Prevalence of irritable bowel syndrome is predominant among women, especially during late teens. In the US the number of people affected by IBS is around 45 million. The condition refers to acute discomfort and pain in the stomach, with disturbed bowel movements. As a result of the change in bowel movements, individuals who have the condition perform ablutions either more or less than individuals who are not affected. In other words patients are more likely to have either diarrhea or constipation or entirely different consistency in stool. While the condition is not considered to be fatal in nature, it can jeopardize routine and greatly impact social life of the individual. The condition is also not known to manifest into other serious colon related diseases. This condition is commonly known as a life-altering condition, as it involves considerable changes in the manner in which routine activities are performed. We will take an in-depth and completely exhaustive look at Irritable Bowel Syndrome, listing out the reasons, the treatment and various measures that will help manage the condition more effectively.
Irritable Bowel Syndrome: An overview
IBS refers to the combination of symptoms in adults and children that manifest as a result of a gastro-intestinal disorder. It has earlier been known as functional bowel disease or nervous colon among other names. The more commonly reported symptoms of irritable bowel syndrome include severe pain in the abdomen, flatulence, abnormal bowel movements, and bloating. Individuals were diagnosed with IBS are most likely to have intolerance towards certain food products or categories of food products. Additionally, individuals with irritable bowel syndrome are likely to experience frequent muscle cramps in the stomach. The symptoms could be either one or a combination of multiple symptoms. Known in medical parlance as a functional disorder, it impacts the digestive system in a collective manner. For instance, pain in the stomach, change in bowel movements, and food intolerance are some of the collective symptoms that are experienced by individuals with IBS. By virtue of being classified as a functional disorder, it clearly indicates that the condition is about the manner in which the digestive system functions, and does not pertain to any damage at the tissue level. In other words, irritable bowel syndrome does not refer to actual physical damage to the digestive system.
Common symptoms associated with irritable bowel syndrome
The common symptoms that are associated with the condition include chronic diarrhea, constipation, severe abdominal pain (cramps), flatulence, inconsistency in stools and a protruding belly. One of the biggest problems faced by individuals with IBS is the alternating diarrhea and constipation that is sometimes experienced. This severely impacts routine as the individual is unable to predict when he or she is going to get a bout of diarrhea. The abdominal pain is typically in the lower abdomen and is usually experienced after a meal. In a large number of cases, patients with IBS are known to experience considerable relief after passing stool. The shape and consistency of stool also differs in patients with irritable bowel syndrome and this can also help diagnose the existence of the condition. In addition to the above symptoms, individuals are also known to have impaired sexual function as a result of IBS. The symptoms can get aggravated as a result of stress, which is itself an outcome of the condition. Consequently this ends up as a cycle of symptoms and stress which aggravate each other.
Common diagnosis used in identifying Irritable Bowel Syndrome
Some of the common diagnostics relied upon by specialists to determine irritable bowel syndrome include a combination of tests of samples and non-surgical examination procedures. For instance the patient may have to undergo colonoscopy or flexible sigmoidoscopy to determine the presence of blocks or inflamed intestines. Additionally, patients may also have to undergo endoscopy of the upper area to look for heartburn or indigestion. This is also sometimes achieved through x-ray imaging. Test of samples ideally look for infections or intolerance. For instance, blood tests are conducted to check if the patient is anemic, or if the patient has thyroid issues. Tests of stool are conducted to look for infections are blood in the stool. Other tests are focused at determining intolerance to food products and to look for indications of problems with bowel muscles. As irritable bowel syndrome is a functional disorder, the purpose of the last test is to rule out other problems for the symptoms. Recent advances in diagnostics help to identify if the patient is suffering from irritable bowel disease or IBS-D. Both the conditions are different, and this identification helps in managing the conditions more effectively.
