Irritable Bowel Syndrome (IBS) Treatment- Dietetics/ Nutrition, Gastroenterology

Irritable Bowel Syndrome (IBS), also known as spastic colon or irritable colon, is a common medical condition that affects millions of men and women worldwide. People with IBS complain of a wide range of gastrointestinal symptoms such as diarrhea, constipation, bloating, flatulence and tummy ache.

IBS is different from IBD (irritable bowel disease), which includes Crohn’s disease and ulcerative colitis, however, the two share many symptoms. Unlike IBD, with IBS, your bowels will appear to be completely normal, both grossly and under the microscope. The problem in IBS is rather related to how your bowels are behaving when passing food. In most cases, IBS can be managed by a proper diet plan and some lifestyle changes, however, in some people it might become debilitating and require more focused therapy.

Symptoms of IBS

IBS is a chronic condition and the symptoms are usually present for years. Some of the observed symptoms in people with IBS include:

• Crampy abdominal pain
• Bloating
• Flatulence
• Diarrhea
• Constipation
• Changes in the frequency of bowel movements
• Changes in the appearance of your stools

The symptoms of IBS are usually closely related to bowel movements, meaning that they develop shortly before you go to the bathroom, and usually tone down after you’ve gone. Since the symptoms of IBS may overlap with other more serious conditions, you should always see a doctor if you develop more concerning symptoms such as:

• Weight loss
• Blood in your stool
• Problems with swallowing
• New sudden changes in your bowel habits
• Vomiting
• Iron deficiency anemia
• No relief of symptoms with bowel movements

Causes

 As opposed to other gastrointestinal conditions, IBS is not caused by a disruption in the tissue that forms your colon and is rather a result of it not functioning normally. Some of the causes that might be underlying spastic colon include:

• Abnormal intestinal muscle contraction: The wall of your colon contains smooth muscle fibers that are responsible for pushing the food forward through your intestines when they contract. If these muscles are malfunctioning for some reason, they are likely to cause some problems with normal bowel movements. If your muscles are, for example, over contracting, they might cause cramps and diarrhea. On the other hand, if the muscles are only weakly contracting, they might lead to constipation.
• Abnormal neural connections: Your guts are extremely well connected to your nervous system and the connection goes both ways. In people with IBS, this connection is disrupted. Normal changes in your bowels after eating might be abnormally perceived by your brain as painful and exaggerated. This would, in turn, lead to abnormal reflexes from your brain causing constipation, diarrhea, and more cramps.
• Severe gastrointestinal infections: In some cases, a severe gastrointestinal infection might pave the way for the development of IBS. This might be caused by an overgrowth of bacteria in your guts.
• Imbalance in your intestinal flora: Your intestinal flora is the harmless bacteria living in your intestines serving all kinds of important functions related to digestion. People with IBS might have an imbalance in intestinal flora which might underly their symptoms.
• Childhood stress: People who had had a stressful childhood might be at higher risk of developing IBS later in life.

Risk factors

Doctors were able to identify several risk factors for developing IBS:

• Female gender: Women are more likely to have IBS
• Younger age: People less than 50 years of age are at higher risk
• Family history: Those who are related to people who have IBS are more likely to develop it
• Mental health problems: Stress, anxiety, depression, and other mental problems are associated with IBS

IBS triggers

Spastic colon is a chronic illness, and its symptoms may wax and wane during your lifetime. People who have IBS are usually aware of specific triggers that aggravate their symptoms, and these might include:

• Certain foods: A person with IBS usually knows that specific foods will trigger their symptoms of pain, diarrhea, constipation, or bloating. It is not exactly understood how these foods exacerbate symptoms, but certain fruits, juices, spices, dairy products, and other foods have been reported as IBS triggers.
• Stress: Doctors have observed that a person’s mood is closely related to their IBS symptoms in many cases.

Diagnosis

Irritable bowel syndrome is usually a diagnosis of exclusion. This means that there are no specific tests to identify the condition, and the diagnosis is only confirmed after every other similar disease is excluded. Your doctor will start by asking you about your medical and surgical history. After that, he/she will ask you for more details about your symptoms: frequency of bowel movement, stool consistency, the intensity of pain, etc.

