Irritable bowel syndrome – Overview
A common disorder that affects the large intestine is known as irritable bowel syndrome (IBS). Cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both are signs and symptoms of irritable bowel syndrome. IBS is a chronic condition that you’ll need to manage long term.
Having severe signs and symptoms with IBS is found in only a small number of people. Some people can control their symptoms by managing diet, lifestyle and stress. More-severe symptoms can be treated with medication and counseling can be a treatment for more severe symptoms.
Changes in bowel tissue or increase the risk of colorectal cancer is not caused by IBS.
The signs and symptoms of IBS may differ. The most common may include:
- Abdominal pain, cramping or bloating that is typically getting relieved or partially getting relieved by passing a bowel movement
- Excess gas
- Diarrhea or constipation
- Mucus in the stool
Certain times are experienced by most people with IBS when the signs and symptoms are worse and times when they improve or even disappear completely.
Doctor should be consulted when having a persistent change in bowel habits or other signs or symptoms of IBS. A more serious condition may be indicated by them, such as colon cancer. Signs and symptoms which are more serious may include:
- Weight loss
- Diarrhea at night
- Rectal bleeding
- Iron deficiency anemia
- Unexplained vomiting
- Difficulty swallowing
- Persistent pain that isn’t getting relieved by passing gas or a bowel movement
The exact cause of IBS is unknown. Factors that may appear to play a role include:
- Layers of muscle are lined in the walls of intestines that contract as they move food through the digestive tract. Gas, bloating and diarrhea can be caused when the contractions are stronger and last longer than normal. Slowing food passage and leading to hard, dry stools can be due to weak intestinal contractions.
- Greater than normal discomfort may be experienced when there are abnormalities in the nerves in the digestive system when the abdomen stretches from gas or stool. Signals between the brain and the intestines may be poorly coordinated which can cause your body to overreact to changes that normally occur in the digestive process, resulting in pain, diarrhea or constipation.
- Number of immune-system cells in the intestines is increased in some people having IBS. This response of the immune-system is related with pain and diarrhea.
- After a severe bout of diarrhea (gastroenteritis) caused by bacteria or a virus, IIBS can be developed. A surplus of bacteria in the intestines (bacterial overgrowth) may also be connected to IBS.
- The “good” bacteria that reside in the intestines and play a key role in health are known as microflora. Research have indicated that microflora in people with IBS might vary from microflora in healthy people.
Trigger for symptoms of IBS can be:
- The role played by food allergy or intolerance in IBS isn’t understood completely. IBS is rarely caused by a true food allergy. When eating or drinking certain foods or beverages, many people may have IBS symptoms which are worse, including wheat, dairy products, citrus fruits, beans, cabbage, milk and carbonated drinks.
- During periods of increased stress, worse or more regular signs and symptoms are experienced by most people. But symptoms may be aggravated due to stress, it doesn’t cause them.
- IBS is likely to be found as twice in women, which might be an indication that hormonal changes play a role. During or around their menstrual periods many women have that the signs and symptoms are worse.
Occasional signs and symptoms of IBS are experienced by many people. But it is more likely to have the syndrome:
- IBS is occurring more frequently in people who are under the age of 50.
- IBS is more common among women in the United States. Also a risk factor for IBS can be Estrogen therapy before or after menopause
- A role is played by the genes, as factors which are shared in a family’s environment or a mixture of genes and environment.
- Mental health problems such as anxiety, depression and other mental health issues are associated with IBS. A risk factor might be a history of sexual, physical or emotional abuse
Hemorrhoids can be caused by chronic constipation and diarrhea.
Additionally, IBS is associated with:
- Poor quality of life is reported in many people who are having moderate to severe IBS. People with IBS miss three times as many days from work as do those without bowel symptoms is indicated by research.
- Depression or anxiety can be steered when signs and symptoms of IBS are experienced. IBS can also be made worse with depression and anxiety.
Finding ways to cope with stress might help in preventing or easing symptoms of IBS. Consider trying:
- Modifying or changing responses to stress can be learnt with the help of counselor. Psychotherapy can provide significant and long-lasting reduction of symptoms which has been shown in studies.
- Receiving information (feedback) on the body’s functions is done with the help of electrical sensors which helps in focusing on making subtle changes, such as relaxing certain muscles, to ease symptoms.
- Relaxation of muscles in the body, one by one can be done with the help of progressive relaxation exercises. This can be started by tightening the muscles in the feet, and then concentrate on slowly letting all of the tension go. Next is to tighten and relax the calves. These exercises should be continued until the muscles in the body, including those in the eyes and scalp, are relaxed.
- A stress-reduction technique that helps to focus on being in the moment and letting go of worries and distractions is known as mindfulness training.
To definitively diagnose IBS no test is available. A complete medical history, physical exam and tests to rule out other conditions could be a starting point for the doctor. If having IBS with diarrhea, gluten intolerance (celiac disease) is likely to be tested for.