Treatment options for Irritable Bowel Syndrome
Treatment options for irritable bowel syndrome involve specific treatment plans to manage the condition. This includes identifying the triggers that aggravate symptoms, use of the right medication to alleviate the symptoms, abstinence from food products that are responsible for triggering the condition, and management of emotional issues that arise as a result of the condition. Patients are advised to undergo changes in diet and lifestyle, which includes the need to increase/balance soluble fiber intake and abstinence from caffeinated drinks. Patients are advised to give up smoking, take part in more physical activities, consume adequate water everyday, and eat smaller portions of meals. By avoiding larger meals, and breaking it down into smaller meals, various symptoms associated with irritable bowel syndrome can be easily managed.
Commonly used medications in the treatment of IBS
Certain categories of medications are commonly used for treating the different types of irritable bowel syndrome. This includes the following:
Bulking agents – this refers to products that are intended to handle the motility of stool in the digestive tract. Psyllium, corn fiber and wheat bran are some of the bulking agents that are typically used to alleviate the symptoms associated with irritable bowel syndrome.
Antibiotics- the purpose of prescribing antibiotics such as rifaximin for patients with IBS is to alter the composition of bacteria in the intestines. This is typically a course of two weeks which is designed to manage the symptoms temporarily – for a period of six months.
Antispasmodics – this is intended to help manage the colon muscle spasms that are regarded as responsible for creating irregular bowel movements.
Antidepressants – these medications to help patients overcome depression and anxiety that are experienced as a result of the functional disorder.
Laxatives – the purpose of laxatives is to help soften stools, which in turn greatly reduces the discomfort experience by patients with irritable bowel syndrome. This is generally prescribed for patients who are unable to use soluble fiber supplements.
Other medications for constipation include linaclotide and lubiprostone. The first option helps to relieve constipation by promoting bowel movements most frequently. The second option is generally prescribed for women when other medications do not result in the desired outcomes. Other medications that are used for treating constipation include plecanatide and tegaserod.
Medications for treating diarrhea include loperamide, bile acid sequestrants, alosetron, and eluxadoline. The purpose of loperamide is to reduce the bowel movements and decrease the fluid content in stools. Similarly, bile acid sequestrants are used for binding bile acid, which helps to prevent motility and production of stool. Other medications such as alosetron and eluxadoline are used to bring down the number of bowel contractions and reduce pain and discomfort. This helps to reduce diarrhea and bring down the pain and discomfort associated with irritable bowel syndrome.
What are the different types of IBS
IBS is broadly classified into four different types:
IBS-C – this refers to IBS with constipation
IBS-D – this refers to IBS with diarrhea
IBS-M – refers to the condition where patient have a combination of constipation and diarrhea
IBS-U – refers to the condition where the patient does not fit into any of the above categories
IBS – C: Irritable Bowel Syndrome with constipation
This is one of the more common digestive disorder with symptoms such as change in bowel movements and frequent bouts of abdominal pain. Constipation mainly as a result of the difficulty in passing stools normally are when the stools are hardened. Patients with IBS-C are known to experience abdominal discomfort and bloating along with constipation. Some of the commonly known changes in bowel movements includes a feeling that the bowel has not emptied fully. A significant percentage of the patients with this type of IBS experience some kind of feeling of a block that is preventing motility or movement of stools. As a result, these patients typically strain to relieve themselves fully, or are forced to change their posture for better bowel movements. The feeling of discomfort typically resolves itself only after a bowel movement.
Reasons behind the condition and diagnosis
While there are no specific reasons attributed for the condition, it is assumed that the condition is mainly due to the changes in the intestines. In some patients the condition is also attributed to get infections, while in others it is attributed to possible changes in the manner in which messages are transmitted between the intestine and the brain. Studies also revealed that changes in the composition of bacteria in the gut are also responsible for the condition. Studies are also ongoing to determine if it is genetically inherited or as a result of changes in the body’s immune system.
Presently, diagnosis of IBS-C is carried out through the physical examination and an in-depth study of the medical history of the patient. One of the more popular tools that are used by specialist to diagnose and determine the existence of the condition is the Rome criteria. This refers to a list of symptoms that help to you clearly identify if the individual is suffering from IBS-c. Diagnosis does not involve any imaging methods to determine the presence of the condition, as this happens to be a functional disorder. The only reason where imaging may be recommended in a limited number of cases is to identify or rule out the possibility of other conditions that are responsible for the symptoms.
