What Is Irritable Bowel Syndrome (IBS)? What Are The Causes Of Irritable Bowel Syndrome?

Irritable bowel syndrome, also known as IBS, spastic colitis, mucus colitis and nervous colon syndrome is a long-term (chronic) gastrointestinal disorder that causes abdominal pain, bloating, mucous in stools, irregular bowel habits, and alternating diarrhea and constipation. Although it is a chronic condition, symptoms tend to wax and wane over the years.

Despite the chronic discomfort caused by IBS, it does not lead to any serious complications in the majority of patients. However, it can be a source of long-term pain, fatigue and some other symptoms, and contributes to work absenteeism. Fortunately, most patients find that symptoms improve as they become better at controlling their condition. Fortunately, only a small percentage of individuals with IBS have severe symptoms.

IBS is regarded as a chronic illness that may have a considerably negative impact on the quality of life of the sufferer.

Irritable bowel syndrome (IBS) is a diagnosis of exclusion (per exclusionem). In other words, a medical condition whose presence cannot be confirmed with complete confidence just by examination or testing. Diagnosis is therefore by elimination of other reasonable possibilities.

There is no cure for IBS. Treatment is aimed at relieving symptoms, and includes dietary changes (avoiding caffeine, milk products, and sweeteners), relaxation techniques, medications and exercise.

According to the National Health Service (NHS), UK, IBS is one of the most common gastrointestinal conditions. Approximately 10% to 20% of the British population is affected by the condition at any one time. Some believe the figure may be considerably higher, because a significant number of patients do not see their doctor about it.

Most commonly, IBS develops in individuals aged between 20 and 30 years; however, it may affect people of any age. Twice as many females as males are affected by IBS.

According to Medilexicon's medical dictionary:

Irritable bowel syndrome is "a condition characterized by gastrointestinal signs and symptoms including constipation, diarrhea, gas, and bloating, all in the absence of organic pathology. Associated with uncoordinated and inefficient contractions of the large intestine."

What are the signs and symptoms of IBS?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

There are three types of irritable bowel syndrome (IBS):

• IBS with constipation - the patient experiences stomach pain, discomfort, bloating, infrequent or much delayed bowel movements, or hard/lumpy stools.
• IBS with diarrhea - the patient experiences stomach pain, discomfort, an urgent need to pass stools (open bowels, go to the toilet), very frequent bowel movements, or watery/loose stools.
• IBS with alternating constipation and diarrhea

Many patients alternate between types as time goes by. In each category there are about the same number of patients.

The most common symptoms experienced by people with IBS are:

• A change in bowel habits, either diarrhea, constipation, and even both.
• Abdominal pain and cramping - these symptoms are usually relieved after going to the toilet.
• After going to the toilet the patient may feel that his/her bowels are not fully emptied.
• Gas (wind, farting).
• Passing of mucus from the back passage (rectum).
• Sudden urgent need to go to the toilet, which can lead to fecal incontinence if a lavatory is not at hand.
• Swelling/bloating of the abdomen.

Most symptoms tend to worsen after eating. Typically, a patient will have a flare-up which may last from 2 to 4 days, and then symptoms either improve or go away completely.

IBS signs and symptoms may vary considerably from patient to patient. They often resemble those of other diseases and conditions.

Most individuals only have mild symptoms of IBS. However, symptoms may sometimes be severe and disabling. It is important to discuss symptoms with a doctor because they may occur with other diseases.

IBS may also cause symptoms to appear in other parts of the body, apart from the bowel area. These may include:

• Burping
• Frequent urination
• Halitosis (bad breath)
• Headache
• Joint pain
• Muscle pain
• Nausea
• Pain in the lower back
• Persistent fatigue

Anxiety and/or depression may also occur in people with IBS, usually because of the discomfort and embarrassment that are often linked to the condition.

What are the risk factors for irritable bowel syndrome (IBS)?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2. The following groups of people are more likely to have IBS:

• Younger adults - in 50% of cases the patient is aged less than 25 years.
• Gender - women are twice as likely to suffer from IBS as men.
• Family history - people with a close relative who has/had IBS are more likely to develop it themselves.
• There is ongoing research to try to find out whether family history IBS risk is linked to genes, a shared family environment, or both.

