irritable bowel syndrome

What is Irritable Bowel Syndrome

Definition

Irritable bowel syndrome (IBS) is a common disorder that affects your large intestine (colon). Irritable bowel syndrome commonly causes cramping, abdominal pain, bloating gas, diarrhea and constipation. Despite these uncomfortable signs and symptoms, IBS doesn’t cause permanent damage to your colon.

Most people with IBS find that symptoms improve as they learn to control their condition. Only a small number of people with irritable bowel syndrome have disabling signs and symptoms.

Symptoms

The signs and symptoms of irritable bowel syndrome can vary widely from person to person and often resemble those of other diseases. Among the most common are:

  • Abdominal pain or cramping
  • A bloated feeling
  • Gas (flatulence)
  • Diarrhea or constipation — sometimes even alternating bouts of constipation and diarrhea
  • Mucus in the stool

Like many people, you may have only mild signs and symptoms of irritable bowel syndrome. However, sometimes these problems can be disabling. In some cases, you may have severe signs and symptoms that don’t respond well to medical treatment. Because symptoms of irritable bowel syndrome can occur with other more serious diseases, it’s best to discuss these symptoms with your doctor.

For most people, IBS is a chronic condition, although there will likely be times when the signs and symptoms are worse and times when they improve or even disappear completely.

Causes

irritable bowel syndrome
Irritable bowel syndrome. Illustration of a digestive system suffering from irritable bowel syndrome (IBS). IBS is also known as spastic colon or irritable colon syndrome. It causes abdominal pain and cramps, and irregular bowel habits such as constipation and diarrhoea. The condition is thought to be linked to anxiety and stress, which disturb involuntary muscle movement in the intestines. There is no cure, but laxatives, anti-diarrhoeal and anti-spasmodic drugs may help to alleviate the symptoms. Increasing the intake of fibre and water in the diet, and decreasing stress is also recommended. Labelled image.

It’s not known exactly what causes irritable bowel syndrome. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food from your stomach through your intestinal tract to your rectum. If you have irritable bowel syndrome, the contractions may be stronger and last longer than normal. Food is forced through your intestines more quickly, causing gas, bloating and diarrhea.

In some cases, the opposite occurs. Food passage slows, and stools become hard and dry. Abnormalities in your nervous system or colon also may play a role, causing you to experience greater than normal discomfort when your intestinal wall stretches from gas.

There are a number of other factors that may play a role in IBS. For example, people with IBS may have abnormal serotonin levels. Serotonin is a chemical messenger that’s normally associated with brain function, but it also plays a role in normal digestive system function. It’s also possible that people with IBS don’t have the right balance of good bacteria in the intestine.

Triggers affect some people, not others.

For reasons that still aren’t clear, if you have IBS you probably react strongly to stimuli that don’t bother other people. Triggers for IBS can range from gas or pressure on your intestines to certain foods, medications or emotions. For example:

  • Foods. Many people find that their signs and symptoms worsen when they eat certain foods. For instance, chocolate, milk and alcohol might cause constipation or diarrhea. Carbonated beverages and some fruits and vegetables may lead to bloating and discomfort in some people with IBS. The role of food allergy or intolerance in irritable bowel syndrome has yet to be clearly understood.

If you experience cramping and bloating mainly after eating dairy products, food with caffeine, or sugar-free gum or candies, the problem may not be irritable bowel syndrome. Instead, your body may not be able to tolerate the sugar (lactose) in dairy products, caffeine or the artificial sweetener sorbitol.

  • Stress. If you’re like most people with IBS, you probably find that your signs and symptoms are worse or more frequent during stressful events, such as a change in your daily routine. But while stress may aggravate symptoms, it doesn’t cause them.
  • Hormones. Because women are more likely to have IBS, researchers believe that hormonal changes play a role in this condition. Many women find that signs and symptoms are worse during or around their menstrual periods.

Complications

IBS isn’t associated with any serious conditions, such as colon cancer. But, diarrhea and constipation, both signs of irritable bowel syndrome, can aggravate or even cause hemorrhoids. The impact of IBS on your overall quality of life may be its most significant complication.

