DR MONIQUE MARAIS

GASTROENTEROLOGIST CAPE TOWN

DR MONIQUE MARAIS

GASTROENTEROLOGIST CAPE TOWN

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a chronic yet benign condition of the digestive system. The cardinal symptoms are those of abdominal pain and altered bowel habits (e.g., constipation and/or diarrhoea). No definite cause for the combination of symptoms have been found, although there are many theories behind the possible pathophysiology. One of these are that people with IBS suffer from a heightened sensitivity of the gut for neurologic stimulus. This is known as visceral hypersensitivity. There are also episodes of spasms of the colon, hence the term ’spastic colon’. Some experts speculate that a subset of patients with IBS might have developed the syndrome after a gastro-intestinal infection. IBS is the most commonly diagnosed gastrointestinal condition and is second only to the common cold as a cause of absence from work. IBS is more common in women and only about 15% of sufferers seek medical attention.

The diagnosis of IBS is made after exclusion of any other pathology in a person who has fulfills diagnostic criteria for IBS.

People with irritable bowel syndrome who seek medical help are more likely to suffer from anxiety and stress than those who do not seek help. Stress and anxiety are known to affect the intestine; thus, it is likely that anxiety and stress worsen symptoms. However, stress or anxiety is probably not the cause. Some studies have suggested that irritable bowel syndrome is more common in people who have a history of physical, verbal, or sexual abuse.

Food intolerances are common in patients with irritable bowel syndrome, raising the possibility that it is caused by food sensitivity or allergy. This theory has been difficult to prove, although it continues to be studied. The best way to detect an association between symptoms of irritable bowel syndrome and food sensitivity is to eliminate certain food groups systematically (a process called an elimination diet), which should only be considered for patients in the care of a doctor or nutritionist. Eliminating foods without assistance can lead to omission of important sources of nutrition. In addition, unnecessary dietary restrictions can further worsen a person's quality of life.

A number of foods are known to cause symptoms that mimic or aggravate irritable bowel syndrome, including dairy products (which contain lactose), legumes (such as beans), and cruciferous vegetables (such as broccoli, cauliflower, Brussels sprouts, and cabbage). These foods increase intestinal gas, which can cause cramps. Several medications also have effects on the intestines that may contribute to symptoms.

Symptoms of Irritable Bowel Syndrome

Irritable Bowel Syndrome Treatment

There are a number of different treatments and therapies for irritable bowel syndrome. Treatments are often combined to reduce the pain and other symptoms of irritable bowel syndrome, and it may be necessary to try more than one combination to find the one that is most helpful for you. Treatment is usually a long-term process; during this process, it is important to communicate with your doctor about your symptoms, concerns, and any stressors or home/work/family problems that develop.

Monitor Symptoms

It is advisable to monitor when you experience symptoms, whether it is associated with any specific foods, stressful events and any other lifestyle factors. Also monitor you bowel habits. This might help in identifying any trigger factors. A food diary can be helpful.

Dietary Changes

It is reasonable to try to eliminate any foods that may aggravate irritable bowel syndrome, although this should be done with the assistance of a dietician. Eliminating foods without assistance could potentially worsen symptoms and even cause new problems.

I suggest you avoid fatty foods and large meals. Try to eat regular small portions meals. Breakfast is very important. Do not skip this meal. Have fresh fruit during the day, aim to eat at least 2-3 fruits per day. Any type of fruit would do. Then have some nuts during the day as well. Nuts aid in digestion and can help you to achieve regular bowel motions.

You could consider avoiding lactose containing foods as a trial to see if this leads to any improvement. All lactose containing products should then be eliminated for a period of two weeks. If symptoms do not improve, you may resume eating lactose-containing foods.

Foods That Cause Gas

The most common gas-producing foods are legumes (such as beans) and cruciferous vegetables (such as cabbage, Brussels sprouts, cauliflower, and broccoli). In addition, some people have trouble with onions, celery, carrots, raisins, bananas, apricots, prunes, sprouts, and wheat.

Increasing Dietary Fibre

Increasing dietary fibre (either by adding certain foods to the diet or using fibre supplements) may relieve symptoms of IBS, particularly if you have constipation. Fibre may also be helpful in people with diarrhea predominant symptoms since it can improve the consistency of stools.

A bulk-forming fibre supplement may also be recommended to increase fibre intake since it is difficult to consume enough fibre in the diet. Fibre supplements should be started at a low dose and increased slowly over several weeks to reduce the symptoms of excessive intestinal gas, which can occur in some people when beginning fibre therapy.

Fibre can make some people with irritable bowel syndrome more bloated and uncomfortable. If this happens, it is best to decrease fibre intake and consider other laxative treatments for constipation.

Psychosocial Therapies

Stress and anxiety can worsen irritable bowel syndrome in some people. The best approach for reducing stress and anxiety depends upon your situation and the severity of your symptoms. Have an open discussion with your clinician about the possible role that stress and anxiety could be having on your symptoms, and together decide upon the best course of action.

Some people benefit from formal counseling, with or without antidepressant or antianxiety medications. Other treatments, such as hypnosis and cognitive behavioral therapy may also be helpful.

Exercise can help reduce anxiety and stress. It also can alleviate constipation and is part of a healthy lifestyle.

Irritable Bowel Syndrome Medications

One always needs to remember that there is no cure for IBS. We can try to treat the symptoms, but the syndrome is chronic. We aim to relieve symptoms and the treatment will depend on your specific symptoms. As discussed above, the first line of treatment is lifestyle modification. Only if this fails do we initiate further treatment. Drug include antispasmodics, fibre supplements and other safe drugs to alleviate symptoms. Sometimes it might be necessary to prescribe laxatives. Antidepressants can also be used a part of pain management, in low doses. Amiptriptyline is usually used in a very low dose at night. Remember that the full effect might only be noticeable after 3-4 weeks. Another class of antidepressants can also be used, namely the serotonin reuptake inhibitors (SSRIs). Treatment should be individualized for every patient.

Peppermint oil: There is some evidence supporting the use of peppermint oil, although it is difficult to make definitive conclusions. Peppermint oil can cause or worsen heartburn.

There are many probiotics available on the market. Their benefit is still unproven in IBS. Please consult your doctor before purchasing any remedies for IBS.

Irritable bowel syndrome prognosis

It is important to remember that IBS is not a dangerous syndrome. It does not lead to colon cancer or any other malignancy. Yet it is a syndrome that can cause substantial physical and emotional discomfort. Most IBS sufferers learn to control their symptoms over time. It is important to share your symptoms and concerns with your doctor. If your symptoms change over time, please consult your doctor as you might need further investigation.

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Irritable Bowel Syndrome - Mayo Clinic