Aside from the common cold, irritable bowel syndrome (IBS) is the most common reason people miss work. 10-20% of people have it, and women are twice as likely as men to have it; however, only 15% of IBS sufferers actually seek medical help.
What is IBS?
It is a chronic condition of the digestive system that causes abdominal pain and an alteration in bowel function, including constipation or diarrhea. As such, IBS is called a functional bowel disorder. Although all the tissue is normal, there is an abnormality in the amount or the synchrony of the normal functioning. IBS’s exact nature is still being investigated, but it has proven to be an elusive disease to diagnosticians and scientists alike.
What causes IBS?
The exact cause is unknown. A number of theories have been proposed, but it is unlikely that any one of them is the cause; instead, it is more likely that IBS is caused by a confederation of causes that vary in terms of their influence on the gastrointestinal tract. These causes include:
- Hyperactive colon: This is also known as spastic bowel and refers to when overactive contractions cause cramps and move digested foods too quickly, resulting in an incomplete balancing of hydration; this result causes constipation or diarrhea.
- A hypersensitivity of function caused by a previous infection.
- Intolerance to certain foods, such as dairy, legumes (beans), and cruciferous vegetables (cabbage, kale, cauliflower, and broccoli, etc.) can produce excessive gas as a by-product, which in turn stimulates excessive peristalsis to deal with it.
- A fibromyalgia-like (FM) condition in which normal stimuli results in abnormal reactions, including a heightened sensitivity to intestinal contents, may be another cause. FM does the same thing with pain perception, and although IBS and FM are two different afflictions, the results at the respective local levels can be the same. FM is probably a disease of the central nervous system (CNS), whereas it is unknown whether IBS is purely a disease of the gastrointestinal tract or CNS or both. However, most people seeking professional healthcare help for IBS are more likely to suffer from stress and anxiety, which may suggest a CNS component. It’s a chicken-and-egg question: does stress and anxiety cause IBS, or does IBS contribute to stress and anxiety? It is probably a bidirectional pathology.
- A cause of an IBS-like condition is celiac disease or inflammatory bowel disease (IBD), both of which are autoimmune. However, celiac and inflammatory bowel disease are not IBS. IBS is not one of the autoimmune illnesses like Crohn’s disease or ulcerative colitis, but it is called a functional bowel disorder. It can overlap with autoimmune disease, however, making accurate diagnosis both important yet confusing.
What are the symptoms of IBS?
- A main symptom of IBS is pain; this includes cramping that is worsened by eating and stress. This pain can be relieved by bowel movements.
- Another symptom is a change in bowel habits. This can result in diarrhea, constipation, or alternating aspects of both. Diarrhea can be accompanied by mucus.
- Bloating, flatus, and belching are other symptoms of IBS.
- The timing of IBS can be coinciding with the menstrual cycle. This is relevant to the diagnosis of IBS because women are twice as likely to have IBS as men.
How is IBS diagnosed?
Since it can present similarly to other intestinal conditions and it has no one specific diagnostic test itself, diagnosis is usually done via a history and physical exam and blood work so as to rule away all IBS impostors.
How is IBS treated?
IBS is not curable. Therefore, treatment is limited to managing its symptoms. No one strategy is perfect, especially because symptoms are at both ends of the stool-hydration bell curve (i.e., constipation vs diarrhea); so usually a creative combined approach is necessary to treat symptoms. The following are methods and approaches that can be used to treat IBS symptoms:
- Diet: Eliminating certain culprits in the diet in a trial-and-error manner can help pinpoint particularly harmful foods.
- Eliminate lactose products, particularly milk products, yogurt, and ice cream. This is to eliminate any lactose intolerance as a cause or contributor.
- Eliminate foods that are gaseous. Basically, this means to favor foods that are digested more easily. When certain foods, such as beans, cabbage, and other cruciferous vegetables are partially digested, they continue to be acted upon lower down in the digestive tract; this is what produces increased gas.
- Increase fiber consumption to relieve constipation or to improve the consistency of diarrhea. (Beware, fiber can have the opposite effect and make IBS worse.)
- Psychological therapy and support: Address stress and anxiety in an attempt to mitigate or eliminate their sources and their interactions with IBS.
- IBS medications: Although not a cure, medications are chosen primarily upon the predominant complaints: pain, constipation, and diarrhea.
- Certain drugs block the stimulation of the intestines by blocking the nerve signals that cause it. Anticholinergic drugs block acetylcholine, a neurotransmitter that stimulates the colon. The following can also be taken for preventative reasons:
- Dicyclomine (Bentyl)
- Hyoscyamine (Levsin)
- Antidepressants: The tricyclic class of antidepressants, besides improving depression that may augment stress and anxiety, also have a pain-relieving property when used to treat IBS. They also slow the passage of stool through the colon, which may improve the balance of hydration. SSRIs, which improve the effects of serotonin, which is another neurotransmitter, can be helpful if there is also overt depression with IBS.
- Tricyclics include the following:
- SSRIs include the following:
- Fluoxetine (Prozac)
- Sertraline (Zoloft),
- Paroxetine (Paxil),
- Citalopram (Celexa), and escitalopram (Lexapro)
- Other antidepressant medications that are not exclusively SSRI but may be used are mirtazapine (Remeron), venlafaxine (Effexor), and duloxetine (Cymbalta).
- Anti-anxiety drugs (anxiolytics) include the following:
- Diazepam (Valium)
- Lorazepam (Ativan)
- Clonazepam (Klonopin)
- Antidiarrheals: If one were to have a predominance of diarrhea in his or her symptomatology, the following drugs can be helpful to slow down the passage of intestinal contents:
- Loperamide (Immodium)
- Diphenoxylate-atropine (Lomotil)
- Alosetron (Lotronex)—There is a risk of severe GI side effects, so use this when nothing else has been successful.
- Anti-constipation medications:
- Lubiprostone—This increases intestinal secretions.
- Linaclotide (Linzess)—This is for persons over 18 who have had treatment failures with other medications. It is still being studied.
- Antibiotics—These are not routinely recommended due to any of its benefits are yet to be conclusively proven.
- Herbal: Unfortunately, as is true in most of medicine, there is a huge disconnect between natural remedies and appropriate studies to prove their efficacy. This is because these are supplements and don’t have to submit to scientific scrutiny. While many herbal supplements, such as peppermint oil, acidophilus, and chamomile tea, may in fact be very helpful, the efficacy of many other herbal supplements are unsubstantiated. Indeed, wormwood, another herbal supplement, may cause central nervous system damage and therefore should be avoided.
IBS is a functional disorder of the intestinal tract. It causes its symptoms via alterations in normal function, thereby producing an abnormal process. IBS is a cause of missed work and employment, as well as embarrassment, which no doubt contributes to its associations with stress and anxiety. Its manifestations are many, and that makes it necessary to seek the help of a professional to treat this affliction.