Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome or IBS is a chronic (long-term) disorder which affects the functioning of the digestive tract (gastrointestinal tract) especially the large intestine (colon part). The gastrointestinal tract is a term used for the entire pathway through which food passes (mouth, food pipe, stomach, small intestine, and large intestine) and the associated organs like liver, gallbladder, and pancreas which secrete digestive enzymes. IBS is related to problems with the defecation function (bowel movement) of the colon. There may be diarrhoea (loose motions) or constipation (difficulty in passing faeces) or both. It is associated with bloating (feeling full with gas) and abdominal pain.

IBS is a health problem with the main symptom of problems with passing stools.  Based on the type of stool which the person passes every day, it is of following types:

• IBS with constipation (IBS-C).
• IBS with diarrhoea (IBS-D).
• IBS with alternating constipation and diarrhoea (IBS-M).
• Post-infectious IBS.
• Post diverticulitis IBS (swelling in the part of large intestine).

The most common symptom of IBS is abdominal pain. Pain is in the form of abdominal cramps in the lower abdomen. This pain is usually is relieved by passing stools. Abdominal bloating (feeling full due to excessive gas production) worsens throughout the day, but the cause is unknown. (Read more - Bloating causes and home remedies)
People with IBS-C have hard pellet stools (small pebble-shaped stools- which are often hard) along with abdominal pain. A lot of straining occurs while passing stools. People with IBS-D pass stools which are watery and low in volume. There is a persistent feeling of incomplete bowel emptying. Discharge of mucus is also common but is not accompanied by bleeding. There is no weight loss reported. Post diverticulitis IBS causes abdominal pain mainly on the left side along with fever. Patients with IBS-M demonstrate alternating symptoms of both IBS-C and IBS-D. (Read more - Stomach pain causes and treatment)

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The exact causes of IBS are yet unknown to researchers worldwide. Many experts are of the opinion that the symptoms of IBS can be possibly triggered due to psychosocial factors (interaction between behaviour and environmental factors), altered gastrointestinal motility, and problems with the brain-gut interactions. Malabsorption of certain foods such as fermented foods, complex carbohydrates can also cause symptoms related to IBS. For example, lactose intolerance is a significant symptom leading to IBS.

Risk factors

Risk factors are factors which can worsen IBS. Although the cause of IBS is still not entirely known, but the risk factors for IBS have been identified. These include:

• Gender
  Females are more prone to IBS than males. Menstrual cycle and the associated hormonal changes affect the overall health of a female. 
• Family history
  IBS tends to run in families and may be present in many members of the family. There is a belief that it is triggered due to a genetic anomaly.
• Age
  It affects people of a young age group because irregular and improper diet are very common amongst them. Emotional eating, large meals, skipping meals, unhygienic food habits are significant risk factors.
• Food allergies
  Some people are unaware of allergies to specific food products which they take. Taking such foods repeatedly can trigger an allergic response in these people and act as a risk factor. Carbonated drinks and alcohol can also lead to digestion problems. High protein diets, increased intake of bread and processed foods can also worsen the symptoms. (Read more - Allergy treatment and causes)
• Stress
  Stress can aggravate the disorder, but it is not believed to be the cause of IBS.

The most critical step to prevent worsening of IBS is a definite diagnosis and reassurance to the person with IBS. Many people with IBS have apprehensions of developing serious illnesses such as cancers. This can lead to a vicious circle of anxiety which can, in turn, worsen the symptoms. A proper explanation can break this chain of anxiety and apprehensions by reassuring that symptoms are not due to any underlying disease but a result of altered bowel mobility and sensation.

One of the first important steps is to avoid gluten in our diet. Gluten is a protein found in wheat. People with IBS are advised to cut down their lactose (rich in dairy products) intake. Carbohydrate intake and artificial sweeteners should also be curtailed from the diet.

Regular exercise and sound sleep help in stress and anxiety management. It is helpful to engage in fun activities like listening to music or playing some games. Yoga, hypnotherapy, counselling by a counsellor or sharing your stress with friends or family members may work well.