Lifestyle and home remedies

In many cases, simple changes in your diet and lifestyle can provide relief from irritable bowel syndrome. Although your body may not respond immediately to these changes, your goal is to find long-term, not temporary, solutions:

  • Incorporate fiber into your diet, if possible.When you have irritable bowel syndrome, dietary fiber can have mixed results. Although it helps reduce constipation, it can also make gas and cramping worse. The best approach is to gradually increase the amount of fiber in your diet over a period of weeks. Examples of foods that contain fiber are whole grains, fruits, vegetables and beans. If your signs and symptoms remain the same or worse, tell your doctor. You may also want to talk to a dietitian.

Some people do better limiting dietary fiber and instead take a fiber supplement that causes less gas and bloating. If you take a fiber supplement, such as Metamucil or Citrucel, be sure to introduce it gradually and drink plenty of water every day to minimize gas, bloating and constipation. If you find that taking fiber helps your IBS, use it on a regular basis for best results.

  • Avoid problem foods.If certain foods make your signs and symptoms worse, don’t eat them. Common culprits include alcohol, chocolate, caffeinated beverages such as coffee and sodas, medications that contain caffeine, dairy products, and sugar-free sweeteners such as sorbitol or mannitol. If gas is a problem for you, foods that might make symptoms worse include beans, cabbage, cauliflower and broccoli. Fatty foods may also be a problem for some people. Chewing gum or drinking through a straw can both lead to swallowing air, causing more gas.
  • Eat smaller meals.If you have diarrhea, you may find that eating small, frequent meals makes you feel better.
  • Take care with dairy products.If you’re lactose intolerant, try substituting yogurt for milk. Or use an enzyme product to help break down lactose. Consuming small amounts of milk products or combining them with other foods also may help. In some cases, though, you may need to eliminate dairy foods completely. If so, be sure to get enough protein and calcium from other sources. A dietitian can help you analyze what you’re eating to make sure you’re getting adequate nutrition.
  • Drink plenty of liquids.Try to drink plenty of fluids every day. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, and carbonated drinks can produce gas.
  • Exercise regularly.Exercise helps relieve depression and stress, stimulates normal contractions of your intestines and can help you feel better about yourself. If you’ve been inactive, start slowly and gradually increase the amount of time you exercise. If you have other medical problems, check with your doctor before starting an exercise program.
  • Use anti-diarrheal medications and laxatives with caution.If you try over-the-counter anti-diarrheal medications, such as Imodium or Kaopectate, use the lowest dose that helps. Imodium may be helpful if taken 20 to 30 minutes before eating, especially if the food planned for your meal is likely to cause diarrhea. In the long run, these medications can cause problems if you don’t use them appropriately. The same is true of laxatives. If you have any questions about them, check with your doctor or pharmacist.

FODMAP diet & IBS

FODMAP diet & IBS
FODMAP diet & IBS

A group of researchers based in Australia has proposed a theory regarding the use of a low FODMAP diet for IBS. The theory does not take on the question of what causes IBS, rather it looks at the role that certain foods play in triggering digestive symptoms in people who suffer from visceral hypersensitivity and motility dysfunction. The FODMAP theory has been applied to both IBS and the inflammatory bowel diseases.

FODMAP researchers have identified that short-chain carbohydrates, which are components of many foods, may be poorly absorbed by the small intestine and thus rapidly set upon and fermented by bacteria within the digestive system, specifically the small intestine and the upper parts of the large intestine (proximal colon). These carbohydrates were given the acronym FODMAPs and refer to Fermentable Oligo-, Di- and Mono-saccharides, and Polyols.

