What is IBS?
Irritable Bowel Syndrome, commonly known as IBS, is a prevalent digestive disorder that impacts many individuals. Symptoms can range from abdominal discomfort and bloating to constipation and diarrhoea. These symptoms vary in intensity from person to person, with some experiencing brief episodes and others dealing with more prolonged bouts. IBS episodes can often be triggered by stress or certain dietary choices. While IBS is a lifelong condition, many individuals see improvement over time.
Causes
The exact cause of IBS remains a mystery, but experts generally attribute it to increased gut sensitivity and impaired digestion. This heightened sensitivity can lead to stomach pain and discomfort, stemming from either diarrhoea or constipation. Psychological factors, such as stress, are also thought to contribute to IBS symptoms.
Diagnosis
Diagnosing IBS can be challenging, as it doesn't manifest discernible abnormalities within the digestive system. Typically, a diagnosis relies on evaluating the presented symptoms. A healthcare provider may consider IBS if a patient has experienced abdominal discomfort, bloating or altered bowel habits for six months or more. To confirm the diagnosis, specific criteria, including changes in stool consistency, abdominal bloating or tension and mucus passage from the anus, must be met.
While most IBS cases can be diagnosed based on symptoms alone, additional tests may be necessary to rule out other potential causes or underlying conditions. For instance, a blood test might be required to exclude conditions like coeliac disease. In some cases, a stool sample may be requested to test for calprotectin, which can indicate Inflammatory Bowel Disease (IBD) instead of IBS. Rarely, further testing may be necessary if a patient presents "red flag" symptoms like unexplained weight loss, rectal bleeding or abdominal lumps.
Treatment
Although there is no cure for IBS, various treatments can help manage the condition effectively. These treatments include:
- Antispasmodics: These medications relax the muscles in the digestive system, alleviating cramping and bloating. Examples include mebeverine (Colofac), alverine citrate, and therapeutic peppermint oil (Colpermin).
- Laxatives: Bulk-forming laxatives are recommended for individuals with IBS-related constipation. These soften stools, making them easier to pass. Adequate fluid intake is essential to prevent bloating and flatulence when using laxatives. ispaghula husk (Fybogel) is an example of a bulk-forming laxative.
- Antimotility Medicines: These medications slow down bowel contractions, allowing stool to solidify. Side effects may include stomach cramps, bloating, drowsiness, dizziness and rashes. Loperamide (Imodium) is an example of an antimotility medicine.
- Antidepressants: Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are used to treat IBS. TCAs interrupt nerve signals to the digestive system, while SSRIs have other effects. Side effects may include dry mouth, constipation, drowsiness and blurred vision. Examples include amitriptyline for TCAs and citalopram, fluoxetine, and paroxetine for SSRIs.
Prevention
While IBS cannot be cured, its impact can be managed through dietary and lifestyle changes. An IBS-friendly diet can be tailored by keeping a food diary to identify trigger foods. Fibre intake plays a significant role; soluble fibre is helpful for constipation, while insoluble fibre should be reduced if diarrhoea is a problem.
General tips for an IBS-friendly diet include:
- Eating regular meals
- Avoiding caffeinated drinks and alcohol
- Reducing the intake of resistant starch
- Staying hydrated with water
- Trying probiotics, although their effectiveness varies
- Managing stress through techniques like meditation, exercise, and therapy
For severe stress, seek stress counselling to address the psychological impact of IBS effectively. Various therapies, including psychotherapy, cognitive behavioral therapy (CBT) and hypnotherapy, can help individuals cope with IBS-related stress and symptoms.
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