IBS

Irritable Bowel Syndrome or IBS is a common condition that affects the digestive system. The symptoms vary from stomach cramps, bloating, constipation and diarrhoea. The severity of these symptoms will vary from person to person. A typical episode of IBS can last for just a few days. For others, these episodes can be prolonged-lasting up to a few months at a time. Experiencing bouts of IBS is often linked with times of stress, or from eating certain trigger foods. Sadly, Irritable Bowel Syndrome is a life-long condition, although symptoms have been known to improve over a number of years.

What exactly causes IBS is still unknown, but most experts believe it is related to an increased sensitivity of the gut and a reduced ability in digesting food. This can lead to a sufferer becoming more susceptible to stomach pain, resulting from either diarrhoea or constipation. This is due to the food passing through the digestive system either too quickly or too slowly. Psychological factors are also believed to contribute to IBS, for example; stress.

IBS cannot be cured, however, there are a number of lifestyle choices that will help to manage the condition effectively. These include; identifying and avoiding food/drink triggers, increasing the amount of fibre in your diet, regular exercise and avoiding stress where possible.

Irritable Bowel Syndrome is not uncommon. The condition is estimated to affect up to one in five people at some point in their life. It typically develops between the ages of 20 and 30 and around twice as many women are affected as men.

The symptoms of Irritable Bowel Syndrome are usually exacerbated by eating food. For most people, a flare-up will typically last a few days. After which, the symptoms will either improve dramatically or disappear altogether. In a lot of cases, IBS is usually triggered by recently consumed food or drink. In other cases, an episode can be brought upon by psychological factors, such as stress.

The most common symptoms associated with Irritable Bowel Syndrome are:

• Abdominal pain
• Cramping
• Constipation
• Diarrhoea
• Bloating and swelling of the stomach
• Excessive flatulence
• Experiencing an urgent need to empty the bowel
• Not feeling fully emptied after going to the toilet
• Passing mucus from the anus

Other associated symptoms that are inherently linked with Irritable Bowel Syndrome include:

• Lethargy
• Nausea
• Backache
• Bladder problems (such as a frequent need to pass water at night or an inability to fully empty the bladder)
• Dyspareunia (pain experienced during sexual intercourse)
• Incontinence

Suffering from Irritable Bowel Syndrome can significantly impact a person’s day-to-day life, which in turn can have a psychological impact. This can easily result in many IBS sufferers experiencing associated feelings of depression or anxiety. If you believe you have IBS, it is important to go and see your GP for a diagnosis.

Currently, there are no specific clinical tests that can identify IBS, as it does not cause any discernible abnormalities within the digestive system. In the majority of cases, a diagnosis will be based on the presenting symptoms. Your GP will usually consider assessing a patient for IBS If they have experienced abdominal pain/bloating or a change in their bowel habits for a period of six months or longer.

A diagnosis of Irritable Bowel Syndrome will be then considered if the stomach pain/discomfort is relieved by emptying the bowel or whether this pain is associated with the need to visit the toilet more frequently. To be able to perform an informed diagnosis, the criteria above will need to be accompanied by two or more of the following symptoms:

• A change in the consistency of the stools
• Bloating, hardness or tension in the abdominal area
• A change in how stools are passed (straining/urgency/not feeling fully empty)
• The passing of mucus from the anus

Most cases of Irritable Bowel Syndrome can be diagnosed on the symptoms alone. However, occasionally additional tests may be required to check for other possible causes and underlying conditions. For example; a blood test may be required to rule out certain conditions that present with similar symptoms, such as coeliac disease. A stool sample may also be requested to test for calprotectin, which is a substance produced by the gut when inflamed. The presence of calprotectin may suggest Inflammatory Bowel Disease (IBD) instead of Irritable Bowel Syndrome (IBS).

In a small number of cases, additional testing may be required if a patient presents with certain ‘red flag’ symptoms. These are symptoms that could potentially indicate the presence of a more serious condition, such as cancer. Red flag symptoms include:

• Unexplained weight loss
• Rectal bleeding
• A lump of swelling in the stomach or anal passage

If you are over 60 years old or there is a family history of bowel or ovarian cancer, further testing may be recommended to rule out more serious conditions. In these cases, a colonoscopy will usually be performed to check for any abnormalities in the gut.

There are a variety of different treatments available to help treat Irritable Bowel Syndrome. These include; antispasmodics, laxatives, anti-motility medicines and low-dose antidepressants.