What are the causes of irritable bowel syndrome (IBS)?

Experts are not sure what INS causes are. It is thought the following interrelated factors are probably involved:

• Dietary factors (which we don't know about)
• Environmental factors (which we don't know about)
• Genetic factors (which we don't know about)
• The central nervous system does not control the digestive system properly
• The digestive organs are excessively sensitive to pain
• The response to infection is unusual
• The way muscles move food through the digestive tract is abnormal
• There is something wrong with the immune system (possible related to response to infection)

Mental and emotional state - evidence suggests that psychological and emotional factors probably play a big role in IBS. This does not mean the condition is all in the mind, but rather that changes in an individual's emotional/mental state, such as depression, stress or anxiety may cause flare-up symptoms to occur. People who have had a traumatic experience have a higher risk of developing IBS.

Triggers - some people with IBS react strongly to stimuli that would not affect people without IBS. Examples may include:

• Food - a significant number of individuals with IBS find that their symptoms get worse after they have eaten certain foods, such as chocolate, milk or alcohol, which give them either constipation or diarrhea. Bloating and/or discomfort may be caused by some fruits and vegetables, as well as fizzy drinks. Experts are not sure what role food allergy or intolerance play (if any) in IBS.
  
  Cramping or bloating after eating dairy products, sugar-free gum, some candies, or products with caffeine in them may be due to lactose (sugar), sorbitol or caffeine intolerance, and not IBS.
• Hormones - a considerable number of women with IBS find that their symptoms are worse around the time of menses (menstrual periods).
• Infections - gastroenteritis can trigger IBS.

Diagnosing irritable bowel syndrome (IBS)

There is no specific imaging or laboratory IBS diagnostic test. Diagnosis involves ruling out conditions that produce IBS-like symptoms, and then following a procedure to categorize the patient's symptoms. Typically, the following need to be ruled out before a diagnosis of IBS is made:

• Lactose intolerance
• Small intestinal bacterial overgrowth
• Celiac disease

Most patients will visit their GP (general practitioner, primary care physician) initially. The GP will probably recommend a blood test to rule out other possible conditions. In many cases, the GP may be able to diagnose IBS by asking about symptoms. The questions will include the following:

• Have there been any changes in your bowel habits, such as diarrhea or constipation?
• Is there any pain or discomfort in your abdomen?
• Do you ever (often) feel bloated?

Identifying the following symptoms will help the GP make a diagnosis of IBS:

• There is abdominal pain or discomfort, which usually disappears after the patient empties his/her bowel
• There is abdominal pain accompanied with a change in bowel habits; perhaps the patient goes to the toilet more frequently than before, the stools may have a different appearance.

According to the National Health Service (NHS), UK, the patient needs to have at least two of the following symptoms for a diagnosis of IBS to be made:

• The way the patient passes stools has changed - there is a need to strain, a sensation of urgency (need to rush to the toilet), or a feeling that the bowels have not completely emptied after going to the toilet.
• In the abdomen there is bloating, tension or hardness
• After eating the symptoms worsen
• There is passing of mucus from the back passage (rectum)

If there are specific signs or symptoms that may suggest another condition, perhaps a more serious one, further testing may be required. The signs or symptoms may include:

• Anemia
• Localized swelling in the rectum and/or abdomen
• Weight loss (unexplained)

Patients with a history of ovarian cancer may require further testing.

Patients over the age of 60 years whose change in bowel habits have persisted for longer than six weeks may require further testing.

What are the treatment options for irritable bowel syndrome (IBS)?

As nobody is certain what the causes of IBS are, treatment is aimed at relieving symptoms and improving the patient's quality of life. This usually involves some diet lifestyle changes, as well as learning how to manage stress.

Diet - some changes in eating habits can significantly help in controlling IBS symptoms. Unfortunately, there is no magic IBS diet which works for everybody. The patient may have to go through a process of trial and error until an optimum diet is achieved.

Health care professionals recommend keeping a food diary in which details of foods eaten, as well as what effect they might have had, are noted. Eventually, the IBS sufferer should be able to identify the major trigger foods and avoid them.

• Fiber - some IBS sufferers may need to consume more fiber while others may have to do the opposite. Those having to reduce may have to limit their consumption of wholemeal bread, cereals, and whole grains.
  
