Irritable Bowel Syndrome, or more commonly referred to as IBS, is a condition with an increasing prevalence affecting roughly 12 percent of the population.. Sufferers of the condition are mostly women aged 20 – 30, but it can affect anyone at any age.
Individuals with the syndrome can experience a change in their bowel habit, stomach pain, fatigue, bloating and food intolerances amongst a variety of symptoms.
The cause of the condition is not well understood, but it is believed to be caused by a mix of an altered gut flora, bowel hypersensitivity, genetics and psychological triggers.
An Altered Gut Flora
We have bugs in our gut (the ‘flora’) to help digest our food and absorb vital nutrients. However, sometimes this balance between good and bad flora is disturbed, resulting in lower amounts of good bugs such as Lactobacillus, leading to troubles with digestion.
1. Change in Bowel Habit
One of the commonest symptoms found amongst Irritable Bowel Syndrome sufferers is a change in bowel habit. This term refers to an insidious change of a normal habit to diarrhoea or constipation.
There are three broad categories of IBS; IBS-D, IBS-C and IBS-M, encompassing the three changes to one’s bowels: Diarrhoea, Constipation or a Mixed pattern respectively.
IBS-Diarrhoea (IBS-D)
IBS-D is characterised by loose, frequent stools (more than three times a day) and is the result of food in the gut moving too quickly. This leaves little time for the gut to absorb water from the stools, resulting in them becoming thin, loose and watery.
If you suffer from this type of IBS you may also pass mucus when opening your bowels. It is important that you mention this to your doctor as there are other serious health conditions which present in this way too which must be ruled out.
Diarrhoea can cause dehydration and malabsorption of certain nutrients due to the short transit time of stool travelling through the gut, so it is imperative to stay hydrated and eat a well-balanced diet.
Some suggestions to improve diarrhoea include reducing fibre intake, avoiding the sweetener sorbitol and potentially taking medications like loperamide to reduce the water content of the stool.
IBS-Constipation (IBS-C)
It is commonly thought that IBS causes patients to suffer diarrhoea, however it can also cause constipation whereby an individual empties their bowels fewer than three times a week. This is caused by slow contractions of the gut, resulting in the over-absorption of water from the stool thereby leaving it hard and difficult to pass during a bowel movement.
In some cases, chronic constipation increases pressure on the back passage so much so haemorrhoids may develop. If you suffer from IBS-C, It is extremely important measures are taken to soften your stools. The main way this can be done is by increasing dietary intake of fibre through fruits, vegetables, pulses and wholegrains.
Your doctor may suggest “stool-bulking” medications to increase the water content of the stool. These work by retaining water in the stool and stimulating gut contractions to soften the stool in order to treat constipation).
IBS-Mixed (IBS-M)
Although it is the least common type, some individuals may experience the mixed pattern of IBS, where bowel habits alternate between constipation and diarrhoea. Patients with this type often report symptoms of IBS-D such as frequency, urgency to pass loose stools, as well as symptoms of IBS-C which include passing hard stool and tenesmus (the feeling of an incomplete bowel movement).
This changing pattern of bowel habit may make it challenging to find a treatment regime.
Reducing fibre
A daily intake of around 30g of fibre is recommended for the average adult, as it bulks up and softens stool to prevent constipation. However, those suffering IBS-D should lower their daily intake to prevent stools becoming too soft.
2. Stomach Pain
Most patients with IBS complain of suffering some degree of stomach pain.
Normally, the brain and digestive system work synchronously to digest food, however in IBS this mechanism is turbulent and results in a deranged balance of hormones, bacteria and electrical signals. This usually leads to pain in the middle to lower regions of the stomach, relieved by a bowel movement.
Managing stomach pain in IBS can be tricky due to its erratic nature, but some measures which can be considered include avoiding high FODMAP foods, regularly exercising and reducing stress.
You may find it beneficial to utilise therapies like antispasmodics (gut relaxants), such as peppermint oil to further help to reduce stomach pain.
3. Fatigue
Fatigue and low body stamina are seen in those with IBS and can lead to a poor quality of life. This aspect of the disease is poorly understood despite its prevalence amongst sufferers.
In a study, 160 patients with Irritable Bowel Syndrome self-reported their levels of fatigue which were assessed using the Fatigue Impact Scale. It was concluded that the levels of fatigue these patients suffered limited their ability to efficiently carry out activities of daily living, and their bodily reserves to combat fatigue were not as potent as that of a non-IBS sufferer.
In another study of 50 people with IBS, they were told to sleep for longer hours than their non-IBS counterparts. Despite this, high levels of fatigue and a disordered sleeping pattern were reported.
