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What is IBS – irritable bowel syndrome
IBS is a description of a collection of gut symptoms, and it is a common disorder that affects large intestine. It affects one in five adults, and affects women more than men. It is a chronic condition.
There are 3 different types of IBS:
a. IBS with constipation (IBS-C)
b. IBS with Diarrhea (IBS-D)
c. IBS with mixed bowel habits (IBS-M)
How does it occur?
During digestion, the bowel squeezes the content towards the anus (peristalsis), this is usually painless and happen without our notice. IBS occurs when there is an abnormal squeeze within the bowel or when the intestine becomes more sensitive.
IBS patients usually have a higher sensitivity to the way the intestine moves, meaning they feel more pain easily.
Causes
Although the precise cause is unknown, but the potential reasons include:
- Muscle contraction in intestine: stronger contraction and contraction that last for longer caused gas, bloating anddiarrhea while weaker contraction will reduce the food passage flow and resultin hard and dry stools
- Nervous system: Poor nerve coordination betweenthe brain and intestines will make the body overreact with the normal digestiveprocess and leads to pain, diarrhea or constipation
- Inflammation in the intestines
- Severe infection: IBS can be developed afterdiarrhea caused by bacteria or virus. It can also related to bacterialovergrowth
- Food poisoning
- Gastroenteritis
- Early life stress: people with more earlychildhood stressful experience will increase the likelihood of IBS development
- Alters in gut microbes: changes in bacteria,fungi and viruses residue in intestines. It is shown that microbes in peoplewith IBS is differed from those normal healthy individual.
- Eating irregularly
It can also be triggered by food (might have worse symptoms when consume wheat, dairy product, citrus fruit, beans, cabbage, milk and carbonated drink),stress and hormones (worse during or around menstrual period)
Signs and Symptoms
Common symptoms include: Cramping, abdominal pain, wind, bloating, gas, distension, and diarrhoea, change in bowel habit, pooing mucus and constipation.
Other symptoms include: tiredness, feeling sick, backache and bladder symptoms (assessment should be performed if signs are presented for at least 6 months)
Criteria Diagnosis
Diagnosis should be considered only if there is abdominal pain or discomfort that is either relieved by defaecation or associated with a change in bowel habit. It also needed to accompanied by at least two of the four symptoms:
1. Altered stool passage (straining, urgency,incomplete evaculation)
2. Abnormal bloating, distension, tension orhardness
3. Symptoms worsen after food consumption
4. Mucus passage
· Other features that might support the diagnosis includes: 1) lethargy, nausea, backache and bladder symptoms
· If you are IBS-D, a gluten test might be required
Symptoms that may be of concern
1. Unintentional and unexpected weight loss (more than 2kg over a short period of time)
2. Rectal bleeding
3. Family history of bowel diseases such as ovarian cancer, colitis or Crohn’s disease
4. Alter in bowel habit (looser or more frequent stools) for more than 6 weeks for individual aged above 60
5. A fever
The role of a dietitian
The dietitian will help to oidentify foods that caused the IBS symptoms(Trigger food)
o This involves leaving out particular food from the diet to see if the symptoms improve
o May suggest an exclusion diet, particularly the low FODMAP diet
o If the symptoms improves, individual items can then be add back to the diet until a specific trigger food or foods are identified
Management (1st line advice - changes to food)
1. Consume three regular meals per day
2. Avoid skipping meals or eat late at night(symptoms could be eased if comsume a smaller portion of meals)
3. Reduce the consumption of caffeine-containingdrinks (no more than 3 cups per day)
4. Reduce the consumption of carbonated drinks/fizzy drinks
5. Drink at least 8 cups of fluids per day (thiscould include water and tea)
6. Reduce the consumption of rich or fatty foodsuch as chips, fast food, pies, cheese, pizza, creamy sauces, fatty meats
7. limit consumption of manufactured food
8. consume no more than 3 portions of fresh fruitper day
If symptoms include bloating and wind
1. limit consumption of gas producing food such asbeans and pulses, brussels sprouts, cauliflower and chewing gum
2. might be helpful to consume oats (porridges andoat-based cereal) and linseeds
If symptoms include constipation
1. Gradual increase the fibre uptake (it is notrecommended to sudden increase as this might worsen the symptoms). Wholegrains,oats, vegetables, fruits and linseeds are some of the fibre-rich food source
2. Adding one tablespoon per day of brown or goldenlinseeds to breakfast cereal, yoghurt, soup or on salad. Have around a smallglass or teacup of fluid with each tablespoon of linseed taken
3. Avoid taking extra wheat bran
If symptoms include diarrhoea
1. Drink more fluid to replace the water loss
2. Limit caffeine consumption from tea, coffee andsoft drink to three drinks per day
3. Reduce the consumption of fibre-rich food
4. Avoid sugar free sweet, mints, gum and drinkthat containing sorbitol, mannitol and xylitol
Drug therapy (prescribed by doctor of pharmacists)
1. Laxatives, lubiprostone (Amitiza), linaclotide(Linzess), plecanatide (trulance) peppermint oil, fibre supplement (IBS-C)
2. loperamide, rifaximin(Xifaxan), eluxadoline(viberzi), alosetron(lotronex) (IBS-D)
3. Antidepressants such as amitriptyline (painkilling)
Management (lifestyle)
1. take time to relax (Hypnotherapy – Gut directedhypnotherapy, counselling and relaxation therapy, cognitive behaviouraltherapy, yoga and massage)
2. regular exercise (aerobics)
3. take time to eat meal
4. write a food diary whilst you are making changesso you can see what has helped
5. make changes according to the symptoms
Try to give your bowel time to adjust to changes. If symptoms still present after performing general lifestyle and dietary changes, try to re-introduce food that you have cut out and ask your doctor to refer to a dietitian