Irritable Bowel Syndrome (IBS) is the most common digestive disorder seen by doctors, it is a complex functional digestive disorder and encompasses a wide range of symptoms. It is also known as spastic colon, intestinal neurosis, spastic colitis and mucous colitis.
Irritable Bowel Syndrome affects approximately 1 in 5 Australians, women are twice as likely to suffer from IBS than men and symptoms have a tendency to start in adolescence or early adulthood. It is unusual for symptoms to start after the age of 40 years although IBS can affect any one at any age, race or culture.
Irritable Bowel Syndrome affects the muscles and nerves in the bowel, causing the normal rhythmic muscular contractions of the bowel to become abnormal, irregular, uncoordinated and overactive. This can cause abdominal pain, irregular bowel movements and cause an accumulation of mucous, toxins and faecal matter in the bowel which can lead to gas, bloating and constipation.
The Cause of Irritable Bowel Syndrome
The underlying cause of IBS is currently unknown. It is thought that a single cause is unlikely and that there are irregularities in the intestinal hormones motilin, vasoactive intestinal peptide (VIP) and cholecystokinin (CCK) which are responsible for bowel motility. Factors that can ‘trigger’ IBS attacks include stress, medication, food intolerances, changes in routine and infection.
- General diet: People suffering from IBS can have different food triggers, some may find spicy or sugary foods are a trigger for them and others may find having a low fibre diet can exacerbate their symptoms. Generally once food intolerances and triggers are identified and eliminated from the diet IBS sufferers can have a relatively normal, healthy balanced diet
- Food intolerances: Dairy is the most common dietary trigger of IBS, in particular it is the sugar lactose which is found in dairy that causes the irritation and reaction. Other sugars that are thought to trigger IBS are sorbitol and fructose
- Infection: Up to 25% of IBS cases may be caused by gastroenteritis (a gut infection which can cause vomiting and diarrhoea). The reason this may occur is unknown but may be due to changes in the nerve function of the bowel, changes in the normal bowel flora population or the virus or germ may trigger or sensitise the gut in some way to cause persisting IBS symptoms
- Medications: Certain medications can cause alterations in the bowel flora and also lead to diarrhoea and constipation.
- Emotional stress: Powerful emotions such as stress and anxiety can affect the nerves in the bowel of sensitive people. Stress is known to alter the contractions of the bowel. Stressful life events, difficulties with interpersonal relationships and work dissatisfaction can exacerbate symptoms
The symptoms of IBS vary from person to person, some people have occasional mild symptoms, some have prolonged periods of unpleasant symptoms and others suffer from flare ups from time to time.
The symptoms of IBS include:
- Abdominal pain or stomach cramps, often relieved by passing wind or a bowel movement.
- Frequent altered stool form (hard, loose, watery, lumpy) alternating between constipation and diarrhoea.
- A feeling of incomplete emptying of the bowel after passing a motion.
- Abdominal bloating, pain, discomfort and wind.
- Experiencing the need to go to the toilet frequently to defecate.
- Mucous present in the stools, frequent passing of mucous.
- Experiencing frequent episodes of diarrhoea.
- Experiencing frequent episodes of constipation.
- A change in the appearance of the stool.
- Nausea, poor appetite, indigestion, belching.
If you experience any of these symptoms persistently, it is essential you have your digestive system checked by a doctor. Due to IBS having similar symptoms to other digestive conditions, you need to see your doctor as soon as possible to have some further investigations done, to help identify the underlying cause of your symptoms. If you have blood or a black tarry substance in your stool you need to seek immediate medical attention. Blood in the stool is not a symptom of IBS.
There are three major categories of IBS:
- Constipation-predominant: People who suffer from constipation predominant IBS frequently experience abdominal cramping, pain and bloating, particularly after eating. Their bowels can often alternate between being constipated to having normal bowel motions.
- Diarrhoea-predominant: People who suffer from diarrhoea predominant IBS often feel an urgent and uncontrollable need to have a bowel motion, generally going to the toilet cannot be delayed and incontinence may be a problem. They tend to experience diarrhoea first thing in the morning or after eating and rarely have symptoms at night. They can also suffer from abdominal pain and discomfort.
- Alternating constipation and diarrhoea: Like the title says people suffering from this category of IBS tend to suffer from both constipation and diarrhoea and alternate between them.
However, many people will not fall neatly into any one category and overlaps can occur.