After ruling out other conditions, the doctor is likely to use one of these sets of diagnostic criteria for IBS:
- Abdominal pain and discomfort lasting on average at least one day a week in the last three months, associated with at least two of these factors: Pain and discomfort are related to defecation, the frequency of defecation is altered, or stool consistency is altered is included in Rome criteria
- Pain relieved by passing stool and on having incomplete bowel movements, mucus in the stool and changes in stool consistency is the focus area for manning criteria. The more the symptoms, the greater the likelihood of having IBS.
- IBS can be divided into three types for the purpose of treatment, depending on the symptoms: constipation-predominant, diarrhea-predominant or mixed.
The doctor will be likely to evaluate whether other signs or symptoms that might suggest another, more serious, condition are present or not. These signs and symptoms include:
- Onset of signs and symptoms after age 50
- Weight loss
- Rectal bleeding
- Nausea or recurrent vomiting
- Abdominal pain, especially which is not fully relieved by a bowel movement, or occurs at night
- Diarrhea that is persistent or awakens from sleep
- Anemia related to low iron
If having the above signs or symptoms, or if an initial treatment for IBS doesn’t work, additional tests are likely to be required.
Several tests may be recommended by the doctor, including stool studies to check for infection or problems with the intestine’s ability to take in the nutrients from food (malabsorption). A number of other tests may also be done to rule out other causes for the symptoms.
Imaging tests can include:
- Flexible sigmoidoscopy where the doctor assesses the lower part of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope).
- Colonoscopy is where a small, flexible tube to examine the entire length of the colon is used by the doctor.
- X-ray and CT scan are tests that produce images of the abdomen and pelvis that might allow the doctor to rule out other causes of the symptoms, especially if having abdominal pain. Large intestine may be filled by the doctor with a liquid (barium) to make any problems more visible on X-ray. This barium test is sometimes known as a lower GI series.
Laboratory tests can include:
- Lactose intolerance tests
- Breath test for bacterial overgrowth
- Upper endoscopy
- Stool tests
To live as normal as possible, Treatment of IBS focuses on relieving symptoms
Signs and symptoms which are mild can often be controlled by management of stress and by making changes in the diet and lifestyle. Try:
- Avoiding foods that are triggering the symptoms
- Eating high-fiber foods
- Drinking plenty of fluids
- Exercising regularly
- Getting enough sleep
The doctor might recommend eliminating from the diet:
- If bloating or gas is experienced, items such as carbonated and alcoholic beverages, caffeine, raw fruit, and certain vegetables, such as cabbage, broccoli and cauliflower might be avoided.
- Research has shown that some people with IBS who have stopped eating gluten (wheat, barley and rye) even if not having celiac disease have reported improvement in diarrhea symptoms
- Certain carbohydrates such as fructose, fructans, lactose and others, known as FODMAPs — fermentable oligo-, di-, and monosaccharides and polyols are sensitive to some people. Certain grains, vegetables, fruits and dairy products have FODMAPs. If a strict low-FODMAP diet is followed and then reintroducing foods one at a time might ease IBS symptoms.
These diet changes can be helped by the dietitian.
If your problems are moderate or severe, if having depression or if stress tends to worsen the symptoms then the doctor might recommend counselling.
Additionally, depending on the symptoms the doctor might suggest medications such as:
- Consuming a supplement such as psyllium (Metamucil) with fluids may help control constipation.
- If symptoms are not eased by fiber then the doctor may prescribe magnesium hydroxide oral (Phillips’ Milk of Magnesia) or polyethylene glycol (Miralax).
- To help control diarrhea, over-the-counter medications, such as loperamide (Imodium) may be prescribed. A bile acid binder, such as cholestyramine (Prevalite), colestipol (Colestid) or colesevelam (Welchol) might also be prescribed by the doctor. Bloating can be caused by bile acid binders
- Medications such as dicyclomine (Bentyl) can help in relieving painful bowel spasms. People having bouts of diarrhea are prescribed sometimes with this. These medications are generally safe but constipation, dry mouth and blurred vision can be caused.
- Tricyclic antidepressants can help in relieving depression as well as inhibit the activity of neurons that control the intestines to help minimize pain. If having diarrhea and abdominal pain without depression, the doctor may recommend a lower than normal dose of imipramine (Tofranil), desipramine (Norpramine) or nortriptyline (Pamelor). If the medication is taken at bedtime side effects might be reduced and can include drowsiness, blurred vision, dizziness and dry mouth.
- Selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil), may be helpful if depressed and having pain and constipation.
- Severe pain or bloating might be eased by Pregabalin (Lyrica) or gabapentin (Neurontin)
Medications for IBS
Medications which are approved for some people with IBS include:
- Alosetron (Lotronex). Alosetron medication is designed to relax the colon and slow the movement of waste through the lower bowel. Doctors can only prescribe this medication when enrolled in a special program, when it is intended for severe cases of diarrhea-predominant IBS in women who haven’t responded to other treatments, and for men it is not approved. It has been connected to rare but crucial side effects, so it should only be considered when other treatments aren’t successful.