Antispasmodics:

Antispasmodics are medicines that work by relaxing the muscles in the digestive system. These medicines are the most commonly used IBS treatments and help to ease cramping and bloating. They are generally well tolerated with associated side-effects being quite rare. Examples of antispasmodics include; Mebeverine (Colofac), Alverine Citrate and therapeutic Peppermint Oil (Colpermin).

Laxatives:

Bulk-forming laxatives are generally recommended for patients who experience IBS-related constipation. They work by softening stools, which makes them easier to pass. Whilst taking bulk-forming laxatives it is important to drink plenty of fluid this will stop the laxative from creating a blockage in the digestive system. Possible side-effects can include; bloating and flatulence. However, if taken appropriately these side-effects are minimised. An example of a bulk-forming laxative is; Ispaghula Husk (Fybogel).

Antimotility Medicines:

Antimotility medicines work by reducing the contractions of the muscles in the bowel. This has the effect of slowing down the speed at which food passes through the digestive system. This process allows extra time for the passing stool to solidify. Associated side effects include stomach cramps, bloating, drowsiness, dizziness and rashes. An example of an antimotility medicine is; Loperamide (Imodium).

Antidepressants:

There are two types of antidepressants used to help treat IBS. The first being; Tricyclic Antidepressants (TCAs) and the second; Selective Serotonin Reuptake Inhibitors (SSRIs).

TCAs are generally recommended where antispasmodics have been found ineffective. TCAs work by interrupting the signals sent between the nerves and the digestive system. The body needs to first get used to TCAs before the effects are felt, which usually takes between 3-4 weeks. The most common side-effects associated with TCAs are; dry mouth, constipation, drowsiness and blurred vision. However, these side-effects usually improve after the first few days of starting treatment. An example of a TCA is amitriptyline.

Alternatively, SSRI can be used to help treat Irritable Bowel Syndrome. The most common side-effects include; dizziness, diarrhoea and blurred vision. Examples of SSRIs include; Citalopram, Fluoxetine and Paroxetine.

Irritable Bowel Syndrome sadly has no cure. However, the condition can be successfully managed through simple diet and lifestyle changes, as well as a better understanding of the condition and its triggers.

An IBS friendly diet could be the most important factor in controlling Irritable Bowel Syndrome. A tailored diet can be produced by keeping a food diary. These diaries will then help discern what foods make the symptoms better or worse and which foods act as triggers. An individual food diary is recommended as sadly there is no universal diet that works for everyone. A food that exacerbates the symptoms in one individual may have no effect in another.

The amount of fibre in an IBS sufferer’s diet is an important factor. Fibre can be divided into two groups; soluble fibre (which the body is able to digest) and insoluble fibre (which the body is unable to digest). If an IBS sufferer finds diarrhoea a common symptom, it may help to decrease the amount of insoluble fibre in their diet. For those who find constipation a more prominent symptom, increasing the amount of soluble fibre in their diet can help. Examples of foods that contain both types of fibre include:

Soluble fibre

• Oats and Barley
• Rye
• Root vegetables, such as carrots and potatoes
• Fruit, such as bananas and apples
• Golden linseeds

Insoluble Fibre

• Whole grain bread
• Bran
• Nuts and seeds
• Cereals

More general tips for an IBS friendly diet include:

• Eating regular meals
• Avoiding caffeinated drinks
• Avoiding alcohol
• Avoided fizzy drinks
• Drinking plenty of fluids, particularly water
• Reducing the intake of resistant starch (often found in processed foods)
• If suffering from diarrhoea, avoiding sorbitol (an artificial sweetener found in chewing gum and sugar-free sweets)
• If suffering from flatulence and bloating, try eating oats, which can be found in oat-based breakfast cereals or porridge
• Probiotics are found to be useful for many IBS sufferers, although there is little scientific evidence to support this

Reducing stress levels can help reduce both the severity and frequency of sufferers IBS flare-ups. Some useful stress relieving techniques include; meditation and breathing exercises, regular exercise (walking/running/swimming) and physical activities, such as Yoga or Pilates. It is recommended to aim to achieve a minimum of 150 minutes of moderate-intensity aerobic activity every week. The exertion should be strenuous enough to increase your breathing and heart rates.

If stress levels are so high that these techniques will be ineffective then it will be advised to seek stress counselling. Your GP can refer you for a type of therapy called a psychological intervention. This type of therapy can include the following:

• Psychotherapy; which involves discussing your worries with a trained therapist.
• Cognitive Behavioural Therapy (CBT); which examines how a person’s beliefs are linked to their behaviour. This type of therapy is designed to alter someone’s way of thinking in order to change how they view and cope with their situation.
• Hypnotherapy; where hypnosis is used to change the unconscious mind’s attitudes towards the condition.