There is no specific test for IBS, diagnosis tends to be based on a process of elimination. As IBS is a functional digestive disorder there are no abnormalities in the bowel structure. Doctors will use diagnostic tests to rule out other conditions which can have similar symptoms to IBS. Investigations which may be performed include blood and stool tests, ultrasounds, x-rays, sigmoidoscopy, colonoscopy and or a barium enema.
There is currently no cure for IBS, identifying and avoiding individual triggers is the general treatment. The majority of IBS sufferers mainly control their symptoms through dietary changes, stress management and some may use medication to help. Naturopathy, hypnotherapy and Chinese and western herbal medicine may also be used as part of IBS treatment.
Irritable Bowel Syndrome differs from person to person so there are no specific dietary guidelines. Finding out if you have any food intolerances and eliminating them from your diet is extremely important, as is finding out what your other triggers are and implementing strategies to help deal with them. Consulting a naturopath or nutritionist is important as they can design a diet specifically for your needs. A naturopath or nutritionist can educate you on the available alternatives to the food or food group you are eliminating, they will also ensure you are getting the essential nutrients that the food or food group was providing. Foods to Enjoy:
- Fibre: increasing fibre intake is generally recommended for IBS sufferers, although for some IBS sufferers increasing their fibre intake can worsen symptoms. When increasing fibre in your diet it needs to be done gradually. Also when increasing your fibre intake, it is also extremely important to increase your water intake.
Foods to Limit or Avoid:
- Junk food, chocolate, lollies, fried foods, cakes, biscuits.
- Processed foods.
- Animal fats, butter.
- Artificial sweeteners, colourings, preservatives and additives.
- If wind is a problem look at avoiding or limiting gas producing foods such as beans, cabbage, broccoli and cauliflower. Once symptoms have settled and triggers have been identified these food may be reintroduced if not problematic.
- Avoid dairy, if lactose is a trigger.
Beverages to Enjoy: Fluid intake should be spread evenly over the day:
- Drink at least 1.5 - 2 litres of filtered water daily.
- Don’t drink with meals, drink 15mins prior to the meal or 1 hour after the meal.
- Herbal teas: eg peppermint, ginger, chamomile.
- Liquid chlorophyll.
- Aloe vera juice.
Beverages to Avoid: These beverages can aggravate the symptoms of IBS
- Soft drinks – even sugar free alternatives.
- Caffeine – coffee, energy drinks.
- Alcohol – as it irritates the lining of the stomach and colon.
- If you haven’t already, have some allergy tests done – food sensitivities and intolerance can trigger IBS symptoms.
- Have a stool analysis done as this can help identify if there are any bugs in your digestive tract or an imbalance of gut flora that may be contributing/causing your symptoms.
- Have your nutrient levels tested as malabsorption problems can be a part of IBS and some IBS sufferers can suffer from chronic diarrhoea which may lead to low levels or deficiencies of specific nutrients.
- Keep a food and lifestyle diary - record everything you eat, drink, times you were stressed and when you exercised. This may help to identify triggers and may also see if exercise helps ease or prevent IBS symptoms.
- Manage your stress – meditate, exercise, deep breathing, make sure you get eight hours of sleep a night.
- Exercise – exercise is extremely beneficial as it aids stress management, helps maintain a healthy weight, keeps you fit and also helps to regulate bowel movements.
- Stop smoking as tobacco irritates the lining of the colon and stomach.
- Eat small regular meals - take time to enjoy your food, chew well, eat at a leisurely pace, seated and stress free.
- Relax during and after eating a meal, don’t read while eating, with the TV on in stressful situations.
- Do not skip meals or leave long gaps between eating, do not eat in a hurry, do not eat large meals and leave one to two hours after eating before going to bed
- Reduce stress levels as stress can exacerbate IBS symptoms.
- Educate yourself - understanding your condition and knowing you are not alone can help give you control and confidence and greatly improve the quality of your life. This may make you less anxious which in turn may ease the severity of your IBS symptoms.
- Have regular counselling, psychology or hypnotherapy sessions - this may help with stress management, depression and anxiety.
- Avoid chewing gum – chewing gum can cause you to swallow air which can lead to gas and it also stimulates the secretion of digestive juices which can be problematic when there is no food to digest.
- Take a good quality multistrain probiotic - make sure you don’t take the same probiotic all of the time this will prevent developing an overgrowth of one particular strain of probiotic.