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Irritable bowel syndrome (IBS) is one of the most prevalent gastrointestinal disorders that hamper the functioning of your gut and, as a result, trigger a lot of digestive distress.
The muscle motility in the gastrointestinal tract is either too slow or too fast, accompanied by sudden or excessive contractions that trigger abdominal pain.
This illness occurs when the movement of your intestinal muscles becomes erratic or spasmodic. Irregular muscle contractions and increased irritability in both the small and large intestines can lead to the onset of IBS.
IBS is also referred to as spastic colon and mucous colitis.
According to the American College of Gastroenterology, IBS is very common in the United States. Around 10%-15% of adults experience IBS symptoms, but only 5%-7% have been diagnosed with it. One in five Americans suffers from IBS.
Even at the global stage, IBS has emerged as one of the most prevalent gastrointestinal disorders.
IBS is further categorized into three types. These include:
- IBS-C (constipation-predominant): The person alternates between constipation and normal stools. Eating may cause abdominal spasms or severe pain.
- IBS-D (diarrhea predominant): The patient suffers from diarrhea soon after getting up or after he/she eats something. Sometimes, the bowel movement may be involuntary and the person may need to make frequent urgent visits to the toilet.
- IBS-A or IBS-M (alternating constipation and diarrhea)
Causes of Irritable Bowel Syndrome
The exact etiology of IBS is not clearly known as of yet. However, several factors may engender it. These include:
- Diet: Diets low in fiber content or containing extremely sweet or spicy foods.
- Intolerance to food items: Poor digestion of the sugars lactose (present in most of dairy and processed items), fructose (found in syrups), and sorbitol (found in stone fruits and dried fruits).
- Infections: Bacterial infections in the digestive tract such as gastroenteritis (even after the microorganism has been removed).
- Excessive bacteria: Increased number of bacteria in the small intestine or a change in their type.
- Mental ailments: Anxiety disorder, depression, and somatic symptom disorders.
- Early life events: Traumatic memories of the past that may have induced stress, such as physical or sexual abuse.
- Emotional stress: Strong emotions, such as anger, anxiety, frustration, nervousness, and stress, which can affect the bowel nerves.
- Gastrointestinal motor problems: IBS is characterized by an abnormal or irregular movement of the colon muscles.
Constipation occurs when the intestinal muscles do not move as fast as they normally should, increasing the transit time of the stool.
Loose motions, on the other hand, are triggered by an unusually rapid movement of the colon muscles.
Patients with IBS may also experience spasms or abrupt contractions of the colon muscles, which may come in waves and induce abdominal pain.
Sometimes, the colon muscles may become hyperreactive or contract excessively, usually in response to stress or eating.
Signs and Symptoms of IBS
The symptoms of IBS are not consistently poor. Sometimes, they are controlled; other times, flare-ups occur. The symptoms may become worse with the consumption of some foods or drinks.
Some of the main symptoms of IBS include:
- Abdominal pain – Gets better when you defecate, but gets worse when you eat
- Bloating – An uncomfortable feeling that your belly is swollen or full
- Mucus in the stool
- Extreme exhaustion and a feeling of lethargy
- Involuntary or accidental bowel movement
- Troubles in micturition – frequent/sudden need to urinate; feeling as if your bladder is never free
- Loss of appetite
How is IBS Diagnosed?
Diagnosing IBS is very important in order to get prompt treatment.
The doctor first assesses your symptoms and analyzes your family and medical history.
Then, a physical examination is conducted. The doctor evaluates your condition, checking for pain and bloating in your abdominal region. The doctor may also check the sounds in your stomach using a stethoscope.
Some tests may also be prescribed by the doctor. These include:
- Blood Tests: Blood tests are done to determine whether the person is suffering from something other than IBS, such as anemia, gastrointestinal diseases, or infection.
- Stool Tests: Stool tests are ordered by the doctor to see if there is blood in your stool or any indication of some other ailment and infection.
Blood in the stool is also checked by the doctor when he examines your rectum during the physical tests.
