Irritable Bowel Syndrome

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Irritable Bowel Syndrome (IBS) is defined as a functional bowel disorder. It is a very common condition that affects approximately 10-15% of the population [2]. Interestingly women are affected more than men and usually the onset of this ailment is between 20 and 30 years of age [8].

Symptoms [8]

The most common symptoms are:

Even though these main symptoms are strictly related with this disorder, a lot of people suffering from IBS can also experience other problems such as:

  • A lack of energy
  • Feeling sick
  • Sexual problems
  • Need to urinate in the night
  • Incontinence

The severity of the symptoms can vary a lot [1]. Unfortunately, for some people this disorder can be so serious and debilitating that it dramatically reduces their quality of life.

What are the characteristics of IBS?

This condition usually lasts a lifetime. However the symptoms are not always present, but can come and go. Symptoms are more likely to come during periods of high stress and pressure and often appear after eating.

Unfortunately, the cause of IBS is unknown. However several abnormalities seem to be linked with this condition such as: altered visceral sensitivity, functional brain alteration, gut dysbiosis, genetic factors, bowel mobility and secretion dysfunctions (etc.) [2].

In particular recent studies have shown that the epithelial barrier, the gut microbiota, the food antigens and bile acids can play a very important role of the development of this disorder and these factors can potentially be used as biomarkers for this condition. [2]. Furthermore the psychological factors play a significant role [1], in particular 20-25% of IBS patients suffer from anxiety [4].

People suffering from IBS can experience a sensitive gut and also suffer from digestive problems. The digestive problems can cause both diarrhoea and constipation. In fact, if the foods that we ingest pass through the gut too quickly, our body does not have enough time to absorb the water, causing diarrhoea. On the other hand, if the ingested food stays for too long in the gut, an excessive water amount is absorbed and constipation appears [8].

How this syndrome is diagnosed?

There is not a specific test to detect IBS and often the diagnosis is made after a negative exclusion of other pathologies [4].

You may be diagnosed with this condition when one of these symptoms are present for more than 6 months [8]:

  • Abdominal pain
  • Bloating
  • Change in the frequency of defecation/consistency of stools.

However, a diagnosis can be made only if your stomach discomfort is revealed after going to the toilet, or is associated with a need to go to the toilet regularly or can also be associated with a change in the stool consistency.

This should be accompanied with at least two of the following symptoms:

  • A change in the stool passing
  • Bloating
  • Your symptoms get worse after eating
  • Mucus in the faeces.

How to alleviate the symptoms?

Medication [8]

There are some medications that can help to alleviate the symptoms as:

  • Antispasmodics
  • Laxatives
  • Antimobilities drugs
  • Low dose antidepressants

The importance of diet

The diet plays an extremely important role for the management of IBS.

It is important to do the following when suffering from IBS [3,8]?

  • Eat regularly and have regular bowel hygiene
  • Take your time when eating
  • Try to have small meals
  • Do not eat food with excessive food chemicals, lactose, alcohol and caffeine, because they can worsen the symptoms.
  • Avoid high sugar intake
  • Avoid fatty foods
  • Drink good amounts of liquids (eight cups of fluid a day)
  • Avoid fizzy drinks
  • Avoid processed snacks
  • Reduce the intake of resistant starches

If you are suffering from diarrhoea it could be useful to reduce the intake of insoluble fibres like those contained in bran, cereals and wholegrain breads. These types of fibres are not easily absorbed and can cause a laxative effect.

Instead if you have constipation it may be useful to increase the intake of soluble fibres. These types of fibres can be found in oats, barley, fruits and root vegetables. These fibres have a high ability to absorb water and are easily digested by the bacteria in the gut [4,8].

Because sometimes IBS is linked with food intolerances [4], it could be useful to try an exclusion diet to understand which products are more harmful.

People undertaking an exclusion diet can be at risk of developing nutrient deficiencies. In particular, people who do not eat dairy products may have an insufficient intake of calcium and vitamin D.

