Irritable Bowel Syndrome (IBS) is a syndrome that affects the large bowel, or colon, which is the part of the digestive tract that stores stool. Current theory is that people with IBS have very sensitive bowels that get upset easily, causing stomach pain, bloating and chronic diarrhoea or constipation.
IBS is very common, affecting up to 1 in 5 people at some time in their lives. It is more common in women, and often first begins in the late teens or early twenties. Symptoms tend to come and go, and a person have long periods of feeling fine, and then suffer a ‘flare’ of symptoms. Symptoms often tend to be more severe just before a woman’s period.
Symptoms of IBS
The most common symptoms of IBS are:
- Abdominal pain or discomfort that is often relieved by passing wind or having a bowel movement.
- Stomach bloating that can be very painful
- Chronic diarrhoea or constipation or alternating between the two
Less common symptoms of IBS are:
- Mucus in the stool
- The feeling that you haven’t finished a bowel movement
IBS can be very painful and seriously impact the sufferers quality of life. It does not, however, damage the colon or lead to other health problems, or increase the risk of bowel cancer.
Symptoms NOT due to IBS
If you’re experiencing the following symptoms:
- Bleeding from the back passage
- Unintentional weight loss
- Severe diarrhoea , especially at night
You should see your doctor for further testing, as these could be signs of more serious illness.
What causes IBS
The cause of IBS is still uncertain, and each individual has different triggers. Figuring out what the triggers are can be the first step to improving symptoms, but this can be a difficult process. Certain factors commonly trigger attacks or ‘flares’ in susceptible people, including:
Infection. An episode of gastroenteritis may persist, and result in ongoing bowel issues. It is unsure why this happens, but one theory is that it involves changes to the nerve function in the bowel, or changes in the normal bacteria population of the bowel (microbiome).
Food intolerance. There are many food implicated as the cause of IBS. Impaired absorption of lactose (the sugar found in milk), fructose, FODMAPs and sorbitol (an artificial sweetener) are common triggers.
General diet. Diets low in fibre can exacerbate constipation in some people with IBS. Fast food can also be a trigger in some people.
Stress. Emotional turmoil, anxiety and other strong emotions can affect the nerves that control the bowel and exacerbate diarrhoea and stomach pain. IBS and anxiety often co-exist and can form a ‘vicious cycle’ where IBS feeds anxiety, which in turn worsens the IBS.
Medications. Some medications, including antibiotics, antacids, and pain medications can lead to diarrhoea and/or constipation.
How is IBS diagnosed?
IBS tends to be a diagnosis of exclusion. Your doctor will often run a series of tests, often including blood tests (including tests for celiac disease), a stool test (to look for bacterial infections), and colonoscopy to examine the lining of the colon (large bowel).
These tests are usually run to rule out more serious diseases and conditions. If no other reason for your symptoms can be found, and they persist, the diagnosis will be IBS.
While IBS is not “serious” in that it doesn’t lead to damage to the digestive tract or increase your risk of bowel cancer, in some people the symptoms are severe and are life altering, having a major impact on a person’s quality of life.
Treatment for IBS
Treatment for IBS is individual. What works for one person may not work for another. Changes to diet are usually the first line of treatment, looking for triggers that increase symptoms. People often go on elimination diets and then re-introduce suspect foods to see if they cause an increase in symptoms.
There is clinical evidence that a low FODMAP diet helps many people with IBS.
Sticking to a regular routine and eating at the same time every day has been recommended to reduce symptoms.
While there is no medication proven to control the condition, there are medications to help control symptoms including:
Anti-diarrhoea agents. Imodium and fibre supplements can be effective in management of IBS symptoms.
Pain-relieving medications. Simple analgesics such as panadol, and/or mild opioids such as codeine can provide effective pain relief.
Anti-spasmodics. Peppermint oil may help relieve cramping pain.
Constipation treatments. Fibre supplements and gentle laxatives may help with constipation dominant IBS.
Tricyclic antidepressants. Antidepressants can sometimes be effective in managing pain, but IBS is NOT caused by depression. IBS can cause depression however, so antidepressants may help with overall quality of life.
I’ve been plagued with IBS C and D since I was and infant. The C being most prominent. Ironically it’s even in my baby book, my mother kept copious notes so I know I suffered even when I was too tiny to tell them what was wrong. For years I was told fiber fiber fiber and of course needing an occasional laxative or anti diarrheal. I lost count of the nights spent on the bathroom floor curled up in the fetal position most of my life and the numerous tests to rule everything else out. One doctor likened the pain of severe IBS C attacks lI had in my late teens to the pain of childbirth but no relief was ever offered for fear of making it worse.
Many years later I was fortunate to find a Gastroenterologist who took me off of fiber treatment (in the interim I’d had a horrific episode of ischemic bowel related to my now diagnosed RA and the vascular issues that have come with it) This doctor said the fiber treatment in many IBS patients even though it’s been the go too for years causes excess gas leading to additional pain and does nothing for many IBS patients to actually stimulate the bowel. The nerve disfunction is not affected by fiber and in fact can make it worse in some patients.
I suffered for over 20 years before I was put on a small dose of Miralax which has since been backed up by another Gastroenterologist and my GP. For me it works (the key is keeping fluids up which I should anyway). If I’m going the other way I lessen the dose it but I have to be careful with that being C/D it can switch in hours. There are several medicines in the USA specifically for IBS but most are for C or D not the combo. They tried the usual SSRI, Nueronontin, Tricyclic antidepressants and anti spasm medicines to no avail.
It’s such a difficult thing to treat, like colitis it hits without notice and causes missed social activities. I wouldn’t wish it on anyone. I’ve always had an extremely sensitive digestive track since childhood whenever I would be upset during the day from home stress (and there was a lot or school) I would inevitably end up vomiting several times during the night. My grandmother forced my mother to take me to the doctor. The doctors came up with nothing more then “sensitive stomach”. Yeah right.