Present treatment options for the condition
Treatment methods that are presently recommended for IBS-C include modifications in lifestyle and an attempt to manage the symptoms effectively. This includes changes in dietary habits, the use of prescribed medications and the right psychosocial therapy. Modifications and lifestyle involve the need to abstain from all alcohol and tobacco products. One of the most critical requirements is the need for proper exercise in addition to healthy sleeping habits. Changes in diet include the need for identifying and avoiding food products that are known to trigger or aggravate the condition. Since different food products have different effects on patients with the condition, it is important to identify the actual impact on each individual. For instance, it may be necessary to increase the amount of soluble fiber in dietary intake. This is typically achieved by including flax, oats or psyllium in diet. There is a clear need to reduce or stay away from caffeinated products and sodas that promote flatulence. Ideal diet recommendations include what is known as the low fodmap diet – which is basically a diet comprising low fermentable sugars and a gluten free diet.
Other options include therapies that are targeted at the central nervous system. The purpose of these therapies are to help individuals cope with discomfort, bloating sensation and handle the manner in which the brain and mind tackles these abnormal sensations. Therapy includes hypnotherapy, psychological therapy, psychotherapy and behavior therapy. This is more of a holistic attempt to help patients manage various conditions that include post traumatic stress disorder and depression. In addition to the functional disorder, patients experience stress and depression as a result of the altered routines.
Probiotics in the form of food products for special medicine formulations help improve the health of the gut. This is achieved by delivering healthy live bacteria through the food products are formulations which will then change the composition of the gut bacteria. By promoting the growth of healthy bacteria through probiotics, it is possible for patients to experience reduced discomfort from abdominal pain and flatulence.
Other options that are typically used for managing irritable bowel syndrome include herbal supplements. Medication is also recommended to help relieve the symptoms associated with the condition. The aim of education is to achieve relaxation of the smooth muscles in the intestine through antispasmodics. Other medications include laxatives and stool softeners. This helps in improving bowel movements apart from reducing the discomfort experienced during passing of stools. Common medications in this category include polyethylene glycol. While other laxatives can also be used, the reason behind the choice of specific laxatives is to avoid bloating and flatulence. Some of the sugar alcohol laxatives are known to have undesirable effects such as bloating. This is exactly the reason why patients with IBS are advised to stay away from sugar free gum, as the products contain sugar alcohol. Medications that are presently popular now include pro-secretory agents that are known to increase the moisture in the intestines as well as the stool. This improves the bowel movements and also reduces the discomfort experienced by patients when passing hardened stools. Common medications under this category include lubiprostone and linaclotide. Other medications that are typically prescribe include antidepressants that are aimed at relieving pain and other discomfort related symptoms. The purpose of prescribing antidepressant medications is to help patients handle the manner in which pain is experienced in the gut, apart from improving mood. Common medications under this category include selective serotonin reuptake inhibitors.
IBS – D: Irritable Bowel Syndrome with
Irritable Bowel Syndrome with diarrhea refers to the type of IBS where patients experience abdominal pain, bloating and frequent passing of stools. The condition is known to affect more young females than other people, though anyone can be afflicted with the condition. As a functional disorder, there is no conclusive evidence to link the condition to specific reasons. Some of the possibilities that could be responsible for the condition include – earlier gut infection, abnormal contractions of the intestine and food intolerance. In a significant percentage of patients, the speed with which the intestines contract can result in faster stool motility. Consequently, the amount of water absorbed by the intestines from the stool is less, which makes the stool either watery or loose in consistency. The second possible reason for the condition, termed as post infectious IBS refers to infections that are responsible for the irritable bowel syndrome. This could last for as long as many years after the gut has been infected. Food intolerance is another reason for aggravated symptoms in patients with IBS-D. For instance individuals are known to have intolerance towards gluten and lactose. As a result food products with these ingredients can result in aggravated IBS symptoms. Similar to other types of irritable bowel syndrome, the composition of gut bacteria and stress are also contributing factors for IBS-D.