- Colonoscopy: Colonoscopy is a clinical procedure that uses a tube with a lens to inspect your large intestine.
The tube is inserted in your anus, goes to the rectum and colon, and provides images on the monitor, making it easy for the doctor to identify problems.
- Sigmoidoscopy: Sigmoidoscopy is a medical test that uses a small camera to check the inside of your rectum and lower colon for some disease or infection.
- Upper Endoscopy: An upper endoscopy may be performed, which involves inserting a narrow, flexible fiber-optic scope with a camera into your digestive tract through the mouth.
This test allows the doctor to examine your stomach and upper small intestine for any signs of bleeding, ulcer formation, and inflammation.
Standard Medical Treatment
Your doctor will most likely prescribe medications to soothe your symptoms. These include:
- Antidiarrheal drugs such as loperamide or antibiotics to inhibit bacterial growth.
- Antispasmodic medications such as dicyclomine, hyoscine, pinaverium, and cimetropium to regulate the contractions of the colon muscles and relieve the abdominal pain.
- IBS medicine for women who have constipation-predominant IBS such as lubiprostone (FDA approved).
- Laxatives and stool softeners are routinely used as the first-line treatment for IBS-C, a specific form of IBS in which the abdominal pain and bloating are accompanied by constipation.
However, not everyone responds well to laxatives, especially those that contain nondigested sugars or sugar alcohol.
Laxatives containing polyethylene glycol are usually found to be the most effective, provided you stick to the appropriate dosage.
These drugs may help stimulate bowel movement and facilitate the easy passage of stools, thereby relieving constipation.
- If your IBS symptoms do not respond to any of the above-mentioned drug therapies or if your condition gives way to more serious complications, your doctor may consider surgical options.
Depending upon the severity of your IBS, your colon may have to be removed either partially or entirely.
Surgery serves as the last resort for treating IBS. It is mostly recommended for older patients who have grappled with this illness for many years.
- Biofeedback is a new-age therapy that involves recording the patient’s physiological responses to stress and relaxation. The findings are then shared with the patient.
Through this feedback, the patient learns to manipulate his/her physiological activity to get better health results. The same technique may enable IBS patients to improve their digestive functioning as well.
A combination of relaxation strategies to de-stress the patient’s mind and body may be beneficial in facilitating a smooth bowel movement.
IBS: Self-Care and Medic
If you are dealing with IBS, you may find relief with the following tips and home remedies.
1. Self-Care Tips
These self-care measures can provide some relief from the symptoms of IBS:
- Consume a diverse and nutritious diet and avoid fatty foods.
- Do not skip meals or take a long break between them. Eat frequently.
- Eat small portions of food six times daily instead of three sumptuous meals.
- Cut down on your intake of processed foods as they may contain resistant starch, which is not easy to digest.
- Maintain adequate fluid levels in your body to counter dehydration, particularly those that do not have caffeine are recommended.
Water (6-7 glasses) is the best option to supplement your fluid needs, but you can also consume unsweetened juices or succulent fruits and vegetables for this purpose.
- Avoid alcoholic and caffeinated beverages as they can trigger diarrhea by stimulating your intestines and leave your body dehydrated.
Similarly, limit your intake of carbonated drinks as they can contribute to the buildup of abdominal gas.
- Foods and drinks that contain artificial sweeteners are also associated with an increased incidence of diarrhea and must be avoided.
This is particularly true for sweeteners that contain sugar alcohols such as xylitol, sorbitol, and mannitol.
- A sleep-deprived body is more prone to digestive dysfunction than a well-rested one.
It is essential that you get enough sleep regularly to keep IBS symptoms under control.
- Stress management is key to avoiding IBS flare-ups. Make concerted efforts to keep your mind and body tension-free.
To that end, you can try a number of restorative techniques such as meditation, yoga, deep breathing, listening to calm and restful music, or simply engaging in therapeutic hobbies and activities that you find enjoyable.
- Exercise may help improve your intestinal health and relieve the discomfort associated with IBS.
