Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is also known as irritable colon, spastic colon, mucous colitis, and spastic colitis. It is a common disorder that affects the large intestine and causes persistent discomfort. IBS is a chronic condition that needs to be managed for the long term.

There are three main types of IBS:

1. IBS with constipation (IBS-C): A person experiences discomfort, bloating, stomach pain, passing of hard or lumpy stools, infrequent or delayed bowel movements.
2. IBS with diarrhea (IBS-D): There is stomach pain, an urgent need to go to the toilet, discomfort, watery or loose stools, or frequent bowel movements.
3. IBS with alternating stool pattern (IBS-A): Alternate pattern means when a person experiences constipation and diarrhea.
4. What Causes it?

Factors that may cause Irritable Bowel Syndrome:

1. Diet: high-protein diet, processed food, dairy products. 
2. Stress
3. Hormonal fluctuations (e.g., menstrual periods)
4. Digestive organs with high pain sensitivity.
5. Genetic factors
6. A malfunction in the muscles- intestinal walls are lined with layers of muscles that help move food through the body.
7. An unusual response to infection.
8. Faulty communication between the gut and the CNS. There could be the inability of the central nervous system (CNS) to control the digestive system: 
9. Mental and emotional state- Anxiety and stress may make your mind more aware of pain and discomfort. 
10. Changes in gut microbes.
11.  What are the Risk Factors?

Following conditions may increase the risk of IBS:

1. Gastroenteritis.
2. Being a younger or older adult.
3. A history of anxiety or depression.
4. Stress.
5. Overusing healthcare.
6. A family history of IBS.
7. Pain.
8. Sleep disorders.
9.  Signs and symptoms of IBS:

The most common symptoms of IBS include:

1. Abdominal pain and cramping. The pain often reduces after passing a stool.
2. Changes in bowel habits.
3. Flatulence (passing excess gas).
4. An urgent need to use the bathroom.
5. Even after passing stools, you may feel that the bowels are not empty.
6. The passing of mucus from the rectum.
7. Swelling or bloating of the abdomen.

 What are the Complications?

Following are possible complications of IBS:

• Chronic constipation or diarrhea.
• Hemorrhoids.

Diagnosis: How to diagnose Irritable Bowel Syndrome?

• Medical history – Check for symptoms and other risk factors.
• Physical Examination – To help diagnose irritable bowel syndrome, the doctor will perform the following physical tests:

1. Feeling the abdomen.
2. A digital rectal exam.
3. Listening for bowel sounds (with a stethoscope).
4. A pelvic exam (in women).

Diagnostic tests – The tests performed are:

1. Blood test – to rule out other possible conditions like:
2. Lactose intolerance.
3. Small intestinal bacterial overgrowth.
4. Celiac disease.
5. Stool studies – to check for infection or signs of malabsorption.
6. Colonoscopy – to examine the entire length of the colon.
7. X-ray or CT scan.
8. Lower GI series – the doctor might fill the large intestine with a liquid (barium) to make any problems more visible on X-ray.
9. Upper endoscopy investigates the upper part of the digestive tract. The gastro-surgeon can collect a tissue sample (biopsy) and fluid from your small intestine to look for overgrowth of bacteria.
10. Breath test for bacterial overgrowth.

 Treatment: How is IBS treated?

•  Surgery: There is no role in treating irritable bowel syndrome (IBS)
• Medications: 
• Your doctor might suggest medications, Based on your symptoms, such as:
• Fiber supplements – such as psyllium (Metamucil) with fluids may help control constipation.
• Laxatives – such as magnesium hydroxide oral (Phillips’ Milk of Magnesia) or polyethylene glycol (Miralax).
• Anti-diarrhoeal medications – such as loperamide (Imodium A-D), can help control diarrhea. 
• Anticholinergic medications – such as dicyclomine (Bentyl) can help relieve painful bowel spasms.
• Tricyclic antidepressants – help relieve depression as well as inhibit the activity of neurons that control the intestines to help reduce pain – e.g., imipramine (Tofranil), desipramine (Norpramin), or nortriptyline (Pamelor).
• SSRI antidepressants – such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil), may help if you are depressed and have pain and constipation.
• Pain medications – Pregabalin (Lyrica) or gabapentin (Neurontin) might ease severe pain or bloating.
• Medications specifically for IBS – Alosetron (Lotronex), Rifaximin (Xifaxan), Lubiprostone (Amitiza), etc.

Prevention: Can we prevent Irritable Bowel Syndrome?

•  Prevention –
• Getting regular exercise.
• Limit caffeine and alcohol.
• Limit the intake of fatty foods.
• If diarrhea is the main symptom, limit dairy products, fruit, and artificial sweeteners such as sorbitol or xylitol.
• Increase fiber in the diet to help relieve constipation.
•  Living with the disorder –
• Following lifestyle changes can help in the long term:
• Consume fiber-rich food or take fiber supplements.
• Avoid foods that trigger the symptoms.
• Eat at regular times. 
• Exercise regularly. Exercise stimulates normal contractions of your intestines, helps relieve depression and stress and can help you feel better about yourself. Ask your doctor about an exercise program.

 When to see a doctor?

• Always consult a gastroenterologist immediately if observed any symptoms. The typical consultation fee for a gastroenterologist ranges from ₹ 500 to ₹ 1500 in India.