Irritable bowel syndrome (IBS) is a chronic disorder of the gastrointestinal system however it has no structural manifestations and the exact cause
is not yet known. As IBS is a syndrome it can be classified by a set of known symptoms, these symptoms are present with no evidence of anatomic, metabolic, neo-plastic or inflammatory processes that could otherwise be responsible.
WHAT IS IBS?
IBS is a complicated illness occurring in unpredictable transient episodes and varies from person to person. IBS can be classified by 3 main criteria that confirm diagnosis11,12;
- that of recurring abdominal pain or discomfort that is alleviated by defecation,
- mobility changes associated with change in stool frequency resulting in either diarrhoea or constipation
- and a change is stool appearance.
These symptoms are present at least 3 days per month and have been ongoing for the last 3 months. Symptoms present may be indicative of other gastrointestinal disorders and therefore alarm symptoms such as blood in the stool, rectal bleeding or weight loss need to be excluded as part of
diagnosis11. Tests such as full blood count, C-reactive protein and Coeliac antibodies can rule out alternative diagnosis8.
IBS is classified into subgroups, changes in transit time are the maker for classification, these are8,11,12:
» IBS-C: IBS with constipation, predominantly hard stools, with constipation, longer transit time
» IBS-D: IBS with diarrhoea, predominantly loose stools, with diarrhoea, shorter transit time
» Mixed IBS, this is the most common
Other symptoms occur but can be specific to each person, these include
- excessive wind and bloating, lack of satisfaction (incomplete defecation),
- mucus in stool and nausea,
- as well as psychological symptoms such as anxiety and depression. IBS affects quality of life episodes can occur at any time and immediate defecation is often necessary and uncontrollable 5,10.
WHAT CAUSES IBS?
IBS has no set of morphological changes or specific biomarkers that can be measured in order to determine an exact cause.
KNOWN MECHANISMS INVOLVED IN IBS
- Gut brain axis dysfunction, resulting in visceral hypersensitivity brought about by a heightened response of the nerves in the gut either by distension of the gut, or over stimulation by the autonomic nervous system5,13
- Motility changes, altered transit time due to uncoordinated colonic contractions, resulting in either constipation or diarrhoea 4,5,8,10
- Altered psychosocial function, emotional response to visceral stimulation, affecting the time and way the patient responds and influences symptom frequency and pain4,8
- Gut microflora overgrowth, these microorganisms create gas with slows colon transit time, contributing to bloating
- Changes in the mucosal barrier, causing mild inflammation and contributing to sendory nerve pain1,4,10
- Excessive secretion of serotonin (5-HT) by cells in the intestinal lining are thought to bring about an immune response increasing abdominal pain and discomfort 4,6,12
IBS RISK FACTORS
- GUT INFECTION – IBS follows gastroenteritis 8,9
- GUT MICROBIOTA -Dysbiosis, an imbalance in gut flora5,8
- STRESS- IBS often follows a stressful life event8,9
- PSYCOLOGICAL – Anxiety and depression
- FOOD HYPERSENSITIVITY-Caused by food allergies or intolerance3
- GENES -Family history of bowel dysfunction
Affects 15% – 20% of the population, more prevalent in women, and persons younger than 55 years of age, however medical attention is not always sort so could be higher2,8. This is a particularily high rate of occurance, if you compare to diabetes which affects 8-10%.
- Optimise the GIT microflora – dysbiosis in the gut is addresssed as this is crucial to the management of IBS, achieved through the use of prebiotics, probiotics and fibre (Some patients will show improvement by including fibre in the diet, however fibre intake needs to be carefully
monitored as it been shown to make symptoms worse)10. The use of strain specific probiotics and prebiotics can help in the restoration of gut flora which may be out of balance in a person with IBS due to altered GIT peristalsis, stress, overuse of antibiotics and bad diet 4,8,10 .
- Diet – manage any food intolerances, diet is specific to each case. A recent study in Australia showed significant improvement in patients that followed a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccarides and polypols) diet. This diet removes foods from the diet that bytheir nature bring fluid to the gut and causes distention, which contributes to abdominal pain in IBS. These include fructose, from fruit, fructans from wheat, and onion, lactose from diary and galactans from beans. The specifics of the diet are quite detailed and further information can be provided by your Naturopath 7. It is also recommended to drink plenty of water and chew food well8.