Regular physical activity is known to have a stimulating effect on the colon muscles, which may help facilitate the easy passage of stools and gas through the digestive tract.
- Fiber-rich foods add bulk to your stools and make them easy to pass. Thus, patients with IBS are often advised to gradually increase their dietary fiber intake to regularize their bowel movement.
- Flaxseed is a good source of both soluble and insoluble dietary fibers required for the swift passage of waste products.
Flaxseed is also replete with omega-3 fatty acids that help embolden your body’s natural defenses and improve your digestive functioning.
These fibrous seeds may be useful in reducing the incidence of both constipation and diarrhea.
- Soluble fiber forms mucilage, a gel-like substance that makes the stool soft. Insoluble fiber adds bulk to the feces.
- Eating oat bran daily can supplement your body’s fiber requirement and reduce the severity of IBS symptoms. Oat bran may work as a natural stool softener, which can aid smooth and painless defecation in the case of IBS-C.
In comparison to barley, rye, and wheat, oats have lesser quantities of prolamins. Prolamins are components in gluten that make the patients more susceptible to toxicity.
- Flaxseed is a good source of both soluble and insoluble dietary fibers required for the swift passage of waste products.
- Chamomile can also reduce inflammation in the intestines, relieve abdominal spasms, and internally soothe the symptoms of gastrointestinal ailments.
This is because the extracts of chamomile flower contain wound-healing, anti-inflammatory, and antispasmodic properties.
- Ginger has a carminative effect and can reduce gas and bloating. Its effect lacks much scientific explanation, but ginger is often recommended for the management of symptoms of IBS.
A component in ginger known as gingerol has analgesic, antibacterial, antiemetic, and sedative properties. It offers certain psychological benefits as well. Ginger may also decrease pain and improve gut motility.
- Maintain a journal. A food journal can help you identify the food choices and dietary habits that aggravate your IBS symptoms.
Note down everything you consume daily, including the spices and flavorings that go into your food.
Moreover, you must list the number of times you had a bowel movement along with the timing and specify whether it was painful or not. If you experience painful defecation, rate the intensity of the pain on a scale of 1–10.
Lastly, maintain a written record of your feelings or mood during each meal. This information can provide your doctor with important insight into your condition.
This technique only helps if whatever information you write in the journal is completely authentic and is thoroughly updated.
This journal should be taken to the physician for assessment so that a correlation between dietary stimulants and worsening of symptoms can be established.
2. Follow a Low-FODMAP Diet
FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) is a term used to define the short-chain carbohydrates that are not easily digested.
This can happen because the enzymes that break down the carbohydrates are not present and for several other reasons. These carbohydrates are acted upon by the bacteria present in the intestines.
As a result, osmotically stimulating by-products and gas are formed and the fluid levels in the intestine increase.
Studies have concluded that diets low in FODMAPs are beneficial for patients with IBS. The reduction of FODMAPs relieves the digestive symptoms of IBS.
In this diet, you stop consuming FODMAPs altogether for around 2 weeks. This inhibits the IBS symptoms.
After this, FODMAPs are reinitiated in the diet one by one to understand what food item is causing complications and what quantity the gut can easily digest.
A low-FODMAP diet should be incorporated only after you have consulted your dietician/nutritionist, who can give you a personalized diet rich in the necessary nutrients based on your symptoms.
Also, refrain from consuming agave, foods high in sugar, gluten, and tea.