• People with IBS-C type are advised to have better dietary choices like regular intake of fibre in the diet by adding cereals, beans, fruits, and vegetables. Try to avoid foods with high sugar content. Adequate hydration is also important to prevent constipation.
• In people with IBS-D, moderate intake of soluble fibre is recommended. You may be advised to take Psyllium (obtained from foodstuffs like oats) which is found in laxatives and adds bulk to watery stools. Also, mixing foods with varied temperatures like a cold drink with a hot soup in the same meal should be avoided. Foods which increase bloating (gas) such as cabbage, cauliflower, and drinking water or cold drinks with meals should also be avoided. Eating small portions of food throughout the day has been proven to be beneficial to people with IBS-D type.
• Sometimes some medicines like antibiotics or antidepressants or sugar-based syrups to treat a cough can alleviate the symptoms. It is advisable to find an alternative medicine with your doctor which will not worsen your symptoms.
• In females with IBS due to irregular menstrual cycle, birth control pills may be prescribed to regularise their periods. These medicines may, however, aggravate a few of the symptoms like stomach bloating, cramps in stomach and vomiting. Females are advised to seek a doctor’s option regarding suitable medicines for the same. Yoga helps to relieve mood swings due to hormonal imbalance and improve the symptoms of IBS related to it.

A definite diagnosis can be established in people under the age of 40 years without undergoing complicated tests on the basis of signs and symptoms. Complete blood count (CBC), ESR (Erythrocyte sedimentation rate) and sigmoidoscopy (examination of the colon with a flexible, lighted tube) are usually performed to rule out other causes. Investigations like barium enema or colonoscopy are carried out only in older patients to rule out colorectal cancer. Tests to eliminate lactose intolerance, hyperthyroidism, and alcohol abuse are also performed.

Tests taken to rule out other disorders include CT scan to negate abdominal pain due to some other cause, stool test to look for any possible parasite infections, breath test for bacterial growth, and upper gastrointestinal endoscopy to collect a fluid sample from the intestine.

Reassurance to the patient and an explanation for the symptoms should be carried out. The treatment for IBS depends on the type of IBS category that the person has. 

• Pain
  If the pain is not relieved on its own, a course of an anticholinergic agent (dicyclomine 10 mg) or an antispasmodic (mebeverine 135 mg) thrice a day may be given.
• IBS-D
  The fibre content of the diet is increased and bulk laxatives like fruits with skin, vegetables, methylcellulose or isabgol husk are added. Medicines like Loperamide (2-4 mg up to 4 times a day) or Colestyramine (1 sachet daily) or Codeine phosphate (30-90 mg daily) may be prescribed if symptoms persist. A psychotropic drug like Amitriptyline (10-25 mg) once at night may also be recommended in extreme cases.
• IBS-C
  Drinking plenty of water to make the stool softer, and increase soluble fibre like oats, pulses, carrots, peeled potatoes. Milk of magnesia may be added to the treatment plan if fibre supplements fail to relieve the symptoms.
• Post-infectious IBS
  In post-infectious IBS the accurate antibiotic regime should be followed to cure the infection and subsequently eradicate the symptoms.
• Antidepressants in IBS
  Tricyclic antidepressant therapy improves the condition of irritable bowel patients. Patients who have major symptoms like pain, diarrhoea, and constipation as a predominant symptom benefit the most.

Lifestyle management

There are no concrete steps or medications to cure IBS completely. However, symptoms can be avoided by making proper changes in the daily diet and lifestyle.

• Opting for home cooked food using the best quality ingredients and maintaining a food diary with a record of the food items consumed along with those that alter the symptoms help in keeping symptoms in check.
• Taking up an exercise regimen daily also helps in improving overall symptoms. Drinking enough water in case of constipation, adding fibre to the diet in case of diarrhoea, and trying some healthy probiotic drinks which increase the good bacteria in the gut also help in better digestion.
• People with IBS are advised to avoid skipping meals, have small meals, avoid fatty and packaged foods like chips and biscuits, avoid smoking, alcohol, and caffeine (in tea and coffee) etc.
• Stress management through playful activities and relaxation activities such as meditation is essential as stress can aggravate the symptoms. 

Constipation persisting over an extended period or even if occurring recurrently can lead to an impacted bowel. It results in pain and vomiting and may require immediate surgery or hospitalisation. Dehydration and electrolyte imbalance are common complications among people with IBS-D type who are suffering from recurrent diarrhoea. Imbalance of electrolytes can cause life-threatening complications affecting the nervous system (brain and spinal cord and nerves), cardiovascular system (heart-related) etc. People often try to avoid different food products which trigger the symptoms related to IBS. It can lead to malnourishment and related disorders. Haemorrhoids (swollen blood vessels in the anus causing bleeding tools) are predominant lesions caused due to excessive constipation in IBS-C type patients. Many people also miss work days due to the severity of the symptom which is recurrent in nature.