Introduction:
Under normal conditions, the food that we consume, passes through the gastrointestinal (GI) tract where food is digested and the nutrients are absorbed by our body and the undigested food or waste material is excreted from the body. Irritable Bowel Syndrome is a chronic gastrointestinal condition that affects your gastrointestinal (GI) tract, predominantly your bowels causing stomach cramps, lower abdominal pain, abdominal bloating, and episodes of diarrhoea and constipation. It affects approximately 10% of adults worldwide, making it a prevalent condition. The pain is typically triggered by bowel movements and affects individuals of any age, lasting for extended periods with chronic effects.Irritable Bowel Syndrome can have a significant impact on your quality of life, with some patients finding it very challenging to live with.
Prevalence of Irritable Bowel Syndrome
According to a paper published on the “The Lancet “- a prestigious medical journal, on “Global prevalence of irritable bowel syndrome according to Rome III or IV criteria”
The prevalence of irritable bowel syndrome was higher in women than in men (12·0% [95% CI 9·3–15·0] vs 8·6%
According to the 2014 paper published on “ National Library of Medicine” which titlied ” The epidemiology of irritable bowel syndrome
Depending on the diagnostic criteria employed, irritable bowel syndrome affects around 11% of the population globally
Types of Irritable bowel syndrome :
Irritable bowel syndrome manifests in several subtypes, each characterised by distinct patterns of bowel habits and associated symptoms. The primary types of irritable bowel syndrome include:
Irritable bowel syndrome with Constipation (IBS -C): The infrequent bowel motions or difficulties passing faeces are the defining characteristics of this subtype. Bloating and discomfort in the abdomen are common symptoms of IBS-C. Stools can be characterised as pellet-shaped and are in most cases, firm. Even when the rectum is entirely empty, patients may feel that the evacuation is not quite complete.
Irritable bowel syndrome with Diarrhoea (IBS-D): Patients experience frequent episodes of loose or watery stools, but in small volumes. The urge to pass stools usually occurs in the morning or after a meal. Along with diarrhoea, symptoms may include urgency to use the bathroom, cramping in the abdominal area, bloating, and gas.
Mixed irritable bowel syndrome (IBS-M): Patients with this condition alternate between constipation and diarrhoea, or vice versa. Depending on the predominant bowel pattern at any particular time, symptoms like discomfort, bloating, and stomach pain may change.
What causes Irritable bowel syndrome ?
The exact cause of irritable bowel syndrome is not fully understood ,though various factors can contribute to irritable bowel syndrome . Most common include:
Gastrointestinal Motility Abnormalities: In the gastrointestinal tract, food particles travel in a rhythmic manner. Any modification to this pattern can lead to either high or low motility. This anomaly causes a shift in bowel habits, resulting in constipation and diarrhoea, often occurring alternately.
Visceral Hypersensitivity: Visceral hypersensitivity refers to a condition where patients experience increased pain or discomfort originating from the gastrointestinal tract. In other words, they are hypersensitive to pain or any sort of discomfort arising out of contractions that are normally involved in bowel movement or gas movement.
Intestinal Inflammation: One of the factors that have an important role in irritable bowel syndrome is the regulation of the immune system or immune system dysfunction in the gastrointestinal tract. It is also known as low-grade inflammation. It is noteworthy that the exact cause of low-grade inflammation or immune system dysfunction in irritable bowel syndrome is not fully understood.
Changes in Gut Microbiota: We are aware that our gut is home to trillions of bacteria and other microorganisms that play a vital role in the digestive process of food. Studies indicate that the number of microorganisms in the lower parts of the GI system can reach as high as 10¹² per ml. The makeup of this gut microbiota is changed as a result of dietary modifications, stress, sleep patterns, or pharmaceutical side effects, which might result in issues that worsen irritable bowel syndrome.
Psychological Factors: Psychological factors are also known to contribute to irritable bowel syndrome . Stress, anxiety, depression, or past traumatic experiences, can significantly influence the onset and severity of irritable bowel syndrome symptoms. Stress and emotional distress can exacerbate gastrointestinal symptoms by affecting gut motility and sensitivity.
Genetic Predisposition: While not fully understood, there appears to be a genetic component to irritable bowel syndrome . The role of genetic factors influencing the prevalence of irritable bowel syndrome has been shown in several studies. Family members of patients suffering with this condition may exhibit similar GI complaints
Food Intolerances and Sensitivities: Certain foods and dietary components, such as lactose, gluten, FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), caffeine, or artificial colouring and flavouring agents, and artificial sweeteners, may trigger or exacerbate irritable bowel syndrome symptoms in susceptible individuals. Food intolerances can lead to abdominal pain, bloating, gas, and changes in bowel habits.
Symptoms of irritable bowel syndrome
Signs and symptoms include:
Abdominal pain or cramps( are usually related to the urge to use the bathroom)
Excess gas and bloating.
Diarrhoea, constipation, or alternating between the two.
Mucus in your Stool (may look whitish).
Not getting a feeling that you have emptied your bowel after using the bathroom
Abnormal stool frequency, either more than three times a day or less than three times a week.
Diagnosis:
There were no formal diagnosis criteria in the early years, irritable bowel syndrome remained “frequently misdiagnosed and poorly understood”into the 1970s.
Dr. Andrew Manning, formulated one of the earliest formal criteria to diagnose irritable bowel syndrome. These criteria were established in the late 1970s and provided a structured approach for diagnosing this disorder based on the presence of specific symptoms such as abdominal pain relieved by defecation, onset associated with a change in stool frequency, and changes in stool consistency.