Common symptoms that indicate IBS-D and diagnosis
Cramps and abnormal bowel movements are indicative of possible IBS-D. While this is the same for all the different types of irritable bowel syndrome, there are specific symptoms that can help identify the type of IBS. Abdominal cramps are common to all types of IBS, but loose stools with the presence of mucus and increased frequency of passing stools are an indication of IBS-D. Across all types of irritable bowel syndrome, the discomfort and pain associated with irritable bowel syndrome generally reduces after passing of stools. It is important to note that IBS-d is characterized by passing of stools more during the day then when asleep at night. Other symptoms that are indicative of this type of IBS include flatulence and bloating. Some of the less common symptoms of IBS-d includes irregular menstruation, impaired sexual ability and the urge to urinate more frequently.
Diagnosis for the condition is more or less the same as that of IBS-c. For instance, the in-depth physical examination and scrutiny of medical history are the same as that of all types of IBS. The only difference is the need to determine or confirm the type of IBS, which is typically understood from the medical history and symptoms as shared by the patient.
Available treatment options for IBS-D
Treatment options for IBS-D are more or less similar to that of treatments for other types of IBS. The primary difference is in the change in dietary intake. For instance patients who are gluten or lactose intolerant need an appropriate changes in dietary intake. Other treatment options are the same as the holistic methods used for treating other types of irritable bowel syndrome. For instance the goal of managing the bowel movements, such as therapy, medications, changes in diet and modifications of lifestyle are the same. Slight changes in medications are necessary for treating IBS-D. For instance, it is necessary to use specific medications such as loperamide to manage frequent passing of stools. The mechanism of action of these medications are targeted at reducing the number of contractions of the growth, and permitting the intestine to absorb more water from the food during motility. The outcome of this action is a reduction in the frequency and the volume of stool that is excreted. Other medications that are used in treating IBS-d include formulations that are intended to bind bile and reduce diarrhea. One of the conditions that cause diarrhea is the inadequate re-absorption of bile from the intestine. Medication that binds the bile helps to bring down diarrhea. Most of the other treatment options are similar to that of options used for treating other types of irritable bowel syndrome. This includes the use of probiotics and food supplements.
IBS-M: combination of IBS-C and IBS-D
Commonly known as IBS-A or IBS-M, this condition refers to the subtype of irritable bowel syndrome where symptoms alternate between IBS-C and IBS-D. In other words the patient is likely to experience symptoms from either of the two types, alternatively. As a consequence of changes in bowel movements, it can be difficult to check out the right treatment plan.
Diagnosis for IBS-M includes applying of Rome-IV criteria to determine the condition. Commonly reported symptoms of this condition includes passing of hard and lumpy stools during one fourth of the symptomatic days, and passing of loose stools during one fourth of the symptomatic days. The changes in the consistency of stool during the symptomatic days can be as short as a few hours or it could also change over a few days. Diagnosis as per Rome 4 criteria does not take into account the days on which individuals do not have any symptoms of IBS. In addition to the alternating bowel movements and differences in stool consistency, patients with IBS-M have symptoms that are common to all subtypes of irritable bowel syndrome. This includes flatulence, bloating, cramps, presence of mucus in stool and a feeling of incomplete passing of stool.
IBS-U: Irritable Bowel Syndrome unclassified
This refers to patients with irritable bowel syndrome that does not fit into any specific category. In other words the in other words the syndrome does not fully belong to any one of the three different categories explained above. While most of the symptoms experienced are common and similar to that of other subtypes, there are no specific symptoms in this subtype. For instance, individuals may experience abdominal pain, flatulence, passing of mucus in stool, and bloating. All of these symptoms are similar to that of symptoms seen in other subtypes. However, in this subtitle, patience will not have any specific symptoms that can clearly identify it as belonging to one of the three subtypes. The consistency of the stool in patients with this subtype of the condition does not match or fit the criteria used for diagnosing any of the other conditions. The reasons for this subtype is similarly attributed to possibilities, such as motility issues in the gastro-intestinal tract, impaired functioning of the connection between the brain and the guts, change in composition of bacteria in the gut and heightened sensitivity in the digestive tract.
What is the Rome criteria used in diagnosis?