|Foods high in FODMAPs||Suitable alternatives low in FODMAPs|
|Lactose||Milk: regular as well as low-fat. Cow, goat, and sheep milk Ice cream||Milk: lactose-free milk and rice milk |
Ice cream alternatives: gelato, and sorbet Cheeses: soft and fresh cheeses
|Excess fructose||Fruits: apple, peach, mango, pear, watermelon, and canned fruit immersed in natural juice Honey sweeteners: fructose and high-fructose corn syrup||Fruits: banana, blueberry, cantaloupe, carambola, durian, grape, grapefruit, honeydew melon, kiwi, lemon, lime, orange, passion fruit, raspberry, and strawberry Honey substitutes: golden syrup or maple syrup Sweeteners: any sweetener except polyols|
|Oligosaccharides (fructans and/or galactans)||Vegetables: artichoke, asparagus, beetroot, broccoli, brussels sprouts, cabbage, fennel, garlic, leek, okra, onion, pea, and shallots||Vegetables: bamboo shoot, bok choy, capsicum, carrot, celery, chives, corn, eggplant, green beans, parsnip, pumpkin, and spring onions (green part only)|
|Cereals: Rye and wheat cereals when eaten in large amounts (e.g., biscuits, bread, couscous, crackers, and pasta)||Cereals: gluten-free cereals, spelt bread, and other such cereal-based products|
|Polyols||Fruits: apple, apricot, avocado, cherry, lychee, nashi pear, nectarine, peach, pear, plum, prune, and watermelon||Fruits: banana, blueberry, cantaloupe, grape, grapefruit, honeydew melon, kiwi, lemon, lime, orange, passion fruit, and raspberry|
3. Use Peppermint
Peppermint oil is effective in the management of IBS symptoms as it has anti-infective, anti-inflammatory, and carminative functions.
Peppermint contains (PO) menthol oil (L-menthol), which has an antispasmodic effect on the smooth muscles of the digestive tract.
This helps relieve IBS symptoms such as bloating, cramping, diarrhea, gas, pain, and intestinal spasms. It can help food pass through the stomach easily.
A randomized, double-blind, placebo-controlled clinical trial conducted on 72 patients with IBS found PO to be a safe and effective treatment agent that provides quick relief from IBS symptoms.
A 2019 comprehensive meta-analysis of 12 randomized trials involving 835 adult subjects lends further support to the therapeutic potential of PO in addressing the pain and digestive discomfort associated with IBS.
Consult your healthcare provider for PO supplements and dosage or naturally supplementing your diet with peppermint tea.
Conclusion: PO may help facilitate the smooth movement of the intestinal muscles and thereby improve bowel motility.
However, you must use this potent oil in suitable amounts for it to yield the desired results. Speak with your doctor about the safest and most suitable PO formulation for your case.
Also, if you decide to take dietary PO supplements, consult your doctor before starting.
4. Consume Yogurt/Probiotics
Yogurt that contains “live cultures” is a popular remedy for IBS-related diarrhea. Probiotics refer to friendly strains of live bacteria that produce lactic acid, which helps in the elimination of harmful bacteria in the body.
A 2010 study conducted on 274 patients with IBS suggested that probiotic foods such as fermented milk yogurt may help improve bowel motility, possibly by activating the muscles of the digestive tract.
However, further research is required to establish the exact mechanism by which probiotics may facilitate the passage of stools and .
Similarly, a 2105 meta-analysis that included a total of 1793 patients IBS highlighted the promising potential of probiotics as digestive aid, especially in terms of relieving the intensity of IBS symptoms.
Another 2012 study conducted on 130 IBS patients demonstrated the greater therapeutic effect of probiotic yogurt in reducing IBS symptoms than that of regular yogurt.
The effect was attributed to the presence of acacia fiber (a type of soluble fiber) and Bifidobacterium lactis in the probiotic yogurt
Yogurt is a versatile product that can be used in multiple food preparations or consumed on its own. It is best to use probiotic yogurt to gain maximum digestive relief.
Conclusion: Dietary sources of probiotics such as yogurt can help populate your gut with healthy bacteria to improve your digestive function.
It may be best to ask your doctor about the recommended daily intake. Consuming probiotics may provide relief from IBS symptoms, provided you do not exceed the recommended dosage.
5. Do Yoga
Yoga has been shown to be beneficial in relieving IBS symptoms.
Yoga focuses on making the body alert and aware. It also induces a sense of discipline in your body.
Yoga compels you to follow a healthy lifestyle interspersed with regular exercise that would then perhaps help you calm the symptoms of IBS.
Research has shown that yoga makes you more “in touch” with your senses and provides you with a positive body experience and a feeling of being well.