- Diarrhea can be eased by reducing muscle contractions and fluid secretion in the intestine, and increasing muscle tone in the rectum with Eluxadoline. Nausea, abdominal pain and mild constipation can be possible side effects. Eluxadoline has also been related with pancreatitis, which can be critical and more common in certain individuals.
- Rifaximin (Xifaxan) is an antibiotic that can reduce bacterial overgrowth and diarrhea.
- Lubiprostone medication can increase fluid secretion in the small intestine to help with the passage of stool. For women who have IBS with constipation is has been approved, and is generally prescribed only for women who are experiencing severe symptoms that haven’t responded to other treatments.
- Linaclotide (Linzess). Linaclotide medication also can increase fluid secretion in the small intestine to help with the passage of stool. Diarrhea can be caused by linaclotide, but taking the medication 30 to 60 minutes before eating might be helpful.
Potential future treatments
New treatments for IBS are being investigated by researchers. Serum-derived bovine immunoglobulin/protein isolate (SBI) is a nutritional therapy that has shown some promise as a treatment for IBS with diarrhea.
Studies have also shown that people who are having IBS with diarrhea, a specially coated tablet that gradually releases peppermint oil in the small intestine (enteric-coated peppermint oil) can help in easing bloating, urgency, abdominal pain and pain while passing stool. It isn’t clear how enteric-coated peppermint oil might affect IBS is not clear, so doctor should be consulted before using it.
Lifestyle and home remedies
Simple diet and lifestyle changes often provide relief from IBS. Time will be needed by the body to respond to these changes. Try to:
- Fiber helps in the reduction of constipation but gas and cramping can also get worse. Try to slowly increase the amount of fiber in the diet over a period of weeks with foods such as whole grains, fruits, vegetables and beans. Gas and bloating may be caused by fiber supplement rather than fiber-rich foods.
- Foods that trigger the symptoms should be avoided.
- Don’t skip meals should not be skipped, and try to eat at about the same time each day to help bowel function to regulate. Eating small and frequent meals may help in feeling better if having diarrhea. Eating larger amounts of high-fiber foods may help move food through the intestines if constipated.
- Depression and stress can be relieved with the help of exercise as it stimulates normal contractions of the intestines, and can help to feel better about you. Doctor should be asked about an exercise program.
The role is not clear about alternative therapies in relieving IBS symptoms. Before starting any of these treatments the doctor should be consulted. Alternative therapies may include:
- How to enter a relaxed state and then guiding in relaxing the abdominal muscles can be taught by a trained professional. Abdominal pain and bloating may be reduced by hypnosis. The long-term effectiveness of hypnosis for IBS is supported in various studies.
- An act of being intensely aware of what you’re sensing and feeling at every moment, without interpretation or judgment is known as mindfulness training. Research has indicated that mindfulness can help in easing symptoms of IBS.
- Acupuncture has been found to help improve symptoms for people with IBS by researchers.
- A natural antispasmodic that relaxes smooth muscles in the intestines is called peppermint. Short-term relief may be provided of IBS symptoms, but study outcomes have been inconsistent.
- A “good” bacteria that normally live in the intestines and are found in certain foods is called probiotics, such as yogurt, and in dietary supplements. Certain probiotics may relieve IBS symptoms have been suggested in recent studies, such as abdominal pain, bloating and diarrhea.
- Stress can be relieved with the help of yoga and meditation. Classes can be attended or practicing at home using books or videos.
Preparing for appointment
Doctor who specializes in the digestive system (gastroenterologist) may be referred to.
- Any symptoms which are being experienced should be written down, including any that may seem unrelated to the reason for which the appointment is scheduled.
- Key personal and medical information which might be crucial should be written down, including any major stresses or recent life changes.
- A list of all medications should be made such as, vitamins or supplements that are being taken.
- During an appointment may be difficult to remember all at once. Someone accompanying may remember something that is missed or forgot.
- Any triggers to symptoms should be written down, such as specific foods.
- Any questions to ask the doctor should be written down.
In addition to the questions that have been prepared to ask the doctor, additional questions may also be asked during the appointment without hesitation.
What to expect from the doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked:
- Beginning of experiencing symptoms?
- Severity of the symptoms? continuous or occasional?
- Anything that seems to triggers to the symptoms, such as foods, stress or menstrual period in women?
- Weight loss without trying?
- Fever, vomiting or blood experienced in the stools?
- Significant stress recently experienced or emotional difficulty or loss?
- Typical daily diet?
- Food allergy or with lactose intolerance ever been diagnosed?
- Family history of bowel disorders or colon cancer?
- Symptoms affecting the quality of life, including personal relationships and ability to function at school or work?
While waiting for the appointment:
- Family members if any relatives should be asked if they have been diagnosed with inflammatory bowel disease or colon cancer.
- How often the symptoms are occurring should be noted and any factors that seem to trigger them.