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Irritable Bowel Syndrome & Bloating

Irritable Bowel Syndrome (IBS) is a chronic digestive system disorder broadly characterised by common gastrointestinal (GI) complaints including abdominal pain, spasms, bloating, flatulence and changes in bowel habits [1]. Most of us will experience varying degrees of these non-specific symptoms at some stage and with no definitive structural or biochemical abnormalities (the problem with IBS is functional) [2], reaching a diagnosis is often a process of elimination [3]. When no other likely cause (coeliac disease, lactose intolerance, inflammatory bowel disease, etc) can be found, the condition is referred to as IBS. Responsible for up to 50% of referrals to gastroenterology clinics [4], studies suggest at least one in ten people in the UK suffer from IBS to some degree [5]. Those most affected are generally aged 20-30, and women are twice as likely as men to have IBS [3].

Irritable Bowel Syndrome symptoms

The key feature of IBS is abdominal pain or discomfort associated with a change in stool frequency or formation [3]. The nature of this change in bowel habit is often used to further classify the ‘type’ of IBS. Constipation dominant refers to those experiencing irregularity, straining, hard stools and incomplete evacuation; diarrhoea dominant refers to those with frequent, loose or urgent bowel movements; and alternating IBS refers to those experiencing alternating periods of constipation and diarrhoea. In addition to these primary symptoms, people with IBS often experience a range of other problems including:

For some people with IBS their symptoms are generally mild and can be relieved with defecation. While others can experience severe and prolonged symptom ‘flare ups’ where pain, bloating, cramps and visits to the toilet are an ongoing nuisance. Abdominal bloating tends to affect those with constipation dominant and alternating IBS more so than those with diarrhoea dominant IBS [6].

Abdominal bloating that isn’t associated with any pain or change in bowel habits is unlikely to be classified as IBS. Click here to read more about the causes of bloating. Bloating, distension, fullness and abdominal sluggishness is however often a sign of an imbalance in the digestive system that if ignored may encourage other digestive problems such as IBS to develop in future. 

Irritable Bowel Syndrome causes

In many ways, IBS is a concept describing a wide range of unexplained digestive disturbances rather than a well-defined disease with an organic cause [5]. Unlike other digestive conditions such as gastritis or peptic ulcer disease where there is an erosion in the lining of the GI tract or coeliac disease where abnormal immune activity attacks the bowel, no distinct physiological damage or abnormality can explain the often varied symptom profile of IBS [7]. Instead, those with IBS appear to have a ‘normal’ bowel that doesn’t function properly. Disorganised peristalsis seems to alter GI motility (too fast a transit through the bowel producing diarrhoea or too slow producing constipation), with unnecessarily powerful GI muscle contractions producing spasms and pain [2]. Mounting evidence also suggests those with IBS have an altered perception of what is going on in the bowel, tending to over-react or experience pain in response to what would  otherwise be harmless and unnoticeable activity; simply eating food for example [6].

Despite no universal underlying cause for IBS, a number of interrelated factors have been recognised as potential contributors to this inflammatory, GI motility syndrome. Acute infection (traveller diarrhoea, food poisoning, etc); prolonged antibiotic use; dysbiosis, small intestinal bacterial overgrowth or other microbial imbalances;  inflammatory and immunological changes associated with leaky gut syndrome and/or food intolerances; impaired mind-gut (central nervous system to enteric nervous system) communication, for which stress is perhaps the most common cause; psychological factors (depression, anxiety, etc); serotonin signalling problems; and hormonal factors, are all suspected [5]. Recognising IBS as a complex and multifaceted issue that differs significantly from one person to another is the key to understanding IBS.

Managing Irritable Bowel Syndrome  

There is no cure for IBS but there are many treatments aimed at relieving symptoms available. Drugs commonly prescribed include laxatives, antidiarrhoeals, antispasmodics, antidepressants and serotonergic agents. Their routine use is limited however, with IBS patients often requiring multiple treatments to achieve broad spectrum relief. Their usefulness also varies, with many producing undesirable side effects [5]. The majority of IBS patients find a holistic approach and combination of treatments, to be the most effective way of managing their condition and optimising digestive health. This usually involves dietary and lifestyle modifications in addition to preventative and symptomatic treatments. Keep in mind this sounds a lot harder than it generally turns out to be.

Be sure to drink plenty of clean water; keep a food and symptom diary so you can perhaps start to correlate how certain food or drink, stress, emotions or situations affect your symptoms; eat healthily and avoid overly processed, sugary or fatty foods.  Slowly introduce more dietary fibre or perhaps consider a fibre supplement (soluble fibres like oats and psyllium husk are often better tolerated by those with IBS); get some regular exercise; work on reducing your stress level; and why not try some of these bloating natural remedies - all of which are also great for helping manage IBS.

If you have bloating and think it could be IBS it’s definitely worth getting it checked out by your doctor. Especially if you notice blood in your stools, experience unexplained weight loss, develop symptoms after the age of fifty, or have a family history of bowel or ovarian cancer. Digestive complaints such as abdominal bloating and IBS are prime examples of issues where patient education and dietary, lifestyle and behavioural interventions often achieve significant results without unnecessary medications. Studies suggest psychological treatments (psychotherapy, hypnotherapy, cognitive behaviour therapy, relaxation, meditation, etc) can reduce IBS symptoms by up to 50% [5] while complimentary medicines such as acupuncture, herbal medicine, homeopathy and so on, offer IBS sufferers additional treatment options. You can’t just take a pill and fix IBS but you can explore what contributes to your digestive imbalance and perhaps find what works to minimise your symptoms and optimise digestive health.  

References 

[1] Schuster, M., 2001, 2001, “Defining and diagnosing irritable bowel syndrome”, American Journal of management and care; 7(8):246-251.
[2] Thomas, W., et al, 2000, “Functional bowel disorders and functional abdominal pain” Functional gastroenterology disorders: diagnosis pathology and treatment; McLean Editor – Degnon Associates.
[3] NHS National Institute for Health and Clinical Excellence, 2008, Irritable bowel syndrome in adults – clinical guidelines v6.1, National Collaborating Centre for Nursing and Supportive Care, http://www.nice.org.uk/nicemedia/live/11927/39622/39622.pdf

[4] Mercinier, et al, 2003, “Probiotics as Biotherapeutic Agents: Present knowledge and Future Prospects”, Current Pharmaceutical Design; 9(2).
[5] Foxx, A., 2006, “IBS – Review and What’s New”, Medsace General Medicine, 8(3):20.
[6] Drossman, D., et al, 2002, “AGA technical review of irritable bowel syndrome”, Gastroenterology; 123:2108-2131.
[7] Schwetz, I., et al, 2003, “Current insights into the pathophysiology of irritable bowel syndrome”, Current Gastroenterology Reports; 5:331-336.

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