Additionally when suffering from IBS it could be very useful to keep a food diary. This can help to figure out the foods that trigger and exacerbate the symptoms [3].

Recently it is becoming quite usual for IBS sufferers to follow a FODMAPS diet [3].

This type of diet allows a low intake of those carbohydrates (CHOs) (oligosaccharides, disaccharides, monosaccharides and polyols) that are not easily digested. These CHOs ferment in to the gut causing the production of high doses of gases.

People following this type of diet have to exclude a lot of products from the diet including some fruits, vegetables, milk and wheat products. So anyone desiring to start this diet are recommended to seek the advice and help of a dietician [3,8]. Furthermore as underlined by Rao et al (2015), this type of diet can have positive results for the short term management of IBS (for selected patients) but more rigorous studies are needed to establish its long term efficiency alongside its safety.

Supplements

  • Some IBS sufferers find it very helpful to use probiotics. Probiotics are products that contain the so called good or friendly bacteria that can help restore microbiota in the gut. Even though their use to alleviate IBS symptoms is not proven, some people find them helpful (i.e: Bifidobacterium infantis). In particular taking these supplements can be useful if the IBS has developed after having gastroenteritis or a course of antibiotics. Some researchers argue that probiotics can alleviate the IBS symptoms by improving the immune response, enhancing the gut permeability and altering the colonic fermentation [5]. Moreover probiotics could also modify the motility and the sensation of the intestine due to neurotransmitter production [6].
  • Peppermint oil may help reduce symptoms of IBS [3,6]
  • Different Chinese Herb mixtures are also used to treat the symptoms in women, the most common are: Padma lax and STW 5 [6]
  • Recently Abbasnezhad et al., 2016 has found that vitamin D3 supplements could be useful in reducing some of the symptoms associated with IBS, in comparison with a placebo.

Other important factors to be taken in to consideration

People suffering from IBS can find it beneficial to undertake physical activity. In fact it can help with constipation problems and to improve symptoms and feel generally fitter [3].

For people suffering from IBS it could be very useful also to reduce stress levels. Relaxation techniques such as yoga, Pilates and regular exercise can help to alleviate the sensation of stress. Finally those diagnosed with IBS also suffering from anxiety, depression or psychological problems could find it useful to undertake psychotherapy, counselling or cognitive behavioural therapy.

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  1. Abbasnezhad, A., Amani, R., Hajiani, E., Alavinejad, P., Cheraghian, B., & Ghadiri, A. (2016). Effect of vitamin D on gastrointestinal symptoms and health‐related quality of life in irritable bowel syndrome patients: a randomized double‐blind clinical trial. Neurogastroenterology & Motility.
  2. Enck P., Aziz Q., Barbara G., Farmer A. D., Fukudo S., Mayer E.A., Niesler B., Eamonn M.M., Quigley E.M.M., Rajilic´-Stojanovic M., Schemann M., Schwille-Kiuntke J., Simren M., Zipfel S. and Spiller R.C. (2016). Irritable bowel syndrome. Nature reviews. Disease primers, 2. 24 pp.
  3. Escott-Stump, S. (2015). Nutrition and diagnosis-related care. Wolters Kluwer.
  4. Geissler, C., & Powers, H. (2010). Human nutrition. Elsevier Health Sciences.
  5. Han, K., Wang, J., Seo, J. G., & Kim, H. Efficacy of double-coated probiotics for irritable bowel syndrome: a randomized double-blind controlled trial. Journal of Gastroenterology, 1-12.
  6. Magge, S. S., & Wolf, J. L. (2013). Complementary and alternative medicine and mind-body therapies for treatment of irritable bowel syndrome in women.Women's Health9(6), 557-567.
  7. Rao, S. S. C., Yu, S., & Fedewa, A. (2015). Systematic review: dietary fibre and FODMAP‐restricted diet in the management of constipation and irritable bowel syndrome. Alimentary pharmacology & therapeutics41(12), 1256-1270.
  8. http://www.nhs.uk/Conditions/Irritable-bowel-syndrome/Pages/Introduction.aspx

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