IBS – Irritable Bowel Syndrome
What is IBS? It is the most common gastrointestinal disorder seen by doctors. For years, many thought it was a psychological condition, rather than a physical one. (1) It has been called by many names colitis, mucous colitis, spastic colon, spastic bowel, and functional bowel disease. (2). What is it? Irritable Bowel Syndrome or IBS is a disorder of the intestine that shows no sign of disease that can be seen or measured. (3) According to the FDA, it is second only to the common cold in causing days missed from work and it may affect up to 20 percent of Americans – some 54 million people. (4).
IBS itself is not a disease. As its name indicates, it is a syndrome – a combination of signs and symptoms. (5) This means it cannot be caught or transmitted from person to person as a cold can, nor can it be cured by an operation or medication. (6) Furthermore, IBS is one of the three major ‘functional intestinal disorders’, (Dyspepsia and Inflammatory Bowel Diseases are the others) and is a general term for conditions that show no physical evidence or disease in the intestines upon examination, and the cause of which does not show up in a blood test or an x-ray (7). Because of this, IBS is associated with many different symptoms.
The term IBS can encompass a wide variety of symptoms and is, therefore, often overused. In fact, according to the National Digestive Disease Information Clearinghouse, IBS is defined by having:
- Abdominal pain or discomfort for at least 12 weeks out of the previous 12 months These 12 weeks do not have to be consecutive.
- The abdominal pain or discomfort has two of the following three features:
- It is relieved by a bowel movement.
- When it starts, there is a change in how often you have a bowel movement.
- When it starts there is a change in the form of the stool of the way it looks (8) .
More specifically, symptoms of IBS can include any or all of the following:
- Diarrhea and/or constipation (often alternating)
- Abdominal pains and spasms
- Excess mucous in the colon and stool
- Bowel urgency or incontinence
- Difficulty swallowing
- A “lump in the throat”
- Nausea (with or without vomiting)
- Chest pain
- Heartburn
- Urinary Frequency
- Fatigue
- Depression
- Anxiety
Basically, IBS is a disturbance of the function of the colon. Patients suffer from chronic diarrhea or constipation, or alternating bouts of the two (9). A person with IBS seems to have a colon that is more sensitive and reactive than usual, so it responds to stimuli that would not bother most people. Researchers have found that the colon muscle of a person with IBS begins to spasm after only mild stimulation (10). This stimulation can be caused by numerous factors and can vary from person to person.
The causes of this “overly sensitive” colon result from a number of factors. Causes of IBS include, but are not limited to emotional stress, diet, and medicines. While these factors usually cause no undue GI distress in the average person, for an IBS sufferer they can trigger painful abdominal spasms. Let’s begin by examining the role stress plays in causing IBS.
Causes of IBS: The brain and the intestine are closely connected by nerve fibers that control the automatic functioning of the intestinal muscles, and many people may experience nausea or diarrhea when nervous or anxious. While we may not be able to control the effect stress has on our intestines, reducing the sources of stress in our lives – high pressure jobs, family tensions, etc may alleviate the symptoms of IBS. (11) Expanding on this concept, a medical officer in the FDA’s division of gastrointestinal and coagulation drug products explains that the gut has its own independent nervous system that regulates the processes of digesting food and eliminating solid waste. According o Marcelo A. Barreiro, M.D., “There’s a network of nerve cells within the wall of the gut – the gut nervous system – that does not depend on the brain fro its minute-to-minute function,” Barrerio says, but rather “responds to its inputs under various conditions. Under stress for example, the brain sends conflicting messages to the gut that may exaggerate the irritability of the gut nervous system” (12).
Diet is another major factor in the occurrence of IBS. Perhaps the largest diet related contributor is the lack of fiber. High-fiber diets keep the colon mildly distended, which may help to prevent spasms from developing. Some forms of fiber also keep water in the stools thereby preventing hard stools that are difficult to pass (13). A good example of this type of fiber is flax fiber, which provides a 50:50 balance of soluble and insoluble fiber. A diet sufficient in the proper balance of fiber can reduce IBS symptoms by increasing the transit time of food in the colon for those experiencing constipation and decreasing the transit time of food for those experiencing diarrhea. Other possible food and diet related triggers of IBS symptoms are listed below:
- Consuming large meals
- Foods that contain wheat, rye, barley, chocolate, dairy products or alcohol.
- Foods high in sulfur such as garlic, onions, leeks, broccoli, cauliflower, cabbage and
- Brussels sprouts (gas producers).
- Drinks with caffeine such as coffee, tea or colas (14).
- Fatty foods like meat, poultry skin, oils and avocados.
These foods can prove to be strong stimuli for colonic contractions for an IBS sufferer.
While there is not a direct link between the usage of medications and IBS, medications may contribute to IBS. Antibiotics are well known to cause GI problems and diarrhea. Steroid medications may also affect the flora, or bacteria balance in the gut, which can contribute to IBS. The widespread usage of both prescribed and over-the-counter medications in the U.S. could be a major factor of IBS occurrences.