The diagnosis criteria developed by Manning have evolved into what is called the “Rome criteria ‘’ through expert consensus, which is now in its fourth iteration. The Rome criteria recommend that irritable bowel syndrome should be a positive diagnosis but are more restrictive than the Manning criteria.
When the following conditions are satisfied, an irritable bowel syndrome diagnosis can be given in accordance with the Rome IV criteria:
Patients with recurring abdominal pain, occurring at least once in a week for the past 3 months or so, often exhibit two or more of the following linked to bowel movements:
Change in the frequency of stool.
Change in the form (appearance) of stool.
Before a diagnosis is made, symptoms must have existed for at least six months.
Symptoms must be present for at least 3 days per month in the last 3 months.
In order to make an accurate diagnosis of irritable bowel syndrome , it is recommended to incorporate Rome IV Criteria along analysing of the following:
Patient history
Dietary questions,
Physical examination,
Lab test such as Blood test,Stool test
Imaging tests such as Colonoscopy, Flexible sigmoidoscopy, Upper endoscopy etc
Management and Treatment
Irritable bowel syndrome is a multifactorial disorder, and approaches to treatment are similarly diverse.The disorder has no definitive treatment but could be controlled by eliminating some exacerbating factors such as certain medications, stressful situations and changes in diet.
Here are the different approaches that can to taken to manage irritable bowel syndrome :
Diet changes: Consult a dietitian for assistance in selecting appropriate foods and adjusting eating/drinking patterns to prevent flare-ups They may recommend that you:
Increase fibre in your diet. Fibre-rich foods, including fruits, leafy vegetables, unpolished grains etc. It’s advisable to introduce fibre slowly into your diet to give your gut time to adjust.
Limit dairy items, such as milk and cheese. Patients with IBS tend to have lactose intolerance. If you reduce your dairy intake, it is advisable to include foods high in calcium that are not dairy, such as salmon, spinach, broccoli, or Finger millets.
Foods that cause bloating should be avoided. Gas-producing foods include Brussels sprouts, cabbage, and beans. Chewing gum and carbonated drinks can also cause gas.
Drink plenty of water. Drink at least 2 litres of water a day..Drinking adequate amounts of water can help prevent constipation and also its lubricates the GI tract.
Lifestyle changes
Exercise regularly: Aim for 120 minutes of moderate exercise weekly. This is about 25 minutes a day, five days a week. “Moderate” means you’re raising your heart rate also called as Cardio exercises.
Relaxation techniques: Breathing exercises,meditation and other de-stressing techniques can be of great help
Get enough sleep: Aim for seven- nine hours of quality sleep each night. Getting a good sleep is the best stress buster.
Medications
Doctor may prescribe medications to provide symptom relief, including:
Antidepressants
Medications to ease constipation (including fibre supplements and laxatives).
Medications to firm stools (anti-diarrheals).
Medications to help with intestinal spasms.
Conclusion:
There’s no known cause for irritable bowel syndrome, so you can’t prevent or avoid it. If you have this disorder, you can keep symptoms from flaring up by avoiding triggers. Irritable bowel syndrome accounts for 20–50% of referrals to gastroenterology clinics. The costs associated with treatment are therefore substantial; it has an impact on individuals, family, and the health service. It also affects the quality of life considerably; individuals with this condition tend to spend more time indoors, which further affects their mental health negatively. Though there is no definite cure available as we speak, irritable bowel syndrome is manageable. You can improve symptoms by changing what you eat and by adjusting your daily habits to better handle triggers.
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FAQs
1.What is irritable bowel syndrome ?
Irritable Bowel Syndrome is a chronic gastrointestinal condition that affects your gastrointestinal (GI) tract, predominantly your bowels causing stomach cramps, lower abdominal pain, abdominal bloating, and episodes of diarrhoea and constipation
2.What are the symptoms of irritable bowel syndrome
Stomach cramps, lower abdominal pain, abdominal bloating, and episodes of diarrhoea and constipation are common symptoms .
3.What foods should I avoid?
It is advisable to consult a nutritionist who will suggest dietary changes, but generally it’s better to avoid inflammatory foods,spicy food ,beans, onions, celery, daily products,food with high levels of caffeine etc.
4.What foods are advisable to lower the triggers leading to irritable bowel syndrome ?
It is recommended that you speak with a nutritionist, who may advise you on dietary modifications, but generally you can consume fibre-rich food,unpolished grain, fresh foods and drink plenty of water.
5.What lifestyle changes should I make, if one has irritable bowel syndrome ?
Exercising daily for about 30 minutes certainly helps, one should indulge in stress-relieving activities, eating smaller, more frequent meals rather than large meals. Ensure that you get good amount of sleep
6.How is irritable bowel syndrome diagnosed?
Doctors generally use a set of guidelines such as Manning or Rome criteria, for diagnosing functional gastrointestinal disorders, to make a diagnosis. Some lab tests such as blood tests, stool tests, colonoscopy, and imaging studies may be performed to rule out other conditions.
7.Is there a cure for irritable bowel syndrome ?
Although there is currently no cure for irritable bowel syndrome , symptoms can frequently be effectively managed with suitable treatment options and lifestyle modifications. Generally, a mix of dietary modifications, stress-reduction methods, medications, and other therapy specific to each patient’s requirements and symptoms are used to manage irritable bowel syndrome .
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