Irritable bowel syndrome (IBS)
What is IBS?
Irritable bowel syndrome (IBS) is the most common disorder of the digestive system and up to one third of the population experience symptoms. Women are slightly more affected than men and the usual age for patients to seek advice is between 20 and 40 years.
Facts about IBS :
- Irritable bowel syndrome (IBS) is a common condition that affects the digestive system.
- Worldwide it’s estimated that 5-10% of the population has IBS.
- It causes symptoms like stomach cramps, bloating, diarrhoea and constipation. These tend to come and go over time, and can last for days, weeks or months at a time.
- We do not really know why women get IBS easier than men. It does not seem to be because they have different hormones than men. It seems to be because women may feel sensations from the intestines differently. IBS seems to be the same in all different types of people here and around the world. IBS is one of the most common disorders seen by doctors.
- The exact cause is unknown – it’s been linked to things like food passing through your gut too quickly or too slowly, oversensitive nerves in your gut, stress and a family history of IBS.
- Symptoms may result from a disturbance in the way the gut, brain, and nervous system interact. This can cause changes in normal bowel movement and sensation.
- Stress does not cause IBS. However, because of the connection between the brain and the gut, stress can worsen or trigger symptoms.
- The impact of IBS can range from mild inconvenience to severe debilitation. It can control many aspects of a person’s emotional, social and professional life. Persons with moderate to severe IBS must struggle with symptoms that often impair their physical, emotional, economic, educational and social well-being.
- IBS is unpredictable. Symptoms vary and are sometimes contradictory. Diarrhoea can alternate with constipation. Long-term symptoms can disrupt personal and professional activities, and limit individual potential.
- Treatments are available for IBS to help manage symptoms. Not all treatments work for all people. Through research, better treatments may be found. Although IBS is common in the general population, few seek medical care for their symptoms.
- Four out of five people reported pain as the most frequent factor contributing to the severity of their IBS.
- Approximately 20 to 40% of all visits to gastroenterologists are due to IBS symptoms. For those with IBS an additional burden comes from living in a society where the word “bowel” may scarcely be spoken. Individuals must cope with multiple symptoms that affect every aspect of their lives. Those around them may be unaware of the impact, or even the existence, of the disorder
IBS is NOT:
A problem with the structure or lining of your bowels as Inflammatory Bowel Disease (IBD)
Caused by physical or chemical disorder
A cancer and will not cause cancer
The start of other serious problems
Something you have to ‘just live with’
Scientific test show that IBS is caused by changes in the nerves and muscles that control sensation and motility of the bowel. IBS is not “in your head,” but it can be worsened by stress and anxiety.
Are There Different Types of IBS?
Generally, doctors think that IBS is different in people due to the type of problems they are having. They group these into IBS with constipation, IBS with diarrhoea, or IBS with mixed symptoms. Abdominal discomfort or pain is present in all groups. There are similar numbers of people in each of these groups. By determining the IBS group that you belong to, your doctor can find the right treatment for you. Make sure you tell all of your symptoms to your doctor so they can know how best to treat you.
When Should You See the Doctor?
If you have constipation or diarrhoea that comes and goes, belly pain or discomfort, and/or bloating, you may have a real and treatable problem called IBS. You should see your doctor to discuss your symptoms also to rule out any other pathology within the colon which could have been wrongly labelled as IBS.
SYMPTOMS THAT MAY BE OF CONCERN
These symptoms are not usually associated with IBS but may be associated with other diseases. If you experience any of these, even if you have had IBS for some time, you should see your doctor as soon as possible:
- A persistent change of bowel habit for 4 weeks or longer, especially if you are over the age of 40
- Passing blood from the back passage
- Unintentional weight loss of more than 2kg (4 pounds) over a short period of time
- Diarrhoea waking you from sleep
- A fever
Book your appointment at the earliest with our specialists at Piles clinic UK.
The doctor will start by asking your symptoms. Make sure to explain to your doctor about your belly discomfort, bloating, and your bowel symptoms. Your doctor may ask if you strain or have problems having a bowel movement. They may ask you to describe the appearance of your bowel movement. Your doctor will ask if you have noticed bleeding, weight loss, fever, low blood counts, or diarrhoea that won’t stop. These problems may need to be looked into more.
For most people with IBS, a doctor can figure this out by talking to you, examining you, and doing a few blood tests. Sometimes additional testing is needed to look for more dangerous problems. People over the age of 45 should have a screening test done for colon cancer.
Recommendations on Diagnostic Testing in IBS
In people with problems that look just like IBS, your doctor will still ask for investigations to rule out other organic causes which can have similar presentations as IBS.
Celiac Blood tests– Blood tests for may be helpful in patients with IBS and a lot of diarrhoea or both diarrhoea and constipation.
Lactose intolerance– This can be checked by testing your breath and may be suggested by your doctor.
Faecal calprotectin (Poo test)- Looks for signs of inflammation in the lining of your bowel as seen in Inflammatory bowel diseases as Crohns an Ulcerative Colitis.
Stool tests for infection– Tests performed on stool for infection usually include looking for bacteria including E coli, Salmonella, Shigella and Campylobacter.
Stools may also be examined for parasites, ova and cysts. These are produced by many tiny organisms such as Giardia lamblia, which is an important cause of intermittent diarrhoea.
