What is Irritable bowel syndrome (IBS)?
Irritable bowel syndrome (IBS) is a disorder affecting the intestine. IBS involves problems with motility (movement of digested food through the intestines) and sensitivity (how the brain interprets signals from the intestinal nerves), leading to abdominal pain, changes in bowel patterns, and other symptoms. So, it's a mix of belly discomfort, pain, and irregular bowel habits (too much or too little). Although often disruptive, debilitating, and embarrassing, it may be some comfort to know that IBS is not life-threatening, nor does it lead to cancer or other more serious illnesses. While incredibly uncomfortable, IBS doesn't cause changes in bowel tissue or increase your risk of colorectal cancer
Canada has one of the highest rates of IBS in the world, estimated at 18% vs 11% globally (Lovell et al. 2012). However, it is thought that IBS often remains underdiagnosed. More than 70% indicate that their symptoms interfere with everyday life and 46% report missing work or school due to IBS.
People with IBS frequently report feeling depressed, embarrassed, and self-conscious. Their inability to predict symptoms places a significant burden on daily living. IBS limits productivity and performance at work has a negative effect on the quality of relationships and limits participation in routine social activity. IBS also has a personal financial burden with individuals sometimes trying multiple over-the-counter (OTC) treatments and alternative therapies in their quest to be symptom-free.
The underlying cause of IBS is still unclear and there are no diagnostic disease markers for IBS. Guidelines recommend doctors make a positive diagnosis using criteria that are based on a person’s symptoms.
Subtypes of IBS are recognized by the Rome IV criteria based on the person’s reported predominant bowel habit, when not on medications, as follows:
- IBS-C: Irritable Bowel Syndrome with primarily constipation
- IBS-D: Irritable Bowel Syndrome with primarily diarrhea
- IBS-M: Irritable Bowel Syndrome with both constipation and diarrhea (mixed)
The signs and symptoms of IBS vary but are usually present for a long time. The most common include:
- Abdominal pain, cramping, or bloating that is related to passing a bowel movement
- Changes in the appearance of bowel movements
- Changes in how often you are having a bowel movement
Other symptoms that are often related include bloating, increased gas or mucus in the stool.
The precise cause of IBS isn't known. Factors that appear to play a role include:
- Muscle contractions in the intestine. The walls of the intestines are lined with layers of muscle that contract as they move food through your digestive tract. Contractions that are stronger and last longer than normal can cause gas, bloating, and diarrhea. Weak intestinal contractions can slow food passage and lead to hard, dry stools.
- Nervous system. Abnormalities in the nerves in your digestive system may cause you to experience greater than normal discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can cause your body to overreact to changes that normally occur in the digestive process, resulting in pain, diarrhea, or constipation.
- Severe infection. IBS can develop after a severe bout of diarrhea (gastroenteritis) caused by bacteria or a virus. IBS might also be associated with a surplus of bacteria in the intestines (bacterial overgrowth).
- Early life stress. People exposed to stressful events, especially in childhood, tend to have more symptoms of IBS.
- Changes in gut microbes. Examples include changes in bacteria, fungi, and viruses, which normally reside in the intestines and play a key role in health. Research indicates that the microbes in people with IBS might differ from those in healthy people.
Symptoms of IBS can be triggered by:
- Food. The role of food allergy or intolerance in IBS isn't fully understood. A true food allergy rarely causes IBS. But many people have worse IBS symptoms when they eat or drink certain foods or beverages, including wheat, dairy products, citrus fruits, beans, cabbage, milk, and carbonated drinks. Common food "triggers" are red peppers, green onions, red wine, wheat, and cow's milk. If you're concerned about getting enough calcium, you can try to get it from other foods, like broccoli, spinach, turnip greens, tofu, yogurt, sardines, salmon with bones, calcium-fortified orange juice, and bread or calcium supplements.
- Stress. Most people with IBS experience worse or more frequent signs and symptoms during periods of increased stress. But while stress may aggravate symptoms, it doesn't cause them.
Diet and Lifestyle Changes
Usually, with a few basic changes in diet and activities, IBS will improve over time. Here are some tips to help ease symptoms:
- Avoid caffeine (in coffee, tea, and soda).
- Add fiber to your diet with foods like fruits, vegetables, whole grains, and nuts.
- Drink plenty of water each and every day (2-3L)
- Don't smoke.
- Learn to relax, either by getting more exercise, learning stress management techniques, or if possible reducing stress.
- Limit how much milk or cheese you eat.
- Eat smaller meals more often instead of big meals.
- Keep a record of the foods you eat so you can figure out which foods bring on bouts of IBS. Avoid any identified "triggers".
The following types of drugs are used to treat IBS:
- Bulking agents, such as psyllium, wheat bran, and corn fiber, help slow the movement of food through the digestive tract and may also help relieve symptoms. Talk to your pharmacist on how to take this. This can also be used as a laxative when taken with fluids.
- Antibiotics can change the number of bacteria in your intestines. You take pills for 2 weeks. It can control symptoms for as long as 6 months. If they come back, you can be treated again.
- Antispasmodics can control colon muscle spasms, but experts are unsure that these drugs help. They also have side effects, such as making you drowsy and constipated, which make them a bad choice for some people.
- Antidepressants may also help relieve symptoms in some people.
- Probiotics, which are live bacteria and yeasts that are good for your health, especially your digestive system.
- Polyethylene glycol (PEG) is an osmotic laxative and causes water to remain in the stool, which results in softer stools. This medication may work best for those who cannot dietary fiber supplements.
- Bile acid sequestrants are cholesterol-lowering medications. Taken orally, they work in the intestines by binding bile acids and reducing stool production.
- Loperamide works by slowing down the movement of the gut. This decreases the number of bowel movements and makes the stool less watery.
- Low Dose Naltrexone (LDN) blocks the effects of the opioid receptors, which could cause the intestines to slow down, This may relieve some of diarrhea and abdominal pain associated with IBS,
To find out more about medications used in the treatment of IBS or to learn about compounded LDN, talk to one of our pharmacists at anyone of our Dispensaries Ltd. locations. We are here to help.