Irritable Bowel Syndrome (IBS)

Disclaimer: Not medical or professional advice. Always seek the advice of your physician.

Irritable bowel syndrome (IBS) is a functional dysfunction of the bowel, manifested by stomach pains. The term Functional means that the symptoms are related to changes in bowel function and not with its anatomical changes. That is, pain occurs not due to inflammation, tumor cells appearance, etc. With this, the attacks frequently happen, not less than once a week.

The pain is related to defecation or changes to stool frequency or form. The patient should notice these symptoms for at least three months for it to be possible to diagnose the disease correctly.

Facts about Irritable Bowel Syndrome

10-15% of the population suffers from IBS.
IBS is 1st amongst gastrointestinal diseases in the US.
Only 25-30% of patients seek medical advice.
Women are more susceptible to IBS than men.
The disease is frequently diagnosed in 20 to 50 years old people. 15-44.6% of patients have IBS together with functional dyspepsia syndrome. Functional dyspepsia — is a disease, which is manifested as heaviness, bloating, discomfort in the upper abdomen in the absence of reasons.
When IBS is diagnosed after 60 years old, it is required to perform a thorough examination to exclude organic pathologies (diverticulosis, polyposis, and colon cancer).
There is no known link between the increased risk of cancer development and inflammatory bowel disease or increased mortality.

Even though IBS does not affect the mortality rate, this disease can significantly worsen the quality of life of patients and causes significant expenses for its treatment and diagnosis.

Classification of IBS

Depending on the character of changes in bowel movements, there are four possible types of IBS.

IBS with constipation — IBS-3 (hard or fragmented stools ≥25%, loose or watery stools <25% of all bowel movements).
IBS with diarrhea — IBS-D (loose or watery stools ≥25%, hard or fragmented stools <25% of all bowel movements).
Mixed form — hard or fragmented stools ≥25%, loose or watery stools ≥25% of all bowel movements.
Non-classified form — there is not enough data for diagnosis of IBS with constipation, IBS with diarrhea, or mixed.

Causes of Irritable Bowel Syndrome

Among the possible reasons, gastroenterologists name.

Neurological — depressions, stresses, anxiety, insomnia.
Social — insufficient and unbalanced diet (fatty meals, lack of dietary fibers, strong tea, and coffee), overeating, absence of regular daily routine, sufficient physical activity (weak muscles of the abdominal wall), chronic tiredness.
Biological — imbalance of the intestinal bacterial flora – insufficient lactobacilli, excess putrefactive microflora, frequent infections. Sometimes the process is activated by an acute intestinal infection.
Hormonal dysfunction is one of the reasons for the disease in women. There has been a link seen between acute IBS and phases of the menstrual cycle.
Inherited — parents suffering from IBS are likely to pass the disease to their children.

What Causes The Development of IBS?

Genetic predisposition and psycho-social factors play an essential role in developing the disease (stressful situations, disruption in the ability to overcome stress, insufficient social support). Their combination brings about the development of visceral hypersensitivity* and disfunction of impaired intestinal motility. Visceral hypersensitivity is an increased sensitivity because of normal physiological stimuli.

Dysfunction of visceral sensitivity.
Psycho-social impact.
Dysfunction of motor skills.
Dysfunction of secretion.
Increase in the strength of signaling receptors.
Dysfunction of cytokine profile.
Dysfunction of non-specific inflammation.
Changes to the qualitative and quantitative composition of the intestinal microflora.

Representatives of opportunistic and pathogenic microflora trigger an immune response, which leads to the development of inflammation in the intestinal wall. Information on the presence of inflammation transforms the electric signal, carried along sensitive nerve fibers to the brain. This causes over-activation of nerve centers and increased intestinal innervation. According to the data presented in the modern literature, supporting anxiety, depressive and hypochondriacal disorders are identified in 75-100% of patients with IBS.

Symptoms of Irritable Bowel Syndrome

Diagnosis of the IBS is given in the presence of chronic symptoms, after exclusion of organic pathologies of the gastrointestinal tract.

Stomach pain, which is possible for IBS.

