Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine (colon).

What is irritable bowel syndrome (IBS)?

IBS is a mix of belly discomfort or pain and trouble with bowel habits: either going more or less often than normal (diarrhea or constipation) or having a different kind of stool (thin, hard, or soft and liquid). IBS affects between 25 to 45% Indians. People are most likely to get the condition in their late teens to early 40s.

Is IBS serious?

It’s not life-threatening, and it doesn't make you more likely to get other colon conditions, such as ulcerative colitis, Crohn's disease, or colon cancer. But IBS can be a long-lasting problem that changes how you live your life. People with IBS may miss work or school more often, and they may feel less able to take part in daily activities. Some people may need to change their work setting: shifting to working at home, changing hours, or even not working at all.

What Are the Symptoms of IBS?

People with IBS have symptoms that can include:

• Diarrhea (often described as violent episodes of diarrhea)
• Constipation
• Constipation alternating with diarrhea
• Belly pains or cramps, usually in the lower half of the belly, that get worse after meals and feel better after a bowel movement
• A lot of gas or bloating
• Harder or looser stools than normal (pellets or flat ribbon stools)
• Bloating sensation: a belly that sticks out

Stress can make symptoms worse.

Some people also have urinary symptoms or sexual problems.

What are the types of IBS?

There are four types of the condition. There is IBS with constipation (IBS-C) and IBS with diarrhea (IBS-D). Some people have an alternating pattern of constipation and diarrhea. This is called mixed IBS (IBS-M).  Other people don’t fit into these categories easily, called unsubtyped IBS, or IBS-U.

What are the causes of IBS?

While there are several things known to trigger IBS symptoms, experts don't know what causes the condition.

Studies suggest that the colon gets hypersensitive, overreacting to mild stimulation. Instead of slow, rhythmic muscle movements, the bowel muscles spasm. That can cause diarrhea or constipation.

Some think that IBS happens when the muscles in the bowels don't squeeze normally, which affects the movement of stool. But studies don’t seem to back this up.

Another theory suggests it may involve chemicals made by the body, such as serotonin and gastrin, that control nerve signals between the brain and digestive tract.

Other researchers are studying to see if certain bacteria in the bowels can lead to the condition

Because IBS happens in women much more often than in men, some believe hormones may play a role. So far, studies haven’t borne this out.

How is IBS diagnosed?

There are no specific lab tests that can diagnose IBS. Your doctor will see if your symptoms match with the definition of IBS, and he may run tests to rule out conditions such as:

• Food allergies or intolerances, such as lactose intolerance and poor dietary habits
• Medications such as high blood pressure drugs, iron, and certain antacids
• Infection
• Enzyme deficiencies where the pancreas isn't releasing enough enzymes to properly digest or break down food
• Inflammatory bowel diseases like ulcerative colitis or Crohn's disease

Your doctor may do some of the following tests to decide if you have IBS:

• Flexible sigmoidoscopy or colonoscopy to look for signs of blockage or inflammation in your intestines
• Upper endoscopy if you have heartburn or indigestion
• X-rays
• Blood tests to look for anemia (too few red blood cells), thyroid problems, and signs of infection
• Stool tests for blood or infections
• Tests for lactose intolerance, gluten allergy, or celiac disease
• Tests to look for problems with your bowel muscles

How is IBS treated?

Nearly all people with IBS can get help, but no single treatment works for everyone. You and your doctor will need to work together to find the right treatment plan to manage your symptoms.

Many things can trigger IBS symptoms, including certain foods, medicines, the presence of gas or stool, and emotional stress. You’ll need to learn what your triggers are. You may need to make some lifestyle changes and take medication.

Diet and Lifestyle Changes

Usually, with a few basic changes in diet and activities, IBS will improve over time. Here are some tips to help reduce symptoms:

• Avoid caffeine (in coffee, teas, and sodas).
• Add more fiber to your diet with foods like fruits, vegetables, whole grains, and nuts.
• Drink at least three to four glasses of water per day.
• Don't smoke.
• Learn to relax, either by getting more exercise or by reducing stress in your life.
• Limit how much milk or cheese you eat.
• Eat smaller meals more often instead of big meals.

Keep a record of the foods you eat so you can figure out which foods bring on bouts of IBS.Common food "triggers" are red peppers, green onions, red wine, wheat, and cow's milk. If you're concerned about getting enough calcium, you can try to get it from other foods, like broccoli, spinach, turnip greens, tofu, yogurt, sardines, salmon with bones, calcium-fortified orange juice and breads, or calcium supplements.

Medications

The following types of drugs are used to treat IBS:

• Antispasmodics can control colon muscle spasms, but experts are unsure that these drugs help. They also have side effects, such as making you drowsy and constipated, that make them a bad choice for some people.
• Antidiarrheal drugs, such as Imodium, may help with diarrhea.
• Laxatives can give short-term relief from constipation.
• Bulking agents, such as psyllium, wheat bran, and corn fiber, help slow the movement of food through the digestive system and may also help relieve symptoms.
• Antidepressants may also help relieve symptoms in some people.

Make sure to follow your doctor's instructions when taking IBS medications, including laxatives, which can be habit forming if you don’t use them carefully.