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Irritable Bowel Syndrome

Overview

Irritable Bowel Syndrome (IBS) is a chronic gut disorder with significant complaints of abdominal cramps and bloating with constipation or diarrhea. The duration of complaints varies from person to person and lasts for days, months to years, having short or long-term intermittent episodes. It is not an autoimmune disease. Only a tiny percentage of IBS patients experience severe signs and symptoms. Diet, lifestyle, and stress management can help some people manage their symptoms. Medication and counseling can help with more severe symptoms.

Causes

The exact cause of IBS is not known but has something to do with the overactivity of part or parts of the gut (bowel). Besides this, intolerance to certain foods, gastroenteritis, or oversensitivity of the heart to pain may cause IBS. According to research studies, the following factors also appear to play a role in causing IBS:

Intestinal Muscle Contractions:

The walls of your intestines are lined with layers of muscle that contract as food passes through your digestive tract. Gas, bloating, and diarrhea might result from more muscular contractions and stay longer than usual. Food passage can be slowed by weak intestinal contractions, resulting in hard, dry stools.

Nervous System:

Due to a lack of coordination between the brain and the intestines, your body may overreact to changes in the digestive process, causing pain, diarrhea, or constipation.

Infection:

IBS can develop after a severe bout of diarrhea (gastroenteritis), which bacteria or viruses can cause. IBS may also be linked to an overgrowth of microorganisms in the intestines (bacterial overgrowth).

Early life Stress:

People exposed to stressful experiences, especially in childhood, are more likely to develop IBS symptoms.

Changes in Microbes: 

According to research, there may also be a change in bacteria usually found in the intestines of healthy individuals, which may lead to the development of IBS.  According to research, microbes in IBS may differ from healthy people.

Risk Factors

Irritable Bowel Syndrome (IBS) is considered a functional bowel disorder while exhibiting no abnormality with the physical structure of the digestive tract. Irritable bowel syndrome (IBS) is one of the most common disorders of gut-brain interaction IBS affects around 11% of the population globally and about 10% to 15% of people in the United States.

 Risk factors contributing to IBS include:

  • If you are female: IBS is more common in women in the United States. Whether used before or after menopause, estrogen therapy is also linked to IBS.
  • Infective Enteritis is the most prevalent enteritis and usually occurs due to consuming contaminated food or liquids.
  • Extensive Use of Antibiotics
  • Family History of IBS: A combination of genes and environmental factors may also have a role in causing IBS.
  • Anxiety and Depression: A history of sexual, physical, or emotional abuse could also put you at risk.

Signs and Symptoms

Following are the signs and symptoms of IBS:

  • Pain or discomfort in different parts of the abdomen. The nature of pain is colic or spasmodic that eases with the passing of stools or passing wind.
  • Frequent swelling (or bloating) of the tummy with the passage of winds more than usual.
  • Some patients may have bouts of diarrhea, while others have constipation.
  • Consistency of stools varies from watery to pallet like, usually mixed with mucus

Other symptoms may include:

  • Heartburn
  • Nausea
  • Headache
  • Fatigue
  • Backache
  • Poor appetite

Diagnosis

IBS is usually diagnosed from the typical symptoms as there is no specific test to confirm IBS diagnosis. Blood tests and stool tests rule out other diseases having the same symptoms. The tests include:

  • Complete Blood Count (CBC) to check anemia associated with various gut disorders.
  • Erythrocyte Sedimentation Rate (ESR) or C-reactive Protein (CRP) - which can show if there is inflammation in the body (which does not occur with IBS).
  • A Stool Test to look for any bleeding from the bowels and check a protein called Faecal Calprotectin that is present only in case of Crohn's disease or ulcerative colitis.
  • X-Ray or CT Scan: These procedures provide images of your abdomen and pelvis that might help your doctor rule out other possible explanations of your symptoms, especially if you're experiencing abdominal pain. 
  • Endoscopy or Colonoscopy is done in complicated cases or to rule out certain conditions.
  • Lactose Intolerance Tests: Lactase is an enzyme that helps you digest the sugar in dairy products. If you don't generate lactose, you may experience symptoms comparable to IBS, such as abdominal pain, gas, and diarrhea. 
  • Breath Test for Bacterial Overgrowth: If you have bacterial overgrowth in your small intestine, you can use a breath test to find out. People who have had colon surgery, diabetes, or another condition that slows digestion are more likely to suffer bacterial overgrowth.

