What is Irritable Bowel Syndrome (IBS)?
Irritable Bowel Syndrome or Spastic Colitis is a functional bowel disorder characterized by chronic abdominal pain, abdominal discomfort, abdominal distension, and changes in bowel habits such as constipation and diarrhea in the absence of any organic disease. IBS can occur after an infection or a stressful situation.
What are the symptoms of irritable bowel syndrome?
Many intestinal disorders have symptoms similar to irritable bowel syndrome. Therefore, it is very important to distinguish whether the symptomatology concerns an inflammatory bowel disease (such as ulcerative colitis and Crohn’s disease) or celiac disease.
The diagnosis of the syndrome is made by excluding other organic diseases. A differential diagnosis should definitely be made by a gastroenterologist during your visit to the clinic.
The main symptoms are:
- Pain in the upper stomach and cramps, often right after eating
- Pain in the upper left abdomen
- Pain under the left ribs
- Pain in the lower right abdomen
- Pain in the lower back
- Diarrhea or constipation or alternating between diarrhea and constipation
- Bloating or flatulence
- Gas
- Feeling of rapid filling of the stomach
- Nausea
How common is it?
IBS is the most common digestive disorder and studies show that it affects approximately 20% of the population in Western societies, with the highest incidence being found in women aged 20-40 years. However, estimating the true incidence of IBS is difficult because many patients do not seek medical help for their symptoms.
Treatment
IBS is multifactorial, so treatment includes changes in the patient’s diet. In addition, medication and psychological support may be necessary to relieve symptoms. The syndrome is a lifelong condition that can be either in exacerbation or in remission, and the treatment for some may be easily manageable while for others not. In these cases, experts are there to help you physically and psychologically.
Food Diary
It is recommended to use a diary to track what you eat every day and how each food makes you feel. This way, you can understand if your activity, medication, or what you consume is improving or worsening your symptoms.
Physical Exercise
Guidelines for treating irritable bowel syndrome emphasize movement. Studies show that physical exercise (at least 150 minutes of moderate intensity per week) improves symptoms of the syndrome, as it contributes to bowel motility, relieves the digestive system, and helps treat constipation. The last snack before exercise should be consumed at least one hour before, in order to avoid unpleasant side effects.
Dietary Strategy
The diet you should follow depends on the symptoms you are experiencing.
If you have frequent diarrhea, it is advisable to reduce foods that contain a lot of fiber and dairy products.
On the contrary, in cases where the syndrome manifests itself with persistent constipation, it is necessary to strengthen the diet with fiber. Foods rich in fiber are oats, whole grain bread, fruits (preferably with the peel) and vegetables.
DietFodmap’s
Beneficial results have appeared after adopting a dietary plan called FODMAPs. The acronym FODMAPs stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols and was developed to describe poorly absorbed short-chain carbohydrates that can lead to excessive fluid and gas accumulation, resulting in bloating, flatulence, abdominal pain and gastrointestinal disorders. This diet should not be followed for more than eight weeks, as it can lead to nutritional deficiencies or an imbalance of gastrointestinal bacteria.
After 6-8 weeks of avoiding foods high in FODMAP, we reintroduce foods. The introduction is done gradually, adding one new food at a time. This way, if the symptoms worsen, we will understand which food caused it.
Pharmaceutical Treatment
The pharmaceutical treatment that the gastroenterologist will apply depends on the symptoms of each patient. Antispasmodic drugs are usually administered for diarrhea and laxatives in cases of constipation. Guidelines for the treatment of irritable bowel syndrome mention the contribution of probiotics in relieving symptoms and changing the intestinal microbiome. However, there are still gaps regarding the duration of use of probiotics in patients with irritable bowel syndrome. In any case, communication with the doctor and monitoring of symptoms is very important.
Psychology
Anxiety and stress are closely related to irritable bowel syndrome as it has been observed that people with excessive anxiety experience flare-ups. Psychological support may be a good practice in cases of patients who are in a bad psychological state and intense stress. Cognitive Behavioral Therapy is a basic indication in the treatment of irritable bowel syndrome. The initiation of treatment is based on appropriate information and psychoeducation of patients. In some cases, the physician may recommend adjuvant antidepressant treatment to increase serotonin and glutamine levels to improve intestinal wall cohesion and consequently relieve symptoms of the syndrome.
Bibliography
Chang L, Sultan S, et al. AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Constipation. Gastroenterology 2022 Jul;163(1):118-36.
