Irritable bowel syndrome -IBS Irritable bowel syndrome (IBS
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Dr. Atul Chowdhury
Irritable bowel syndrome -IBS

Irritable bowel syndrome (IBS) or spastic colon is a symptom-based diagnosis. It is characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits. Diarrhea or constipation may predominate, or they may alternate (classified as IBS-D, IBS-C, or IBS-A, respectively).

As a functional gastrointestinal disorder (FGID), IBS has no known organic cause.[1] Onset of IBS is more likely to occur after an infection (postinfectious IBS-PI), or a stressful life event, but varies little with age. The most common theory is that IBS is a disorder of the interaction between the brain and the gastrointestinal tract. For at least some individuals, abnormalities in the gut flora occur, and it has been theorised that these abnormalities result in inflammation and altered bowel function.

The four types of IBS are

• IBS with constipation, or IBS-C
• IBS with diarrhea, or IBS-D
• Mixed IBS, or IBS-M
• Unsubtyped IBS, or IBS-U

What other health problems do people with IBS have?

People with IBS often suffer from other GI and non-GI conditions. GI conditions such as gastro esophageal reflux disease and dyspepsia External NIDDK Link are more common in people with IBS than the general population.

Non-GI conditions that people with IBS often have include
• syndrome External NIH Link
• chronic pelvic pain External NIH Link
• temporomandibular joint disorders External NIH Link
• depressionExternal NIH Link
• anxiety External NIH Link
• somatoform disordersExternal NIH Link

Who’s at Risk for IBS?

IBS is more common in women than men, almost twice as common. Although the symptoms can begin at any age, they most commonly begin in people in their 20s. There seems to be an increased prevalence of IBS among relatives of individuals with IBS. Anxiety or stress do not cause IBS, but they make the symptoms of IBS worse.

How IBS Impacts Daily Life

When the symptoms of IBS are mild, they do not interfere with activities of daily life. When they are severe they may limit activities because of the pain or the need to go to the bathroom. Patients with IBS and diarrhea need to be constantly aware of the location of the nearest bathroom. Patients even may avoid going out socially to avoid the embarrassment of frequently going to the bathroom.

Stress and IBS

Stress worsens the symptoms of IBS just as it worsens the symptoms of most other disorders. But stress causes few if any disorders. Nevertheless, reducing stress is one reasonable approach to improving the symptoms of IBS. Sometimes reducing stress is enough to make patients comfortable, but usually more is required especially when symptoms are severe. Troublesome symptoms of IBS can cause stress which, in turn makes the symptoms more troublesome - a vicious cycle.

Cause of IBS :

The exact cause of irritable bowel syndrome (IBS) isn't known. But health experts believe that faulty communication between the brain and the intestinal tract is one cause of symptoms. In some people, this miscommunication causes abnormal muscle contractions or spasms, which often cause cramping pain. The spasms may speed the passage of stool, causing diarrhea. Or they may slow it down, causing constipation or bloating.

Many people who have IBS seem to have unusually sensitive intestines. It isn't known why their intestines are more likely to react strongly to the elements that contribute to IBS. People who have IBS may start having symptoms because of one or more factors, including:

Eating (though no particular foods have been linked with IBS).
Stress and psychological issues, such as anxiety and depression.
Hormonal changes, such as during the menstrual cycle.
Some medicines, such as antibiotics.
An infection in the digestive tract, such as salmonella.
Genetics. IBS may be more likely to occur in people who have a family history of the disorder.

Symptoms of irritable bowel syndrome include:

• Changes in bowel movement patterns.
• Bloating and excess gas.
• Pain the lower belly.
• Mucus in stools.

You are more likely to have IBS if you have these symptoms and they have lasted at least 6 months, you have had belly pain at least 3 days each month for at least 3 months, and at least two of the following are true

• The pain is relieved by having a bowel movement.
• The pain is linked to a change in how often you have a bowel movement.
• The pain is linked to a change in the appearance or consistency of your stool.

Because there are no structural problems in the intestines of people who have IBS, some people may think this means that the symptoms "are all in their head." This isn't true. The pain, discomfort, and bloating are real. They have many different causes that can be addressed to help relieve symptoms.

Bowel movement patterns(symptom)

When you have IBS, your pattern of bowel movements may be different over time. Two or more of the following may happen:

• Bowel movements may occur either more often (diarrhea) or less often (constipation) than usual. For example, you may have more than 3 bowel movements a day or less than 3 a week.
• Bowel movements may differ in size or consistency. They may be hard and small, pencil-thin, or loose and watery.
• The way stools pass changes. You may strain, feel an urgent need to have a bowel movement, or feel that you haven't completely passed a stool.
• You may have bloating or a feeling of gas in the intestines.

Other intestinal symptoms

Some people may have pain in the lower belly with constipationthat is sometimes followed by diarrhea. Other people have pain and mild constipation but no diarrhea.