Differential Diagnosis

The symptoms of IBS can be confused with some other conditions. These include:

  • Gut infection
  • Ulcerative colitis
  • Crohn's disease
  • Celiac disease
  • Diverticulosis
  • Cancer of the ovary

Medications

  • Fiber supplements:  Constipation can be controlled by taking a supplement like psyllium with water.
  • Antispasmodic medicines for abdominal pain. These may include Alverine Citrate, Mebeverine, Hyoscine, and Peppermint oil.
  • Laxatives for constipation. The laxatives are advised for short periods if increasing fiber is not enough to ease a troublesome bout of constipation. Your doctor might suggest over-the-counter laxatives such as Magnesium Hydroxide or polyethylene glycol.
  • Antidiarrheals, including (Loperamide) may be helpful if diarrhea is a primary symptom. A bile acid binder, such as cholestyramine, colestipol, or colesevelam, may also be prescribed by your doctor. Eluxadoline is another option only if the condition has not responded to other medicines.
  • Peppermint oil may help with bloating and wind, usually during abdominal pains and spasms.
  • Amitriptyline (a tricyclic antidepressant) is sometimes used to treat IBS. This class of medications can help with depression and alleviate pain by inhibiting the activity of neurons that control the intestines.

Treatment

There is no specific treatment of IBS, but different treatment regimens have a different response on patients of IBS. Many people with mild IBS symptoms don't need any treatment, but treatment can often ease symptoms and improve quality of life in severe conditions. Psychological therapies can also be very effective for some people with IBS. IBS treatment focuses on relieving symptoms to live as normally as possible. Mild signs and symptoms can often be managed by reducing stress and implementing dietary and lifestyle adjustments such as

  • Avoid meals that make your symptoms worse.
  • Consuming a high-fiber diet.
  • Drinking a lot of fluids.
  • Exercising regularly
  • Getting enough rest.

Complications

Hemorrhoids can be caused by chronic constipation or diarrhea.

In addition, IBS has been linked to:

Poor Quality of Life: Many patients with IBS complain about their quality of life. According to studies, people with IBS miss three times as many days at work as those who do not.

Mood Disorders: Experiencing IBS's signs and symptoms can result in depression or anxiety.

Prognosis

IBS causes long-term symptoms and often stays for life, but the symptoms tend to come and go. Treatment can often help to ease symptoms when they flare up. IBS usually improves with time, and, in some cases, symptoms clear up for good at some stage.

Prevention

IBS can typically be relieved by making simple dietary and lifestyle modifications. It will take time for your body to adjust to these changes.

a)  Lifestyle Changes

  • Regular Exercise: Exercise relieves depression and stress by stimulating normal bowel contractions and making you feel better about yourself.
  • Managing Stress Levels: It is essential to manage your stress since it can trigger IBS symptoms. Stress can be relieved by yoga, meditation, or getting involved in healthy activities which make you feel comfortable. 
  • Eating at Regular Times: To help regulate bowel function, don't miss meals and try to eat at the same time each day. If you're suffering from diarrhea, you might discover that eating small, frequent meals helps. However, consuming more high-fiber foods may help move food through your intestines if you're constipated.
  • Increase Intake of Fiber Diet: Fiber can help with constipation. It is usually recommended to gradually increase the quantity of fiber in your diet by eating whole grains, fruits, vegetables, and beans.

b) Maintaining a Diary of daily diet and recording any change in symptoms.  Some people with IBS find that certain foods can trigger symptoms or make symptoms worse.

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