Irritable bowel syndrome

Definition

Irritable bowel syndrome (or irritable bowel syndrome) is a chronic disorder of unknown origin that affects the colon. The disease does not damage the colon, meaning it does not cause inflammation, ulceration, changes in colon tissue or an increased risk of colorectal cancer . However, patients suffer from flatulence , diarrhea , episodes of constipation , etc.

Irritable bowel syndrome is, therefore, a set of gastrointestinal alterations that occur in the long term, but which are not associated with known biochemical or structural changes.

In the past, irritable bowel syndrome was considered more of a psychological problem. Today it is estimated that this is actually a physical disorder.

This is a condition that changes phase, that is, there may be moments of crisis and remission.

Epidemiology

In the United States, about 12% of the population suffers from this syndrome, according to the Mayo Clinic. Other sources, such as Prevention magazine ,  estimate that 10 to 15% of Americans suffer from this syndrome.

Irritable bowel syndrome (IBS) mostly affects people under the age of 45. Women are twice as likely to be affected than men.

Causes

The causes of irritable bowel syndrome are still unknown, as the disorder causes a series of symptoms that are often antagonistic, such as diarrhea and constipation. However, studies indicate that some factors can trigger the disease. One of these factors are psycho-emotional causes. According to studies, about 50% of patients reported suffering from a stressful or impactful emotional event shortly before the onset of the first symptoms.

Other studies indicate that acute infections can modify the intestine’s immunity and trigger the disease. Food also seems to be one of the causative or collaborating factors for the syndrome. Certain patients experience worsening of symptoms when eating certain foods, such as milk, chocolate or condiments. In this sense, the symptoms of the syndrome can be easily confused with those of lactose intolerance .

Gastroenteritis is one of the main risk factors for irritable bowel syndrome.

Another factor that seems to cause irritable bowel syndrome is the influence of hormones. As women are more affected than men, perhaps female hormones play an important role in triggering symptoms.

Studies have been carried out to verify if there is a connection with the immune system, that is, to verify if irritable bowel syndrome is a kind of autoimmune disease or if something alters the immunity of this organ to the point of causing functional changes.

Genetics may play a role, as the Mayo Clinic notes. Studies have shown that running IBS in the family increases the risk for other family members.

Groups of risk

Virtually, irritable bowel syndrome affects any age, however, the highest incidence of the disease occurs in patients under 35 years of age.

Another risk group are women who are apparently more affected than men. However, it is not known if the syndrome really affects women more or if they are more diagnosed because they go to the doctor more.

Studies point out that another risk group are people with a family history of cases of irritable bowel syndrome. It is not known for sure if this risk is due to some genetic factor or if it is due to sharing the same family environment (type of food ingested, daily habits, stress level , etc.).

Symptoms

Irritable bowel syndrome is characterized by a set of functional changes in the colon that generate different symptoms. Roughly speaking, the disease can be divided into:

– Predominance of periods of constipation (intestinal constipation);

– Predominance of diarrhea ;

– Alternation between diarrhea and constipation.

Among these groups, the most reported symptoms are:

– Dor abdominal

– Abdominal distension

– Flatulence

– Diarrhea or constipation (usually alternating)

– Presence of mucus in the stool

– Change in stool consistency

Other symptoms may be present such as: heartburn , vomiting , sweating, incontinence, chills, fatigue , etc.

These symptoms are due to changes in the functioning of the intestine, however, there are no tissue, biochemical or structural changes in the digestive tract.