The Rome criteria is a set of criteria use as a reference during diagnosis to confirm irritable bowel syndrome. The criteria is used to understand if the individual is indeed suffering from irritable bowel syndrome and to also identify the subtype of IBS. The various criteria that are checked include the frequency with which cramps are experienced by the patient. This is ascertained in relation to passing of stools, the difference in the frequency of defecation, and the different inconsistency of the stool. The Rome criteria is a broad set of guidelines generally used by doctors to confirm irritable bowel syndrome. This criteria suggests additional tests to ensure that there is no wrong diagnosis. For instance, there is a possibility of confusion of symptoms of IBS with that of IBD. By following the criteria it is possible to read the symptoms more correctly and eliminate the problems of misdiagnosis. The intent is to increase the accuracy of diagnosis by carefully looking at each of the symptoms and the combination of symptoms.
Possible complications that can arise out of irritable bowel syndrome
While it is true that IBS is a functional disorder, the condition can result in certain complications. The condition, by itself, is not indicative of any physical damage to the tissues in the digestive system. However, as a result of the prolonged impact on bowel functions, certain long term effects are likely to manifest in patients with irritable bowel syndrome. For instance, any patient with chronic constipation is likely to develop hemorrhoids. Similarly, any patient with chronic diarrhea can develop hemorrhoids. It is the same in the condition of irritable bowel syndrome – patients with IBS could have either diarrhea or constipation. Consequently there is a possibility of IBS manifesting into other complications.
Apart from these complications, the other areas of life that are impacted as a result of irritable bowel syndrome includes serious mood disorders. Patients with IBS are likely to suffer from anxiety or depression as a result of the poor quality of life. This is because of the inability to work or discharge responsibilities in the same manner as individuals who do not have the condition. A large number of people with IBS are known to end up missing work or meetings as a result of the irregular bowel movements. The inability to stick to a particular routine can cause serious discomfort and impact quality of life. As a result of this, there is every possibility of individuals undergoing depression and anxiety.
Common risk factors that make individuals more prone to the condition
As a functional disorder, there are various contributing factors that are responsible for the condition. This places certain categories of individuals in the high risk segment. Some of the high risk categories of individuals include people who are below the age of 50, young women, individuals with a family history of IBS and individuals with mental issues. The prevalence of IBS among women is relatively on the higher side, which makes women more vulnerable. This is especially true in the case of females who have undergone estrogen therapy or just entered into menopausal transition. Mental health issues such as depression or anxiety are also known to have a link to IBS in a limited number of cases. Similarly, past record of sexual or emotional abuse is also known to have an impact on digestive health.
Symptoms that warrant the need for consultation with a doctor
Certain symptoms are the little flags that indicate it’s time to consult a doctor. The manifestation of the symptoms could either indicate irritable bowel syndrome or could also point to more serious conditions that are cancerous in nature. For instance, individuals experiencing sudden weight loss, nausea, or bleeding from the rectum, need to consult a doctor at the earliest. Individuals experience difficulty in swallowing food, or observing abnormal night diarrhea need to consult a doctor to rule out or confirm irritable bowel syndrome. Anemia is another indication of the condition, when it is diagnosed in combination with other symptoms.
Role of diet in the functional disorder
Diet has an important role in digestive activity, and contributes either positively or negatively to the condition. In other words certain dietary habits or practices can trigger or worsen the symptoms of irritable bowel syndrome. It is a well-established fact that milk products, chocolates and alcohol have an adverse impact on individuals with IBS. Consumption of any of these three categories of products could result in either diarrhea or constipation. Similarly there are other vegetables and fruits that are known to promote bloating and discomfort in the digestive system. Sodas are also not to have an adverse impact on patients with IBS. Some of the known food/food products that are responsible for triggering flatulence, abdominal pain or bloating include – celery, raisins, bananas, beans, apricot, sprouts, onions, and bagels among others. Patients who are diagnosed as having IBS are typically advised to stay away from dairy products, candies, gum (sugar free varieties) and caffeinated products.