Full Blood Count– This is to evaluate for any low blood Haemoglobin or signs of infection in your blood.
Liver and Kidney Function Tests – To evaluate your Kidney and liver functions
FIT test (Poo Test)- Your doctor may request this test to look for any blood in stools, especially if your symptoms are sudden onset change in bowel habits.
If you are aged over 40 years and have developed these symptoms suddenly, it’s important to see a specialist to rule out bowel cancer or inflammation in the colon.
Colonoscopy– This is endoscopic examination of your colon (see more information on (www.pilesclinicuk.com) which may be required if your doctor wants to rule out Inflammation or bowel cancer.
What are treatment options for IBS?
Most treatment for IBS is focused on changes in lifestyle, the type of food you eat and decreasing your level of stress. Some changes in the diet can help and are safe to try. Up to 90% of IBS patients stop eating some foods trying to improve their problems. Keeping a diary of what you eat and what symptoms you have can help you figure out what to stop.
- For patients who have a lot of bloating, try to slow down when you eat and do not overeat.
- Avoid a lot of sugar substitutes, since these can sometimes cause more gas, bloating, cramping, and diarrhoea.
- Try not to eat gassy foods, such as beans, onions, broccoli, Brussel sprouts or cabbage. Some people have trouble with wheat, dairy products, and some fruits like bananas, apples, apricots, peaches, pears and plums. IBS patients also should avoid any other foods that you have found to aggravate your IBS symptoms. Diet changes are most successful when they are supervised by a dietician.
- Avoid chewing gum, which can lead to too much air being swallowed.
- Taking more dissolvable fibre in your diet may help your symptoms, especially if you are constipated. You should make sure to drink enough water before adding fibre to your diet. Fibre without enough fluid can make your constipation worse. Start with a small amount and increase it slowly.
- When you make any change to your diet, then do it gradually to give your body time to adjust. Stress makes it harder to live with any condition. IBS and its symptoms are no exception. Some people will feel better with relaxation techniques and regular exercise or having a hobby. Meeting with a counsellor can also help.
If a dietary cause is suspected your doctor may refer you to a dietitian.
The dietitian will try to identify any foods that cause your IBS symptoms (trigger food). This may involve leaving out particular sorts of foods from the diet, to see whether these symptoms improve. The dietitian may suggest an ‘exclusion diet’, which will exclude a number of common ‘trigger’ foods from your diet. A particular form of this is the low FODMAP diet. If symptoms improve, individual items can then be added back into the diet until the specific trigger food or foods are identified.
Drugs to reduce bowel spasm have been used for many years and can provide temporary relief. Specific drugs like Mebeverine chloride have also been prescribed widely by doctors. Unfortunately, they only benefit a relatively small number of patients. Laxatives can be prescribed for constipation by your GP or from the pharmacist whilst some patients benefit from treatment with peppermint oil or other over-the-counter medicines. Some patients find probiotics very helpful, but there is no specific prescribed preparation.
New drugs are being developed, some of which may help patients whose main symptom is diarrhoea and others who tend to be constipated. Some of these newer agents are not yet available to doctors to prescribe but it does seem likely that a wider range of treatments will be available to patients with IBS in the near future.
Please visit your doctor before taking over the counter medicine without diagnosis.
Hypnotherapy and relaxation therapy: These have both been shown to be effective for some people but it is unclear whether they improve bowel symptoms. Hypnotherapy can be obtained through approved therapists who should be members of the British Medical Hypnotherapy Association. Ask about a type of therapy called gut directed hypnotherapy. Your GP can advise on counselling, and some specialists believe that a psychological treatment called Cognitive Behavioural Therapy (CBT) can be useful.
Research in IBS
Research centres such as King ́s College London (KCL) and Monash University have carried out research on the Low FODMAP Diet. The team at KCL have gathered evidence that the Low FODMAP Diet is effective in the short and long-term, broadly acceptable to patients and enables a nutritionally balanced diet. They have also provided evidence and practice guidance to assist health professionals in the delivery of the low FODMAP diet.
A large study from the University of Southampton has found that CBT (cognitive behavioural therapy) delivered over the phone or via a website was more effective than usual treatment for refractory IBS (IBS where symptoms continue after 12 months despite receiving appropriate medication and lifestyle advice). Face-to-face CBT had been shown before to be effective in IBS but patients often found adherence difficult and its availability in the NHS was poor. These telephone or web-based alternative ways to deliver CBT are a promising addition to the treatment for IBS.
Managing IBS at Home
- Identifying Trigger Foods
This may be done with a dietitian. Keeping a food diary together with a record of bowel symptoms. This may show which foods cause the most problems or whether there is some other pattern. Foods which commonly cause abdominal upset include wheat products, dairy products, onions, nuts and caffeine-containing drinks such as coffee, tea and cola. Some patients cannot digest lactose (the sugar in milk) and so develop wind and diarrhoea after taking large amounts of milk or dairy products, which can include cream, cheese, yoghurt and chocolate.
- Healthy eating Habits
Following healthy eating habits, avoiding trigger foods and eating regularly can bring about a significant improvement in symptoms.
For more information see useful links at www.pilesclinicuk.com