Diagnosis

The diagnosis of irritable bowel syndrome is often difficult to perform and requires a lot of time, since the disease is confused with several others, so that other alterations must be eliminated in order to make the accurate diagnosis (differential diagnosis). Usually the doctor starts by analyzing the patient’s clinical history and symptoms. As there are no specific physical exams to diagnose the disease, criteria have been established to aid diagnosis. Two criteria used are Manning (1978) and Rome III (2006).

manning criterion

– Abdominal pain that is relieved after a bowel movement

– Loose stools

– Feeling of incomplete evacuation

– Abdominal distension

– Frequent bowel movements when pain sets in

– mucus in the stool

Rome III Criterion

Abdominal pain or discomfort for at least 6 months and at least 3 times a day for the past 3 months accompanied by at least 2 of the following symptoms:

– Improvement of pain after bowel movement

– Changing the frequency of bowel movements

– Change in the appearance of fecal matter (diarrheal or constipated appearance)

– Presence of mucus in the stool

In addition to these criteria, the doctor may be alert if the patient has persistent diarrhea , rectal bleeding, fever, age below 50 years, female gender, flatulence and weight loss.

Other complementary exams can help the diagnosis. In this case, they serve to exclude the possibility of other diseases, that is, to make the differential diagnosis. These exams include:

– Sigmoidoscopy: examination that analyzes the sigmoid portion of the intestine with a flexible tube.

– Colonoscopy: exam that analyzes the colon.

– Computed tomography: allows you to see if there are any changes in the pelvic region.

– Lactose intolerance test : allows you to check that the symptoms experienced by the patient are not due to lactose intolerance.

– Blood tests: allows you to check that the patient does not have any other disease, such as infection or celiac disease .

Complications

Irritable bowel syndrome is not associated with severe complications. However, diarrhea and constipation can trigger or worsen hemorrhoid symptoms . In addition, constant diarrhea can cause the patient to lose weight quickly.

Other impacts of the syndrome occur in the emotional and psychological field. The imminent fear of diarrhea can stress patients and alter their daily activities, impairing their quality of life and self-reliance. In addition, abdominal discomfort and constipation can leave the patient in a state of nervousness and shake their emotional structure which can, consequently, aggravate the symptoms.

Treatments

As irritable bowel syndrome has unknown causes, treatment is symptomatic, that is, it aims to alleviate the symptoms and discomfort caused by the disease.

Good stress control, eating more properly and any changes in lifestyle can already provide an improvement in most of this condition.

The following are treatments and medications used to treat this condition, particularly if lifestyle changes do not work:

– Intake of fibers and food supplements with fibers such as psyllium and methylcellulose, to improve the symptoms of constipation.
However, some insoluble fibers such as som can exacerbate this syndrome;

– Anticholinergic antispasmodics, to relieve the symptoms of colic and pain;

– Medicines that eliminate gas, such as simethicone;

– Anti-diarrheal drugs, such as loperamide;

– Antidepressant medication, such as serotonin reuptake inhibitors (fluoxetine, paroxetine). This type of medication is particularly important, as many of the patients with the syndrome have symptoms of  stress and depression . In addition, medication helps to relieve pain. The doctor may also indicate tricyclic antidepressants (imipramine, amitriptyline ).

In addition to these, there are 2 specific medications for irritable bowel syndrome:

– Allosetron: used to relax the colon and slow down intestinal transit. It should be used if other treatments have failed.

– Lubiprostone: indicated for adults, this drug is used to increase the secretion of fluids in the small intestine, helping the passage of fecal cake.

– In the United States, since 2015 the antibiotic rifaximin has been available on the market. This medicine is mainly indicated in cases of IBS with symptoms of diarrhea (IBS-D in English). It is important to know that this medicine is not absorbed into the systemic (general) circulation, but remains localized at the level of the intestine.

– In the case of IBS with symptoms of diarrhea (IBS-D) antihistamines can help, according to Belgian researchers. Patients suffering from IBS with diarrhea who took antihistamines for 3 months had significantly fewer symptoms than those in the control group.

Finally, as we saw at the beginning of this article, many doctors advise changing the patient’s diet to improve symptoms, the Low Fodmap diet is particularly recommended (read further below).