Patients with irritable bowel syndrome are advised to follow a dietary plan that will help mitigate the condition and eliminate the possibility of triggering symptoms. This includes the need to balance daily fiber intake. For some individuals, this may mean increasing fiber intake, while in others it may involve reduction in the fiber intake. The whole idea is to bring about a proper balance in the intake of fiber with a goal of bringing about healthy digestion. Specialists also advise patients to maintain a diary listing out the food products that are known to cause intolerance. This is necessary considering the fact that different food products have different intensities of food intolerance in individuals. By identifying the specific food products that are reason for the food intolerance, it is possible to stay away from certain products and reduce the intake of other products that are known to cause mild intolerance. Another option is to use probiotic supplements in an effort to improve gut health. Regular use of recommended and standard probiotics help individuals to improve gut health significantly. However the effects of probiotic supplements are not instantaneous, and will required to be consumed over a certain period before the effects are experienced.
It is important to understand that there can be no single diet that can be followed by all patients with irritable bowel syndrome. The effects of certain food products vary for different individuals and it is therefore necessary to identify the right food products and bring about changes accordingly for best outcomes.
Simple preventive measures that need to be practiced
It is essential to practice certain preventive measures which can help manage the symptoms of irritable bowel syndrome more effectively. Some of the more common, popular and effective preventive measures used why patient with IBS include the following.
Exercises – specific exercises are recommended for relaxing targeted muscles in the body. The whole purpose of these exercises is to bring about relaxation in the muscles which will help manage the functional disorder more effectively. The more commonly used exercises include a targeted tightening of muscles on the feet followed by bringing about relaxation. This is then continued in an upward motion covering segments of the muscles in an upward direction.
Use of biofeedback sensors – this refers to the reliance on electrical sensors that provide feedback on the functioning of the body. With help from the feedback and inputs from the sensors, it is possible to about certain changes which includes relaxation of specific muscles. The outcome of such feedback and necessary action is better management of symptoms that are commonly associated with irritable bowel syndrome.
Stress reduction – this involves training the mind to focus on activities, and ignoring other distractions and worries which can have an adverse impact on the functional disorder. By reducing stress levels, it is possible to alleviate the condition, which will greatly help restoration of normalcy to a certain level.
Counselling sessions – patients with irritable bowel syndrome are advised to use the services of a qualified counsellor to overcome the dress. Individuals with IBS are certain to develop stress as a result of the impact on social life and routines. It is therefore necessary for patients to rely on the services of a trained counsellor to modify response to certain situations. There are positive results and outcomes from psychotherapy which is known to help patients overcome the stress associated with the life altering functional disorder.
Roundup of important information about irritable bowel syndrome
The following statistical data and information about irritable bowel syndrome will help get a better perspective about the condition. This cancel as and input that will help individuals with the condition cope with it better by looking at the numbers involved. In the US around 45 million individuals have one of the four subtypes of IBS. Prevalence of the condition is more among women when men. As on date, no conclusive evidence is available about the reasons for the condition. Possible reasons for the condition include a change in composition of gut bacteria, embed transmission of sensations between the brain and the gut, or previous infections. Irritable bowel syndrome is a functional disorder and by itself will not cause any physical damage to the tissues. However as a result of the prolonged constipation or diarrhea, there is a possibility of this manifesting into hemorrhoids. Stress and anxiety are some of the aggravating factors that can make treatment of the condition challenging. The treatment option includes the need for therapy, dietary changes and lifestyle modifications. Medications are typically used for alleviating specific symptoms that are experienced by patients with IBS. The symptoms of IBS can be anything from mild and moderate to extremely serious conditions. This could jeopardize normal life of an individual to a great extent and adversely impact all areas of life. The unpredictable nature of irritable bowel syndrome makes it challenging to have a simple plan of action. It is therefore necessary for patients to exercise complete question and follow the right strategy in consultation with experts to deal with the condition. Treatment options and outcomes differ from patient to patient and depend on the subtype of IBS, apart from the intensity of the condition. In a large number of cases, the actual diagnosis of the condition occurred many years after the actual onset of the condition. It is therefore necessary to you understand all the possible symptoms and act accordingly to prevent the condition from manifesting into a serious nature. More than one fourth of all visits to gastroenterologist are related to irritable bowel syndrome.