- Herbal Medicines – used to support the nervous system, reduce GIT inflammation, support liver processes
- Lifestyle interventions – adaquate fluid intake and exercise to promote easy-to-pass movements especially if constipated (IBS-C).For many IBS is initially triggered by an emotional or stressful event and subsequently made worse during times of stress. Dealing with psychological symptoms such as anxiety and stress is part of IBS management. Learning to relax using techniques such as meditation, yoga, and doing relaxing exercise such as walking, can help you cope with stress. Other modalities that have shown benefit include hydrotherapy, cognitive behaviour therapy and relaxation therapy 8,12.
Like everything else, there is no one-size-fits-all when it comes to treating your IBS. You may be a strict vegetarian, eat the Paleo way or fall somewhere in between. The key is to to create a plan that works well for you, and fits with your lifestyle and beliefs.
How have you taken measures to heal your gut? Do you notice a difference in your overall health? Please share your comments below.
- Braak, B., Klooker, T., Wouters, M., Welting, O., van der Loos, C., Stanisor, O., & … Boeckxstaens, G. (2012). Mucosal immune cell numbers and visceral sensitivity in patients with irritable bowel syndrome: is there any relationship?. The American Journal of Gastroenterology, 107(5), 715-726. doi:10.1038/ajg.2012.54.
- Barbezat, G., Poulton, R., Milne, B., Howell, S., Fawcett, P., & Talley, N. (2002). Prevalence and correlates of irritable bowel symptoms in a New Zealand birth cohort. The New Zealand Medical Journal, 115(1164).
- Böhn, L., Störsrud, S., Törnblom, H., Bengtsson, U., & Simrén, M. (2013). Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. The American Journal of Gastroenterology, 108(5), 634-641. doi:10.1038/
- Camilleri, M. (2005). Etiology and pathophysiology of irritable bowel syndrome and chronic constipation. Advanced Studies in Medicine, 5(10B), S955-S964.
- Craft, J., Gordon, C. Tiziani, A., Huether, S.E., McCance, K.L., Brashers, V.L., & Rote, N.S. (2011). Understanding pathophysiology. Australia: Elsevier.
- Cremon, C., Carini, G., Wang, B., Vasina, V., Cogliandro, R., De Giorgio, R., & … Barbara, G. (2011). Intestinal serotonin release, sensory neuron activation, and abdominal pain in irritable bowel syndrome. The American Journal of Gastroenterology, 106(7), 1290-1298. doi:10.1038/ajg.2011.86.
- Halmos, E., Power, V., Shepherd, S., Gibson, P., & Muir, J. (2014). A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 146(1), 67-75.e5. doi:10.1053/j.gastro.2013.09.046.
- Hill, J., & Wyeth, J.(2014). Irritable bowel syndrome in adults: Not just a gut feeling. Best practice journal. (58).
- Hughes, P., Harrington, A., Castro, J., Liebregts, T., Adam, B., Grasby, D., & … Brierley, S. (2013). Sensory neuroimmune interactions differ between irritable bowel syndrome subtypes. Gut, 62(10), 1456-1465. doi:10.1136/gutjnl-2011-301856
- Pizzorno, J., & Katzinger, J. (2012). Clinical Pathophysiology: A functional perspective. Mind Publishing.
- Rome Foundation. (2006). Rome III diagnostic criteria for functional gastrointestinal disorders. Retrieved May 8, 2014, from http://www.romecriteria.org/assets/pdf/19_RomeIII_apA_885-898.pdf.
- Schlup, M. (2007). Irritable bowel syndrome. New Zealand Family Physician, 34(5).
- Stasi, C., Rosselli, M., Bellini, M., Laffi, G., & Milani, S. (2012). Altered neuro-endocrine-immune pathways in the irritable bowel syndrome: the top-down and the bottom-up model. Journal of Gastroenterology, 47(11), 1177-1185. doi:10.1007/s00535-012-0627-7.