Based on this interrogation, your doctor will put forward a list of differential diagnoses that might apply to you. The list will include other conditions that may resemble IBS, such as celiac disease, food allergy, ulcerative colitis, and Crohn’s disease. After that, your doctor will probably order one or more of the following tests to rule out or confirm these conditions:

• Blood tests: Several blood tests might be ordered to check for conditions that might be underlying your illness or are associated with it. This includes tests for anemia, nutrient levels, inflammatory response, etc.
• Colonoscopy: This is probably the single most important test in order to diagnose colon abnormalities. A colonoscopy is a test where a gastroenterologist inserts a flexible cord with a camera at its tip through your anus and advances it to see how your colon looks on the inside. He/she might also take small pieces of tissue (biopsies) that would be examined under the microscope for any abnormalities.
• Radiologic imaging: Sometimes, your doctor might order a CT scan or an X-ray of your abdomen to check for any abnormalities.
• Stool tests: Your doctor might ask that your stool be examined for possible microbes or parasites that could be causing your symptoms.
• Breath test: A breath test might be ordered to help check if you have bacterial overgrowth in your intestinal tract or if you have lactose intolerance.

If your intestines are found to be normal and these tests fail to confirm any of the conditions that resemble IBS, your doctor will move forward with the diagnosis. Based on predetermined criteria, your IBS will be classified into either constipation-predominant, diarrhea-predominant, or mixed type.

Treatment of IBS

Since there’s no obvious tissue problem in your colon, treatment focuses on controlling symptoms so that people with IBS can have a normal quality of life. A successful treatment plan will include one or more of the following:

• Avoiding triggers: This might be the simplest and most effective way of controlling the symptoms of IBS. If you know that a certain food causes you to bloat and become constipated, you should eliminate it from your diet. If stress usually triggers your symptoms, try to find ways to become more relaxed. This might include meditation, sports, breathing exercises, and even therapy.
• Get your diet in check: Foods high in fiber and low in fat are generally essential for your gut health. Try to incorporate more vegetables, seeds, legumes, and fruits into your diet, and avoid fast food and foods high in carbohydrates, gluten, and FODMAPs. Eating smaller and more frequent meal portions might also help you control your symptoms.
• Laxatives: If your IBS is of the constipation-predominant type, your doctor might prescribe you laxatives that will soften your stool and make your bowel movements smoother.
• Anti-diarrheal drugs: In people with diarrhea-predominant IBS, certain medications might be prescribed to make stool consistency firmer.
• Painkillers: If your IBS is causing you abdominal cramps and pain, your doctor might prescribe you one or more painkillers and antispasmodics to help control it.
• Supplements: Probiotic supplements and fiber supplements can be beneficial for your gut health, and in certain people with IBS they might improve the symptoms.
• Antidepressants: Since there’s probably a neurological abnormality underlying IBS, certain people benefit from using antidepressants that regulate neurotransmitters in the body.
• Specific IBS medications: There are several drugs that have been shown to improve IBS symptoms in certain people. These include Alosetron, Eluxadoline, Rifaximin, Lubiprostone, and Linaclotide. Depending on your specific case and severity of symptoms, your doctor might ask you to take one of these medications.

Irritable bowel syndrome is a lifelong illness, however, thanks to modern medicine, you don’t have to live your whole life in cramps and pains. Many medications can help control your symptoms and even simple lifestyle and diet changes alone can go a long way.

To learn more about Irritable Bowel Syndrome (IBS), please check our blog on UNDERSTANDING IRRITABLE BOWEL SYNDROME.

Sources:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826071/
• https://gi.org/topics/irritable-bowel-syndrome/
• https://www.uptodate.com/contents/treatment-of-irritable-bowel-syndrome-in-adults
• https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-irritable-bowel-syndrome-in-adults
• https://www.uptodate.com/contents/irritable-bowel-syndrome-beyond-the-basics

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