Irritable Bowel Syndrome

There's no known treatment for Irritable Bowel Syndrome, but it can be managed by changes in diet and lifestyle

Satish is getting ready for office. He is already late and his belly is bothering him again. He has just finished breakfast, but is unable to resist the urge to visit the toilet again. So he relents, only to pass some pencil-like stools. This has been happening for over a year. No therapy seems to bring relief.

Satish has Irritable Bowel Syndrome [IBS], the most common disorder of the gut in the developed world, affecting 8 per cent – 20 per cent of the population. In recent years, the problem is being increasingly detected in developing countries like India, with a prevalence of 4 per cent — 12 per cent. It’s more common among the urban affluent, and is found equally in men and women. In more than 50 per cent cases, symptoms appear before 35 years of age.

What is ‘Irritable Bowel Syndrome’?

The problem in ‘Irritable Bowel Syndrome’ is in the large intestine or the colon—a five feet long tube that connects the small intestine to the terminal parts of the gut, namely the rectum and the anus.

The colon is the final passage for digested food. Here, water, salts and some nutrients are absorbed into the body and the rest is pushed into the rectum for evacuation. ‘Irritable Bowel Syndrome’ results from altered functioning of the colon due to heightened sensitivity or altered movements that cause faster or slower than usual contractions.

Is it a serious condition?

‘Irritable Bowel Syndrome’ does not cause any serious health complications or threat to life. However, it does affect a person’s quality of life.

What are the symptoms?

Every person experiences different symptoms, which also vary from time to time in the same person. Abdominal cramps, pain, bloating or a sensation of gas and discomfort are the most common manifestations, along with constipation and/or diarrhoea.

Those with predominant constipation [‘Irritable Bowel Syndrome’-C], experience reduced frequency of bowel movements and after much strain, pass hard, pencil-like or small pellets of stools or no stools at all. Some patients have increased frequency of stools that may be loose or watery [diarrhoea-predominant, [‘Irritable Bowel Syndrome’-D] and may feel uncontrollable need to empty their bowels. Still others, suffer from constipation and diarrhoea alternately, along with pain [‘Irritable Bowel Syndrome’-A].

What causes ‘Irritable Bowel Syndrome’?

The exact causes of ‘Irritable Bowel Syndrome’ are hitherto unknown. However, it is believed that many biological, psychological and social factors may be involved. Moreover, these may vary from person to person. The entire gut, from mouth to the anus, is connected to the brain and the spinal cord through an intricate network of nerves. More than 100 tiny proteins, known as gut peptides, also help in the interaction between various parts of the gut and the brain. This brain-gut axis senses the volume and contents of the food as it passes through the gut and based on this information, the nervous system regulates digestion, absorption and transit of food. Altered sensitivity of the gut and altered signal processing in the brain may be the reason for abnormal bowel movements in patients of ‘Irritable Bowel Syndrome’.

Certain foods, infections, stress and negative emotions may contribute to the hypersensitivity of the gut.

How is it diagnosed?

In the past, the diagnosis of ‘Irritable Bowel Syndrome’ was made by ruling out other diseases exhibiting similar symptoms. For that, a series of expensive tests such as X-rays, scans, endoscopic evaluation and even biopsies were ordered. The Rome III criteria are the latest criteria laid down by the Rome Foundation[1] for diagnosing ‘Irritable Bowel Syndrome’. It helps physicians diagnose ‘Irritable Bowel Syndrome’ easily, right at the first visit on the basis of a detailed history of the illness and a thorough physical examination.

Rome III states that ‘Irritable Bowel Syndrome’ should be diagnosed if symptoms have occurred over at least six months, with recurrent abdominal pain or discomfort occurring for at least three days per month in the previous three months. They should be accompanied by changes in the frequency, form or appearance of stools and improvement in the symptoms with defecation. Applied rationally, these criteria can positively predict the diagnosis of ‘Irritable Bowel Syndrome’ in as high as 98 per cent of cases, obviating the need for expensive and invasive tests.

What role does food play in ‘Irritable Bowel Syndrome’?

Dairy products such as milk, yoghurt, buttermilk and cheese; fructose and fructans found in fruits, juices, sugars and sweets, grains and tubers; chocolates; artificial sweeteners; chemical additives such as dyes and preservatives, carbonated beverages such as sodas; citrus and caffeine beverages; alcohol; red meat or fish may trigger or aggravate the symptoms of ‘Irritable Bowel Syndrome’.

Gluten-containing grains such as wheat, barley and rye are also responsible for aggravating ‘Irritable Bowel Syndrome’. Lack of fibre in the diet or use of laxatives may also be responsible. In some cases, infections of the gut may precipitate an acute onset of ‘Irritable Bowel Syndrome’ and this is more common in developing countries.

How is ‘Irritable Bowel Syndrome’ treated?

There is no single effective treatment. Certain drugs help relieve spasms and pain and improve bowel function. Antidepressants, anxiolytics and such other drugs are also recommended in some cases. Just as the cause of ‘Irritable Bowel Syndrome’ may vary from person to person, treatment measures too need to be tailored. Several alternative therapies have been tried, but there is no conclusive evidence that they work. The patients can only try and keep their condition in control. Being able to identify the triggers and aggravating factors and avoiding them prevent flare ups.

What can I do?

Some people benefit from totally eliminating dairy products, fruits, wheat, corn, barley, peanuts, soy, processed foods, refined oils, caffeine, chocolates and alcohol. Increasing the intake of vegetables ensures availability of fibre as well as minerals such as calcium. Those with a tendency to constipation benefit from eating a high-fibre diet. Drinking at least 6 – 8 glasses of clean water per day keeps you well-hydrated. Regular walking, swimming, techniques such as biofeedback, hypnosis or counselling, may help in alleviating stress.

It’s tempting to try self-medication but relying on over-the-counter remedies for relieving diarrhoea or constipation may do more harm than good.

[1] Rome Foundation, a not for profit organisation that provides support for diagnosis and treatment of functional gastrointestinal disorders [FGIDs].

Srinivas Bevinje
Dr Srinivas Kakkilaya Bevinje, MD, is a Mangalore-based consultant physician. His areas of interest include metabolic medicine, infectious diseases, and community health.


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