Some people have intestinal gas and passage of mucus in stools.

No gastrointestinal symptoms
You may sometimes have other symptoms that don't affect the intestines, such as:
Anxiety or depression.
An unpleasant taste in the mouth.
Sleep problems (insomnia) not caused by symptoms of IBS.
Sexual problems, such as pain during sex or reduced sexual desire.
Heart palpitations. (You may feel like your heart skips a beat or is fluttering.)
Urinary symptoms. (You may have a frequent or urgent need to urinate, trouble starting the urine stream, or trouble emptying your bladder.)
Symptoms often occur after a meal, during stressful times, or during menstruation.

Making the Diagnosis

IBS is a condition with
1) well-defined clinical features, and
2) specific diagnostic criteria.
This understanding can reduce unneeded testing.

While diagnostic testing is useful in evaluating certain problems, a physician can generally diagnose IBS by:

• Recognizing certain symptom details
• Performing a physical examination
• Undertaking limited diagnostic testing

In fact, the absence of certain "red flag" signs, such as blood in the stool or fever, provides confidence that diagnostic testing to rule out other conditions is not needed.
This simpler approach is accurate, less expensive, and less burdensome to patients and physicians alike. It permits proper attention toward treatment and management rather than the unneeded and expensive pursuit of other diagnoses.

Diagnostic Testing
Are there tests that can identify it?

An experienced physician’s judgment is most important in determining what tests are needed. Testing is individualized depending on factors such as family history, presence of stress factors, symptom features, and others. The tests that are especially relevant to the evaluation of IBS symptoms may include:

Blood Tests – A complete blood count is often done to check for anemia and other abnormalities. Others include a test for tissue damage or inflammation, and a test for celiac disease.

Stool Tests – Most commonly these check for a bacterial infection, an intestinal parasite, or blood in the stool.

Sigmoidoscopy or Colonoscopy – Visual examinations of the rectum and a portion or all of the large bowel (colon) performed with a scope. Usually done when there are alarm signs such as rectal bleeding or weight loss, or as part of diagnostic screening for colon cancer after age 50.

Barium Enema – Examines the large bowel, after being coated with barium, performed by taking x-rays. This test has for the most part been replaced by colonoscopy. Women who are pregnant or unsure whether they are pregnant should tell their physician, as this test should not be done in such cases.

Psychological Tests – Questionnaires that detect anxiety, depression, or other psychological problems may be used to supplement the evaluation.

Miscellaneous Tests – Other tests may be done depending on specific aspects of an individual’s illness, especially atypical symptoms or alarm signs. However, many people do not require these other tests.

Irritable bowel syndrome (IBS) can be diagnosed based on symptoms. A doctor diagnoses IBS when a person has the typical symptoms of the disorder and, if needed, tests have ruled out other possible causes.

Most people won't need tests, but some people may because of their age and symptoms. The amount of testing you get depends on several things: your age, how your symptoms come on and how severe they are, and how you respond to your first treatment. For example, a 20-year-old might not need tests. But a 50-year-old with new symptoms might need tests because of the higher risk of coloncancer in people over 50.


How can I treat it at home?

For most people who have irritable bowel syndrome (IBS), home treatment may be the best way to manage the symptoms. It is also helpful to learn all you can about IBS so you can better share your concerns and questions with your doctor.
Careful attention to diet, exercise, and stress management should help keep your symptoms under control. They may even prevent your symptoms from coming back.

1.You’re in Control

No one wants to have irritable bowel syndrome (IBS), but if you take some preventive measures, you may be able to avoid it. Stress, worry, anxiety, and eating and drinking the wrong things can cause digestive problems. You can find long-term solutions by making some simple changes in how you respond to stress and paying attention to your diet, nutrition, and lifestyle.

2.Deal with Stress

Stress-related symptoms—like abdominal pain and bloating—occur more often and more intensely in people with IBS. Managing the stress in your life is important in avoiding flare-ups.
There are several effective methods for stress management that can improve IBS symptoms, including deep breathing. The secret is to breathe from your diaphragm, not your chest, in order to relax your abdominal muscles. According to the Mayo Clinic, doing so can lead to more regular bowel activity

3.Relax Progressively

Another stress soother is called progressive relaxation. Relaxing the muscles in your body can help alleviate an upset stomach. To use this form of relaxation, start by tensing and then relaxing the muscles in your feet. Then move your way up through your calves, thighs, abdomen, arms, and each main muscle group in your body, ending with your face and scalp. Concentrate on releasing all of the tension in each body part as you go.

4.Find More Fiber

In addition to stress management techniques, tweaking your diet can also help prevent IBS. One of the most common ways is to incorporate more fiber into your meals.
However, while dietary fiber can ease some gastrointestinal symptoms (like constipation), it can make other symptoms worse (like gas and cramping). To minimize potential problems, try a gradual increase of fiber over the course of a few weeks.