A study was done for over a period of 2 months and involved 2 groups of people. One group performed yoga asanas two times every day, while the other group was given 2-6 mg of loperamide every day. It was observed that the improvement in the IBS symptoms of both the groups was closely comparable.
Pranayama yoga (breathing control) helps patients with diarrhea-dominant IBS by elevating the low levels of sympathetic tone.
Savasana (complete relaxation) and Pranayama yoga help de-stress your body and give you a temporary escape from all your anxiety and stress.
It brings about positive physiological changes in your body by creating a positive balance in your nervous system.
Sudarshan Kriya dulls the symptoms of anxiety, depression, and other stress-induced disorders. It is an easy breathing practice that utilizes the natural rhythms of the breath, thus bringing your mind, body, and emotions in perfect harmony.
Mental Health Therapies
Mental health therapies can be very efficient treatment methods for the management of IBS symptoms related to the bowel.
This is because the communication between the brain and the gut contributes largely to the overall functioning of the gut.
The gut activity can, at times, be affected by certain psychological aspects, leading to worsened bowel symptoms.
It is believed that psychological interventions can have a better impact on the symptoms than clinical treatment and medications.
Such psychological therapies help in reducing stress, negative feelings, and dysfunctional perceptions.
They may also influence the brain-gut interaction by amending the conclusion that the brain draws from the gut sensations and how it affects the gut.
1. Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) is a type of psychotherapy that consists of using the relationship between events, actions, perceptions, emotions, and physiological reflexes.
The first step in CBT is to make the patients understand their IBS symptoms and the CBT model. The patients are simultaneously stimulated to identify the potential psychosomatic factors contributing to IBS.
After this, the patients work with the counselor/therapist to establish the probable link between actions, perceptions, emotions, and IBS symptoms. Then, behavioral therapy (e.g., stress management) is put to use.
An assessment by a health psychologist is necessary in order to know whether CBT can help you relieve your gastrointestinal symptoms.
The questions asked in this evaluation would pertain to your symptoms, diet, sleep schedule, mood, and the general stress you have in your life.
After this, your healthcare professional would tell you if CBT would help soothe your symptoms or you have to go for some other therapy. They may also refer you to other healthcare professionals if need be.
2. Relaxation Therapy
Relaxation therapy is a treatment method that works on the trust between the caregiver (nurse) and the patient. There are no medical procedures involved.
For patients with IBS, relaxation therapy consists of progressive muscle relaxation, self-discipline, meditation, and imagery.
- Progressive Muscle Relaxation: The technique requires you to first tense a particular muscle group and then relax it.
This method brings about a state of deep relaxation that can considerably reduce anxiety and stress when done along with abdominal breathing.
- Visualization/Positive Imagery: In this method, you suppose that you are in a peaceful and tranquil place, where there is beauty all around. You imagine that you can relax there.
This technique works on the principle of shifting your focus. You concentrate all your attention to this imaginary place and not engage in thoughts that are bothering you.
Hypnotherapy can beneficially affect gastrointestinal diseases in which function is affected, such as IBS.
Aside from relieving digestive symptoms, it works well on psychosomatic symptoms such as anxiety and depression. It also enhances cognitive functions.
Hypnotherapy proceeds in a certain way with you first closing your eyes and then performing progressive muscular relaxation and deepening methods.
The basic aim of hypnotherapy is to equip you to manage your gut function effectively. As the therapy progresses, you learn to control your gut and not the other way around.
The discomfort aside, IBS does not pose any serious threat to your life.
However, if you fail to manage the condition properly, it may give rise to the following complications:
- Patients with IBS who also have hemorrhoids may experience increased pain and discomfort in the rectum or anal region induced by frequent bouts of diarrhea or constipation.
- Prolonged constipation in patients with IBS can result in fecal impaction or progressive hardening of stools that remain stuck in the colon.
The longer the stool remains in the colon, the more solidified it becomes. Hardened stools are extremely painful and difficult to pass.
