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Irritable Bowel Syndrome (IBS): An Inconvenient Pain in the A**

Irritable Bowel Syndrome (IBS): An Inconvenient Pain in the A**
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On Friday the 19th of May 2017, it was International Irritable Bowel Syndrome (IBS) day on the global health calendar. It is a day when the spotlight shines on increasing the awareness on this clinical or medical condition that is still poorly understood in the medical world in terms of the proven causative factors, with several theories being thrown around.  However, none of those hypotheses have been conclusively scientifically proven and accepted by the medical scientific community.

What is IBS?Although the medical scientists are still grappling with the real underlying cause of the clinical syndrome, the reality is that daily a significant percentage of people globally and here in South Africa battle the uncomfortable, inconvenient symptoms and signs of the medical condition. In the US, it is reported that at least 20% of the population suffer from IBS, with the symptoms ranging from mild, to moderate and severe levels of discomfort.

What is strange though is that it is reported that of the one-fifth of the US population who experience the symptoms and signs of IBS, only a fifth seek professional help to manage their clinical condition. The prevalence statistics in the South African population are not available, however, there are a lot of South Africans who battle IBS either continuous basis, or in a periodic fashion with times when symptoms flare up, and periods of no symptoms at all.

What is this IBS?

IBS is a common chronic medical disorder that affects mainly the large intestines (colon) with varied presentation symptoms ranging from Cramping; Abdominal Pains; Bloating; Gas; Diarrhoea that alternates with Constipation. The medical condition can cause severe discomfort to the sufferer, and may even be confused with other more serious inflammatory medical conditions of the large intestines like Ulcerative Colitis or even Colo-rectal Cancer where there is tissue damage on the bowel wall.

The big difference with those more serious clinical conditions is that those clinical conditions also present with symptoms like bleeding per rectum, as well as ongoing weight loss. IBS is, however, a diagnosis of exclusion, wherein the medical doctor must take a full medical history, and conduct several physical examinations and specialised tests before they can certainly confirm that the person is suffering from IBS.

There are at least two diagnostic criteria for IBS, both of which rely on the presence of certain symptoms, and their duration of presence.

Rome Diagnostic Criteria: the sufferer complains of abdominal pain and discomfort at least three days in a month in the previous three months, with two or more of the other typical symptoms of:

  • Pain improvement;
  • Altered frequency or consistency of stools.

Stool Types and Frequency

Manning Criteria:

  • Pain better with defaecation;
  • Incomplete bowel movements;
  • Mucus in Stools;
  • Changes in stool consistency.

The more symptoms from the above, the more the chances of the condition being IBS, in the absence of other symptoms or signs that point to other large intestinal clinical conditions. In addition to the above variety of symptoms, there are a number of non-specific specialised tests that can be performed as part of the diagnosis investigation, for example:

  • Lactose intolerance tests;
  • Breath tests;
  • Blood tests;
  • Sigmoidoscopy;
  • Colonoscopy;
  • CT scans of the abdomen
  • Abdominal X-Rays.

Are there any known Risk Factors for IBS?

There are a few known risk factors for IBS, for example:

  • Age: Young people under the age of 45 years are more at risk of IBS;
  • Gender: Females are twice more likely to have IBS than males;
  • Family History: Higher risk of IBS if having a family member with IBS (genetic or environmental factors or both)
  • History of Mental Health:

 Anxiety conditions;
 Depression conditions;
 Personality Disorder/s;
 Childhood sexual abuse history.

Are there any stimuli or triggers of IBS symptoms?

There are several stimuli or triggers for IBS symptoms, and their identification as triggers and consequent avoidance goes a long way towards the prevention of symptoms recurrence. The following are some of the common known stimuli or triggers:

Foods: Some foods may contain allergens or one may be intolerant to them, and on ingestion, they may trigger the IBS symptoms, for example:

  • Chocolates;
  • Food spices;
  • Fatty foodstuffs;
  • Some fruits;
  • Beans;
  • Cabbage;
  • Broccoli and Cauliflower;
  • Milk;
  • Carbonated drinks
  • Alcohol

Stress:

 Any increase or decrease in stress levels may have an impact on the IBS symptoms;
 Stress aggravates IBS, but does not cause it.

Hormones:
 In females, the symptoms of IBS worsen before and during their periods.

Other Illnesses:
 IBS symptoms can be triggered by gastroenteritis or bacterial overgrowth in the gut.

Is there any effective treatment for IBS?

Since the real underlying scientifically proved causes of the IBS are unknown, most of the available treatment or management interventions tend to focus more on dealing with the predominant presentation symptoms of a patient. The following are some of the examples of the above non-specific symptomatic treatment approach:

o Anti-diarrhoeal Drugs: to stop or limit excessive diarrhoea;
o Anti-spasmodic Drugs: to stop or limit moderate to severe abdominal cramps;
o Anti-depressant Drugs: to manage depression symptoms, if they are prominent.
o Anti-biotics: to eradicate bacterial overgrowth, where present.
o Fibre Supplements: to loosen the stools in cases of severe constipation.

There are a few other FDA approved specific prescription medications that have been found to be effective in treating IBS, for example:

  • Alosetron – this drug relaxes colon muscles and slows down movement of waste through the lower bowel.
  • Lubiprostone – this drug increases fluid secretion in the small intestines to loosen the stools in cases of constipation and poor bowel motility. This treatment is approved for use only in females.

IBS Herbal Treatment

In addition to the above symptomatic and specific orthodox medical interventions, there are some very promising complementary alternative natural products that have been well researched and have been proven to be effective in the management of moderate to severe types of IBS. One of the most scientifically researched product is Iberogast. This natural complementary alternative product contains 9 medicinal plants extracts that work together to relieve multiple digestive symptoms of IBS like abdominal pains, cramps, fullness, heaviness, bloating, flatulence and many others.

In addition to the medicinal interventions (orthodox and complementary alternative) as listed above, there is also a need for a sufferer to adopt a few lifestyle changes that may help to reduce the frequency and or severity of the symptoms. The following are some of the lifestyle and home remedies that every IBS sufferer may have to try to find out what works for him or her:

  • Experiment with introducing incrementally more fibre in your diet;
  • Avoid problematic foodstuffs that you already have identified as triggers of IBS symptoms;
  • Endeavour to eat at regular meal times;
  • Take care with the intake of dairy products, especially if you have lactose intolerance;
  • Drink plenty of water/re-hydration liquids if you suffer from constipation or regular diarrhoea;
  • Exercise regularly, especially if you are prone or have history of stress-related mental illness like depression and or anxiety;
  • Use anti-diarrhoeal or laxatives with caution, as regular use of these may also present other adverse effects.

Role of Stress in IBS (Picture Courtesy of BeyondGoodHealth Holistic Medical Clinics)

Finally, the role of stress in the recurrence of IBS attacks can never be under estimated. If you are going through a stressful phase in your life or at work, or you are a person who has low stress threshold from past experience, it is a good idea to seek professional help by consulting a clinical psychologist, who can help you to deal effectively with unresolved past emotionally stressful issues, and or help you to improve your ability to cope better with stress in the future.

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