5.Steer Clear of These Foods

Certain foods are known to exacerbations. Watch what makes your own symptoms worse, and avoid those products. Some common culprits include:
1. chocolate
2. sugar-free sweeteners (such as sorbitol or mannitol)
3. cauliflower
4. broccoli
5. cabbage
6. beans
7. dairy products

When it comes to dairy, you can try substituting yogurt for milk, or decreasing the quantity of dairy products you consume. Other things that might work are breaking down lactose with an enzyme product, or combining dairy with other foods.

Diarrhea medicines

Medicines that may be used to treat severe diarrhea that does not improve with home treatment include:
Antidiarrheals, including atropine and diphenoxylate (such as Lomotil) and lope amide (such as Imodium).
Bile acid binding agents, including cholestyramine (such as Prevalite).
Rifaximin (Xifaxan), which has been shown to help people who have diarrhea and bloating as their worst symptoms. In one study, people who had fewer symptoms after 2 weeks of taking rifaximin continued to have fewer symptoms for 10 weeks after stopping the medicine. But rifaximin is very expensive, and more research needs to be done. There are still many questions about this treatment, including who will get the most benefit, how long the effect will last, and whether retreatment will work when symptoms come back.5
Alosetron (Lotronex), which is used for some women who have severe diarrhea. This medicine has been shown to contribute to ischemic bowel disease. Specific guidelines for the use of alosetron require doctors who prescribe it to sign a certificate and patients to sign a consent form.

Constipation medicines

There are many medicines for severe constipation that doesn't improve with home treatment. Most of these medicines are available without a prescription and are okay to take once in a while. Check with your doctor before you use any of these medicines every day for constipation. Medicines for constipation include:

• Osmotic laxatives (such as Milk of Magnesia and nonabsorbable sugars such as lactulose).
• Polyethylene glycol (such as MiraLax).
• Stimulant laxatives (such as Senokot).
• Linaclotide (Linzess).
• Lubiprostone (Amitiza).


A wide range of other treatments can be used to treat irritable bowel syndrome (IBS).

Psychological treatment

• Some kinds of psychological treatment may help with IBS symptoms. These treatments include cognitive-behavioral therapy, psychotherapy, and hypnosis.6
• Cognitive-behavioral therapy (CBT).Stopping negative thoughts with CBThas been shown to help with IBS symptoms. People who practiced thinking positively using CBT reduced their IBS symptoms, anxiety, and negative thoughts and improved their quality of life compared to people who practiced stress management exercises.In another study that compared mindfulness-based stress reduction (MBSR) to a support group, people who practiced MBSR had a much greater reduction in their IBS symptoms, even 3 months after the study ended.

• Psychotherapy. Psychotherapy and psychological therapy have been shown to help people who have IBS more than doing nothing.

• Hypnosis. Hypnosis has also been shown to help with IBS symptoms.

• Other psychological treatments that are sometimes used for IBS include relaxation therapy, meditation, and biofeedback.

People who have IBS are more likely than people without the condition to have depression, panic disorder, or other psychological conditions.1Acknowledging these factors may help you and your doctor successfully manage your condition.

Complementary treatment

IBS is different for each person, and no medicines have been proved to work really well for IBS. So people often try alternative or complementary treatments. Some of these treatments have been studied, and some have not.

• Herbal therapies, such as Ayurvedic medicine and Chinese herbal medicine, may improve the symptoms of IBS. This has been shown in many studies of herbal therapy for IBS.

• Acupuncture is used as a treatment for IBS. But how well it works to treat IBS is still unknown. Peppermint oil has also been used to treat IBS. Studies have shown that peppermint oil works to improve IBS symptoms by preventing cramps and spasms in the intestines.6Aloe is commonly used for IBS, especially IBS with constipation. There is currently no evidence for the use of aloe as an effective treatment for IBS.

• Ginger has been used to treat nausea. It has been studied as a treatment for nausea caused by seasickness and surgery. It isn't known how well ginger helps in IBS

• Helpful bacteria, called probiotics, may help with IBS symptoms. In one study, people with IBS who took a daily pill containing the bacteriaBifidobacterium bifidum had fewer symptoms after 1 month compared with people who took a placebo pill. And almost half of the people taking the probiotic had what they considered "adequate" relief of symptoms.11 Other studies show that a supplement with a combination of types (called strains) of bacteria probably helps more than just one type. But more research is needed.

Irritable bowel syndrome (IBS) is a disorder of the intestines. It causes belly pain, cramping or bloating, and diarrhea or constipation. IBS is a long-term problem, but there are things you can do to reduce your symptoms.
Your symptoms may be worse or better from day to day, but your IBS will not get worse over time. IBS doesn't cause more serious diseases, such as inflammatory bowel disease or cancer.
Dr Atul Chowdhury
Rapid Action Force {CRPF}
General Medicine