It is evident that there is a high incidence of tiredness amongst those with IBS.
Whilst it is not entirely clear why this link exists, it is thought to be due to fatigue and poor gut health. It is recommended that you get adequate sleep (around 8 hours for an adult), eat a healthy and balanced diet and take part in moderate exercise as these measures have been shown to reduce fatigue and improve symptoms of IBS.
4. Bloating and gas
If you suffer from IBS, you are likely to have experienced bloating from time to time. Bloating and stomach distension is due to a build-up of gas within the gastrointestinal tract and women tend to suffer from this more than men.
In one study, bloating was described as the most common, and bothersome symptom experienced by patients.
This gas build up has a number of causes, including the breakdown of food, hypersensitivity of the gut or a general gut dysfunction.
Avoiding triggering foods and maintaining a healthy lifestyle can reduce bloating and gas build up.
The NICE Guidelines suggest consuming oats and up to a tablespoon of linseeds a day to help reduce bloating.
5. Food Intolerances
Many people with IBS have some degree of food intolerance, whereby eating certain foods triggers stomach pain and even the sudden urge to empty the bowels amongst other symptoms.
A study of 82 individuals with IBS showed 70% had symptoms related to the intake of food.
In another study, 197 patients filled a questionnaire relating to food triggering their IBS symptoms. 70% of these patients’ symptoms were due to incomplete carbohydrate absorption, 49% due to dairy and 52% due to fried and fatty foods. This is a common trend amongst patients, with gluten, dairy and fatty foods triggering flares of IBS. Whilst food is central to life and is needed to survive, it is important to gauge which ones are safe to consume.
Over the last decade, the focus on using dietary measures to control symptoms has skyrocketed, due to most IBS patients complaining of an onset of symptoms following food intake.
The recommended starting point for anyone with a suspected food intolerance and IBS symptoms is to trial the FODMAP DIET. This plan highlights the foods to avoid and foods to enjoy with IBS.
To work out which foods are triggering your bowel symptoms, it is recommended you keep a food diary for a number of weeks, documenting daily food intake and severity of symptoms. This can be used to prevent symptoms by pinpointing and omitting the offending food and drink items from your diet.
What are the implications of IBS?
IBS is a functional disorder, meaning it is not due to any particular physical or chemical abnormality. Therefore it is very unlikely to have any major effect on your health in the future. A common belief is IBS can increase the chances of bowel cancer in the future, but this is untrue: IBS weighs no bearing on the potential future development of bowel cancer.
Unfortunately, IBS does have a psychosocial impact on individuals, and can lead to mental health disorders like anxiety and depression as well as disrupting normality to the day. Individuals with IBS often have anxiety about going out due to fears of a spontaneous flare up at an inconvenient time or place.
Following the measures mentioned above regarding food intolerance and medications will aid in keeping symptoms in remission. The gut and brain are linked by the brain-gut axis, whereby signals are sent between the two to modulate bowel function. Dysfunctions in this system can be caused by an altered mental state, which will disrupt the bowel’s functioning, leading to symptoms. Therefore stress and anxiety management like meditation and Cognitive Behavioural Therapy will help in keeping symptoms at bay.
So... When should I see my doctor?
If you think you have been suffering from any of these symptoms, it is always a good idea to bring this up with your general practitioner. They will be able to carry out a full medical history and examination to determine the cause of your symptoms.
Whilst IBS is an extremely common condition, its symptoms do overlap with other, potentially more serious conditions which must always be looked out for. If you are over the age of 50 and are experiencing any of these symptoms you must visit your doctor as soon as you can. If you notice blood in the stool, unexplained weight loss or a loss of appetite, your doctor will need to carry out further investigations to rule out other gastrointestinal diseases like bowel cancer or Inflammatory Bowel Disease.
How can I manage Irritable Bowel Syndrome?
Whilst IBS is not curable, it can be managed well with the correct lifestyle changes. Use the measures above like keeping a food diary, following the FODMAP diet and managing stress levels to keep in control of your symptoms.
As maintaining a healthy lifestyle is vital to help prevent unpredictable symptoms, engaging in moderate exercise every day is another way to not only improve gut motility but your overall health. Aerobic exercises like dancing or running on a treadmill have been shown to be incredibly supportive of reducing the symptoms and severity of IBS.
Sometimes, patients require pharmacological interventions to manage their symptoms. Your doctor may offer you one of the gut motility drugs to increase or decrease the speed of your gut if lifestyle changes alone do not manage your symptoms.