- Patients with IBS usually experience persistent or repeated spells of diarrhea, which can drain fluids out of the body and cause dehydration.
- Living with IBS symptoms can take a toll on your emotional or mental well-being and pave the way for depression, anxiety, and other mood disorders. This condition can hamper your quality of life and impede everyday activities.
You cannot preempt a flare-up of IBS symptoms, which can surface at any time or place and send you running to the nearest toilet.
This can prove to be quite a handicap when venturing out, as you may not always have a sanitation facility at your disposal.
Thus, you may find it hard to engage socially. Going out for work may also seem like a daunting task.
How to Backent IBS?
It is very difficult to prevent a problem without knowing its exact causative factor. It is not easy to narrow down the true causes behind IBS. Hence, no preventive measures can be suggested.
If you have been diagnosed with IBS, all you can do is manage the symptoms effectively by regulating your stress levels and eating a wholesome diet.
Risk Factors: What are The Common Triggers?
Several factors can lead to IBS:
- Gender: IBS is more common among women than men. For every male with IBS, there are two females.
This inconsistency is attributed to the hormonal changes in women during their menstrual cycle.
- Smoking: IBS symptoms tend to be worse among people who smoke or those who are regularly exposed to secondhand smoke.
The nicotine in cigarettes is known to aggravate the digestive distress associated with IBS.
- Genetic factors: Certain people are genetically predisposed to IBS. Some of their family members are grappling with this condition as well.
- Stress: You are more likely to have a flare-up of IBS systems during periods of stress, anxiety, and tension.
People who frequently experience high-stress levels are more at risk of this illness.
- Food intolerance: Any kind of food intolerance or allergy can also lead to the onset of IBS symptoms.
- Constipation: Any hindrance in the passage or movement of stools through the digestive tract can set the ground for IBS.
- Oversensitivity: People with naturally oversensitive intestines are more prone to IBS.
- Altered hormonal regulation: A spike in the estrogen level is associated with increased severity of abdominal pain in patients with IBS.
When to See a Doctor
A physician is to be consulted first so that he can review your symptoms and check if there is anything serious. He/she may then refer you to a gastroenterologist if need be.
Consult a physician if:
- You have a swollen abdomen.
- There is bleeding from the anus or you have bloody stools.
- There has been a visible loss in weight.
- You have a breathless episode.
- You have pale skin.
- You experience heart palpitations.
Once you have been diagnosed with IBS, you must consult a gastroenterologist if:
- There is considerable loss in your weight with constant fever.
- You have bloody stools.
- You suffer from pain in the abdominal region along with dizziness, fainting, and vomiting.
- Your sleep was disturbed due to a bout of diarrhea.
What your doctor may ask you:
- Do digestive diseases, such as celiac disease, colon cancer, or inflammatory bowel disease, run in your family?
- Are you on any medication?
- Have you had an infection in the recent past?
- Did you have any stressful event that may have triggered your IBS symptoms?
- Is there anything that relieves or aggravates your symptoms?
- Are the symptoms worse at night or during the day?
- Do the symptoms worsen after eating or staying hungry for too long?
- Do you currently suffer from any other health problem?
- Give a detailed account of your food choices, eating patterns, and other relevant dietary habits.
What you may want to ask your doctor:
- How can I cope with an ongoing IBS?
- Is there any permanent cure for IBS?
- What are the common side effects of IBS medications?
- Is IBS linked to any other health condition?
- Are there lifestyle changes that can help alleviate IBS symptoms or reduce their severity?
- Are there home remedies I could try along with medication?
- What is a food diary and how does it help diagnose or manage IBS?
The above-mentioned home remedies are adjunctive tools that may help relieve the symptoms of IBS to a manageable degree, but only when used along with the doctor-recommended treatment.
You will have to follow a strict diet and implement appropriate lifestyle changes to see any long-lasting or significant improvement in your condition.
Lastly, these remedies may not be suitable for people with certain pre-existing health concerns. To avoid any undue complications later, it is essential to consult your doctor before trying any of these remedies.