  Those needing more fiber will have to increase their intake of soluble fiber - often involving having to take a fiber supplement, or consuming more high soluble-fiber foods.
  
  The GP or a qualified nutritionist/dietician should be able to advise the patient on fiber intake.

The following may help reduce symptoms of IBS:

• Avoid sorbitol if you suffer from diarrhea. Sorbitol is found in some chewing gums, diet foods and sugar-free sweets.
• Consume more oat-based foods if you suffer from gas (wind) or bloating.
• Make sure you eat every meal, do not skip any
• Keep your alcohol intake to a minimum (or cut it out altogether)
• Keep your fizzy drink (carbonated drink) intake to a minimum
• Limit your intake of fresh fruit. It is important to ask a health professional about this.
• Limit your tea and coffee intake to no more than three cups per day
• Make sure your fluid intake is adequate. This typically means drinking at least eight cups of fluid per day (may vary).
• Meals should be eaten at the same time each day
• Some people may have to avoid or limit their intake of resistant starch, which is commonly found in processed or recooked foods, as well as some legumes. Resistant starch is not broken down in the digestive tract and counts as a component of dietary fiber.
• Eat slowly

Exercise - some patients find that exercise helps relieve their symptoms of IBS, while others don't. If exercise helps, the patient should do vigorous exercise for 30 minutes five times a week.

Probiotics - these may help some patients with IBS, while others may not be so lucky. The benefits of probiotics take about four weeks to appear. As there are many types of Probiotics on the market, some of which promote the growth of specific types of bacteria in the gut, the patient should ask a health care professional which one to take.

Anxiety and stress - a significant number of IBS patients will find their symptoms are relieved by:

• Relaxation techniques. This may include breathing exercises or meditation.
• Some specific physical activities, such as Tai Chi or yoga.
• Regular physical exercise.
• Stress counseling or CBT (cognitive behavior therapy) - see further down for more details.

Medications - the following medications are used for IBS symptoms:

• Antispasmodic medications - these may reduce abdominal cramping and pain. Examples include mebeverine and therapeutic peppermint oil. They relax the muscles in the gut. Although side effects are rare, a small number of patients may experience irritation on the skin around the anus, as well as occasional heartburn. Pregnant women should not take antispasmodic medications.
• Bulk-forming laxatives - for patients with constipation. It is important to drink plenty of liquids.
• Antimotility medications - for diarrhea. An example includes loperamide. This medication slows down the contractions of the intestinal muscles. Side effects may include dizziness, abdominal cramps, skin rash, and abdominal bloating. Pregnant women should not take loperamide.
• TCAs (tricyclic antidepressant) - they often help reduce abdominal pain and cramping. It is recommended for patients who have not been able to control their abdominal pain and cramping. Side effects may include dry mouth, fatigue, and constipation.
• Kolanticon - this medication an antispasmodic ingredient for abdominal cramping and pain, simeticone for trapped wind, as well as two different antacids for heartburn and stomach acid. In the UK and most other countries it is an OTC (over-the-counter, no prescription required) medication.

Alternative therapies - some patients have experienced improved symptoms with:

• Acupuncture
• Aloe vera - an herbal remedy
• Reflexology

Experts say alternative therapies need to be more fully investigated before any scientific conclusions are made regarding their effectiveness in treating IBS symptoms.

Psychological therapy (psychological intervention) - this may include PIT (psychodynamic interpersonal therapy), hypnotherapy or CBT (cognitive behavior therapy):

• Psychodynamic interpersonal therapy (PIT) - unconscious thinking, our beliefs and attitudes may have an impact on the way we feel, act and think. The therapist helps the patient explore their past to find out whether anything may have affected them unconsciously. The patient is then helped to face negative attitudes, beliefs and behaviors, and to alter them.
• Hypnotherapy - hypnosis is used to alter the patient's unconscious mind's attitude to symptoms. The individual may also learn self-hypnosis techniques.
• Cognitive behavior therapy (CBT) - this technique is based on the principle that how we feel partly impacts on how we think about things. The patient is trained to react differently to their condition through relaxation techniques and adopting a positive attitude. CBT has been found to be effective in treating pain, stress, anxiety and depression.