Stomach pain (pain presence for over 6 months).
Reduction or relief of pain after bowel movements/passing of gas.
The link between pain and stress, eating.
Transient nature of pain
It can be localized (most often in the lower abdomen), as well as unlocalized.

Stool disorders, in the form of constipation, diarrhea, or their alternation, and the presence of an admixture of mucus in the stool.
Presence of the bloating, increased gas production, and stomach rumbling.
Disruption of defecation in the form of imperative (sudden uncontrolled) urge to defecate or a feeling of incomplete emptying of the intestines.

Complains not Related to Intestinal Functioning

Dispersion (feeling pain and discomfort in the upper abdomen), nausea, heartburn.
Pain in the lower back, other muscular and joint pain.
Urological symptoms (nocturia (night urination urges), frequent and uncontrolled urination, feeling of incomplete emptying of the bladder).
Dyspareunia (presence of pain during sexual activity) in women.
Insomnia.
Low tolerance of medications.
Presence of mental factors
Anxiety.
Hypochondria.
Stress, related to symptoms.

The symptoms listed below can be accompanied by organic pathologies of the gastrointestinal tract and are indications for thorough investigation.

Unexplained weight loss.
Presence of blood in the stool.
Fever accompanying abdominal pain.
Unexplained anemia.
Family anamnesis of colorectal cancer, celiac disease, ulcerative colitis, and Crohn's disease.
Link of symptoms with:
Menstruation
Drug treatment
Dairy intake, artificial substitutes for sugar, dietary products, alcohol.
Trips to sub-tropics and tropics.
Eating disorders:
Irregular, inadequate diet.
Insufficient liquid intake.
Obesity when following a diet.

IBS: When To Contact Your Doctor

If you experience similar symptoms, then you should contact your doctor. Some patients simultaneously suffer from several symptoms (not just stomach pain, but also constipation/diarrhea, bloating, joint pain, and general weakness). However, when talking to a doctor, try to identify the primary manifestation of the disease, primarily affecting your working ability, state, and ability to communicate. It is worth concentrating on treatment, particularly on the primary manifestation of IBS.

Diagnostic algorithm for IBS

IBS is identified as a diagnosis of exclusion, which requires the following studies to be completed.

Clinical and biochemical blood tests.
Identification of antibodies for tissue transglutaminase.
Identification of thyroid hormone levels.
hydrogen breath test with glucose or lactulose.
stool culture for identification of pathogenic intestinal flora (Shigella spp., Salmonella spp., Yersinia spp., etc.), as well as toxins A and B of Clostridium difficult, identification of calprotectin in stool, and 24-hour fat loss (according to indications).
Ultrasound of abdominal organs.
Endoscopic gastroduodenoscopy with duodenal biopsy to exclude celiac disease (biopsy is performed when antibodies to tissue transglutaminase are detected in the diagnostic titer in celiac patients or their first-line relatives).
Colonoscopy with biopsy.

Irritable Bowel Syndrome Treatment

Treatment of irritable bowel syndrome is nearly always long-term. It requires several drugs, as they do not always show enough effect on their own.

Psychotropic drugs.
Pain relief.
Drugs to stop diarrhea.
Drugs for the treatment of constipation.

Diet and Lifestyle

The diet is chosen individually for excluding products causing the increased manifestation of the disease symptoms. It is recommended to:

Eat regularly in the chosen time, avoid rushing and working during eating.
Do not miss meals and do not make too long intervals between them.
Have a food diary for certain products, consumption of which causes increased symptom manifestation.
Moderate exercise also helps to reduce discomfort from the disease (walking, cycling, aerobics), which brings about a significant decrease in manifestation of main disease symptoms.

Probiotics

Probiotics are living microorganisms that can be included in various food products, including drugs and nutritional supplements, which positively impact microflora functioning.

Treatment is effective in 30% of patients; substantial remission is seen in 10% of patients. The data on the IBS progression prognosis is inconclusive. Most patients with IBS continue to experience symptoms, no matter the treatment, but their manifestation does not increase. Factors that negatively affect the disease prognosis are unwillingness to receive treatment, anxiety about the risks related to the disease, long-term IBS progression, chronic stress, and presence of supporting psychiatric diseases.