Dieta “Low Fodmap”

This diet of Australian origin consists of reducing the consumption of certain foods and increasing that of others.
The term FODMAP is an acronym that characterizes different carbohydrates, meaning: “F” for fermentable, “o” for oligosaccharides, “d” for disaccharides, “m” for monosaccharides, “a” for and (“e” in English) and “p” for polyols.
“Low” in English means “lower”, in this diet the objective is to reduce the intake of these carbohydrates: fermentable, oligosaccharides, disaccharides, monosaccharides and polyols, which can cause flatulence, diarrhea or constipation. These sugars are poorly absorbed in the intestine.

The “Low Fodmap” diet has been scientifically approved for its effectiveness.

Decreasing
Some foods rich in these carbohydrates (FODMP), such as artichokes, onions, garlic, celery, apples, mangoes, peaches, watermelon, black beans, ice cream or creams with these ingredients should be reduced.

To increase
On the other hand, the consumption of foods poor in terms of these carbohydrates should be increased, such as: eggplant, carrots, soybean sprouts, alfalfa, green beans, strawberries, bananas, grapes, oranges, pecans, peanuts, milk or lactose-free yogurt, certain cheeses (in English, Swiss cheese).

Ketogenic Diet
Another diet that appears to be effective against irritable bowel syndrome is the ketogenic diet, a diet that is low in carbohydrates and high in fat.

Herbal medicine

There are medicinal plants that improve the symptoms of abdominal pain, diarrhea and constipation from irritable bowel syndrome.

– This is particularly the case with peppermint , which has an effect. It is advisable to consume 1 to 2 capsules (containing 0.2 ml of peppermint essential oil) per day. It is best to consume enteric-coated capsules, as this protection prevents diffusion in the stomach that can cause heartburn.

– Chamomile , melissa , valerian and rosemary also relieve pain and help to calm down.

– Blueberry : assists in the symptoms of diarrhea .

– Frangula , psilo (plantago) and rhubarb : help with the symptoms of constipation.

– Aloe vera : aids in the irrigation of the colon, loosening and washing waste from the digestive system.

– Artichoke : may have a positive effect against irritable bowel syndrome according to a small study. (source: Mayo Clinic)

– Flaxseed , in capsule form.

– Turmeric Curcuma aromatica , Curcuma longa ) , a study showed a reduction of up to 60% in the symptoms of irritable bowel syndrome. Take one capsule of 300 to 400mg of saffron active ingredients 3 times a day.

Before using any herbal medicine, talk to your doctor to find out if you have any contraindications.

Tips

Some attitudes can be adopted to alleviate the symptoms caused by irritable bowel syndrome:

– Observe if any type of food triggers the symptoms. Some patients report worsening after ingesting certain foods such as spices, fats, chocolate and milk. If that’s the case for you, try to avoid them or replace them with others.

– Make sure your problem is not related to the intake of milk and dairy products. Tell your doctor about this so he can test you for lactose intolerance.

– If you have diarrhea, eat smaller portions with meals.

– Incorporate fibers into your diet, they help to clean the intestine and prevent symptoms of constipation and flatulence.

– Drink plenty of fluids, preferably water.

– Exercise regularly. Sport helps relieve and reduce stress symptoms and helps with bowel movement, reducing colic and increasing mobility.

– Use anti-diarrhea medications and laxatives with caution. They can alter the normal functioning of the bowel and change the surrounding tissue. Always talk to your doctor for proper guidance.

– Look for alternative treatments to manage stress, such as hypnosis, acupuncture, massage, relaxation, yoga and meditation.

Prevention

Little is known about the exact causes of irritable bowel syndrome, so prevention methods are poorly developed. However, some measures can be taken:

– Adopt measures to control stress. They vary from the practice of physical activities to consultations with psychologists. Many patients have symptoms of the syndrome after stressful periods.

– Get plenty of fiber from fruits, vegetables and whole grains. They help clean the intestines and prevent colds.

– Adopt healthier and more balanced diets. Avoid alcohol and excessive fats.

– Drink lots of water.

– Use probiotic products.

– Try to eat at regular times.

– Exercise regularly. An effective way to reduce stress (a possible cause of this syndrome).

Also read the section Treatments , in the “Low Fodmap” Diet item

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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