What is IBS?
Irritable bowel syndrome is a functional disorder of the gut and brain where they do not coordinate together. IBS is characterized by recurrent abdominal pain associated with diarrhea that alternates with constipation, or both, without structural abnormality of the gut. It mainly affects the large intestine.
About 10-15 percent of the population are affected at some time but only 10 percent of these consult their doctor because of symptoms.
Young women are affected more often than men.
What are the causes of IBS?
The exact cause of IBS is incompletely understood but biopsychosocial factors along with luminal factors, such as diet and the gut microbiota play an essential role.
Several other factors can cause IBS:
- Serotonin and gastrin maintain the coordination between the brain and GIT through nerve signals. There is evidence that IBS may be a serotoninergic (5-HT) disorder, with excessive release of 5-HT in diarrhea-predominant IBS and relative deficiency with constipation-predominant IBS. Abnormal coordination always causes IBS.
- Most patients seen in general practice do not have psychological problems but 50 percent of the patients with IBS have a psychiatric illness, such as anxiety, depression, somatization, and neurosis.
- Luminal factors like both quantitative and qualitative alteration in intestine contents have been noticed. Overgrowth of bacteria in small intestines can be present in some patients and leads to symptoms.
- Dietary factors are also important. Some patients are susceptible to chemical food (not allergy) and have difficulty absorbing, some short-chain carbohydrates like lactose, and fructose, among others, which can cause fermentation in the colon that leads to bloating, abdominal cramps, and abnormal bowel habits, etc.
- Genetic factors also play a crucial role in this. IBS can run in families but there is no significant link.
Also Read: Foods to eat in IBS
Also Read: Foods to avoid in IBS
What are the clinical features of IBS?
- Recurrent abdominal discomfort is the characteristic symptom of IBS.
- Excess gas and bloating.
- Colicky pain or abdominal cramps are relieved after passing stool.
- Most patients suffer from episodes of diarrhea and constipation alternately. But some patients may have predominantly constipation and predominantly diarrhea.
- Passage of mucus is usual but rectal bleeding does not occur.
Also Read: Signs that indicate you have IBS
What triggers IBS?
A trigger doesn’t cause the disease, but it can worsen or flare up the symptoms. Common triggers include:
- Periods: Females may notice symptoms worsen predictability according to their menstrual cycle.
- Foods: Symptoms my flare up due to some foods like dairy, foods that contain gluten(wheat), carbonated drinks.
- Stress: Some researches suggest that IBS may be triggered by stress, this is why IBS is sometime called “nervous stomach” or “anxious stomach”.
What are the types of IBS?
According to the Rome criteria- ||| IBS is subdivided into 3 categories:
- IBS with diarrhea (IBS-D): Most of the stool is loose and watery.
- IBS with constipation (IBS-C): Most of the stool is hard and lumpy.
- Mixed IBS (IBS-M): Stool is sometimes hard and lumpy while sometimes it is loose and watery.
- IBS unspecified (IBS-U): Symptoms vary and doesnot fit into any of the category.
Also Read: Difference between IBS and IBD
What are the diagnostic criteria for IBS?
Rome ||| criteria for diagnosis of IBS:
- Recurrent pain in the abdomen or discomfort of at least per month for the last 3 months.
- Relief of pain after passing stool
- Symptoms start with a change in the frequency of stool
- Change in the form of stool but there is no bleeding from the rectum.
Features supporting a diagnosis of IBS:
- Symptoms continue for more than 6 months
- When stress aggravates all the gastric complaints
Alarm features:
- If the patient’s age is more than 50 years
- Family history of carcinoma or colon cancer
- Weight loss or not gaining body weight
- Anemia
- Rectal hemorrhage
Laboratory examination or scanning:
- CBC and fecal calprotectin are usually done, and both are normal in IBS.
- Colonoscopy: It should be done on older patients, especially over 40 years of age to exclude colorectal cancer.
- Endoscopy: endoscopy should be done if the patient is complaining of rectal hemorrhage for the differential diagnosis of Colon cancer or IBD.
If a patient is having diarrhoea certain investigation should be done to exclude other diseases:
- HLA-DQ2 and HLADQ8 should be done to rule out celiac diseases.
- A thyroid profile should be done to exclude thyrotoxicosis.
- Lactose intolerance test.
- SeHCAT to rule out bile acid malabsorption.
Also Read: Best and worse foods for IBS
What is the management of the IBS?
- The most important thing is to make a positive diagnosis.
- Due to recurrent episodes, some patients may develop anxiety or fear of cancer or any other serious health condition, in that case, reassure the patient that these symptoms are not due to serious underlying disease but instead, are the results of behavioral, psychosocial, physiological or luminal factors.
- Symptoms of IBS can be relieved by changes in diet and lifestyle.
- Up to 20 percent may benefit from the wheat-free diet, and some may respond to lactose exclusion, excess intake of caffeine or artificial sweeteners, such as sorbitol should be addressed.
- A Low FODMAP diet (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) may help some patients with abdominal cramps, diarrhea, constipation, etc.
- Probiotics in capsule forms are very effective if taken for several months.
- In anxiety-prone patients, psychological intervention, such as cognitive behavioral therapy should be done for the most difficult cases.
- Complementary and alternative therapies should be introduced in regular lifestyles like meditation, hypnosis, cognitive therapy, etc.
Also Read: Lifestyle Management for IBS
What are the complications of IBS?
- IBS can distress patients on physical, mental, or emotional levels.
- Minerals and vitamin deficiencies can occur in patients with IBS due to poor absorption of food.
- Hemorrhoids
- Weight loss
- Depression and Anxiety
- Anemia
- Rectal bleeding.
Also Read: Role of probiotics in IBS
What are the homeopathic medicines for IBS?
- Podophyllum: Painless diarrhea early in the morning. Constipation alternating with diarrhea.
- Lycopodium: Stool hard, difficult, small, incomplete. Ineffectual urging to pass stool.
- Nux Vomica: Constant uneasiness in rectum. Constipation with ineffectual urging.
- Argentum Nitricum: Colic with much flatulent distention. Green, chopped spinach like stool.
- Bryonia: Constipation stool hard, dry as if burnt. Tenderness of abdominal walls.
