight times a day to overcome losses in diarrhea and prevent constipation.
Laxatives or anti-diarrheal drugs are used for specific conditions. It is used if a diet alone cannot control the symptoms, which are very common to sufferers. Laxatives such as Polyethylene Glycol, Lactulose, and Dulcolax can be used for and to prevent constipation. Anti-diarrheal drugs such as Loperamide, Codeine and Diphenoxylate are used to treat diarrhea and can be taken early in the morning or late at night. Anti-spasmodics can help in relieving bouts of cramps and stomach aches like hyoscyamine hydrobromide, dicyclomine, atropine and its derivatives. Low doses of anti-depressants like chlorpromazine, which are used in mood and anxiety disorders, can be effective for irritable bowel syndrome.
Behavioral therapy and hypnosis with a psychologist can be discussed with your doctor. It is helpful in dealing with unexpected stress that can worsen symptoms, as well as controlling symptoms. Probiotics and herbal remedies are also beneficial. Probiotics in foods such as yogurt can maintain a healthy intestinal environment. Herbal products such as peppermint oil have shown success in adults and children. Another is Iberogast, which is a manufactured mixture of herbs that has been effective in treating abdominal pain and reducing IBS symptoms.
Irritable bowel syndrome is a lifelong condition with symptoms that could be disabling and reduce the ability to work.
Irritable bowel syndrome cannot be prevented, but proper self-care may help to minimize symptoms or extend the time between episodes. Avoid caffeine, quite smoking and avoid foods that worsen the symptoms. Focus on a balanced diet and reduce the overall fat intake. Observe proper food hygiene to reduce ingestion of pathogenic microorganisms and get regular exercise.
Having IBS often results in emotional and physical suffering because of the constant fear of an upset stomach and urgent diarrhea throughout the day. Daily physical activities may be limited such as school, work and recreation as the sufferer must endure the pain and spend a lot of time in the bathroom if diarrhea strikes.
An important aspect in living with IBS is a strong patient-doctor relationship to work out ways in relieving diarrhea, constipation and abdominal pains. Keeping a food diary or log is useful so your physician can easily identify food intolerances.
Irritable Bowel Syndrome has caused considerable expense to the economy, as much as $21.7-$30 billion dollars in direct and indirect medical costs in the United States alone. Current research is focused on controlling and reducing the impact in the economy and exploring ways for cheaper remedies and alternatives.
Strong evidence says that restricting oligo, di, and monosaccharide as well as polyols wholly in the diet can control the symptoms of a majority of the IBS patients. Two drugs are approved for IBS, Alosetron (Lotronex) and Lubiprostone (Amitiza). Alosetron is a nerve receptor antagonist that can relax the colon to control diarrhea while Lubiprostone is for women 18 years old and above with constipation.