Researchers in this area theorize that the rapid fermentation of these carbohydrates contributes to GI symptoms by creating a distention of the intestines in two ways – through a higher volume of liquid due to osmosis, and an increase in gas productionThis increase in intestinal distension brought about by high FODMAP foods is thought to be a contributing factor in various IBS symptoms:

  • Abdominal pain
  • Increased intestinal gas
  • Bloating
  • Abdominal distention
  • Motility dysfunction that leads to diarrhea and constipation

Common High FODMAP Foods

FruitsApples Apricots Cherries Mango Pears  Peaches Pears Plums and prunes Watermelon High concentration of fructose from canned fruit, dried fruit or fruit juice
GrainsLevel of FODMAPs is increased when these foods are eaten in large amounts: Rye Wheat
Lactose-Containing Foods  Custard Ice cream Margarine Milk (cow, goat, sheep) Soft cheese, including cottage cheese and ricotta Yogurt/curd
LegumesBeans Chickpeas Lentils Kidney beans(Rajma)
SweetenersFructose High fructose corn syrup IsomaltMaltitolMannitolSorbitol Xylitol  
VegetablesAsparagus Avocado Beets Broccoli Brussel sprouts Cabbage Cauliflower Garlic (with large consumption) Fennel (Saunf) Leeks Mushrooms Ladies Finger Onions Peas  Lettuce  Shallots  peas

Common Low FODMAP Foods

  FruitsBanana Blueberry Grapefruit Grapes Honeydew melon Kiwi Lemon Lime  Orange Raspberry Strawberry
  SweetenersArtificial sweeteners that do not end in -olGlucose Maple syrup Sugar (sucrose)
  Lactose Alternatives  Butter Lactose-free products, such as lactose-free ice cream and yogurt Gelato Rice milk Sorbet
GrainsRice Gluten-free products
VegetablesBell peppersCarrots Celery Corn BrinjalGreen beans Lettuce Parsnip Scallions (green parts only) Sweet potato Tomato

Top Ten GI Irritants

Greasy Food

Food with a high fat content will serve to increase the strength of intestinal contractions triggered by the body’s own natural gastrocolic reflex. If you have a sensitive digestive system, you should avoid fatty meats and fried food. For example:

  • Pizza
  • Sausage
  • French fries

Dairy Products

A large number of people suffer from a condition known as lactose intolerance, in which their bodies are unable to digest lactose, the sugar found in dairy products. Lactose intolerance can lead to digestive symptoms of bloating, cramping and diarrhea. Common dairy products include:

  • Milk
  • Cheese
  • Ice cream

Whole Grains

Although a diet high in fiber is important for overall health, certain high fiber foods may be problematic. For individuals who suffer from celiac disease, ingesting a protein called gluten found in some whole grains (wheat, rye, barley) causes the body’s immune system to attack the small intestine with the result of serious health problems. Even if you don’t suffer from celiac disease, you may want to avoid bran products, as bran appears to be an irritant to the digestive system. Try other whole wheat, non-bran products instead.

Raw Fruits

Fruits are a wonderful source of important nutrients and so should be a major part of one’s diet. However, some people have difficulty with certain raw fruits. Luckily there is always the option of eating fruits that have been cooked or canned. Here are some common raw fruit offenders:

  • Melons, such as watermelon and cantaloupe
  • Citrus fruits, such as oranges and tangerines

Vegetables

Like fruits, vegetables are an important part of a healthy diet. Certain types of vegetables may be harder on your system:

  • Raw vegetables, such as onions, scallions and red peppers
  • Gas-producing vegetables, such as cabbage, broccoli and beans

Artificial Sweeteners

Artificial sweeteners and sugar substitutes, found in many sugar-free and diet foods, are often poorly tolerated, resulting in symptoms of gas and bloating. Again, be sure to read labels carefully and look for these additives in the following products:

  • Sugar-free gum
  • Sugar substitute packets for coffee
  • Sugar-free ice cream

Drinks

Don’t overlook what you are drinking when you are trying to identify foods that may create digestive upset. Here are some common culprits:

  • Sodas and other carbonated drinks, particularly if you suffer from gas and bloating
  • Coffee and other drinks with caffeine
  • Alcoholic drinks, particularly red wine
  • Diet sodas, as artificial sweeteners can also contribute to gas and bloating

Spicy Foods

A recent study suggests that spicy food may contribute to the abdominal pain seen in IBS. The study found evidence that IBS patients have a greater number of a specific type of nerve fiber that reacts with pain to a substance within chili peppers. Chili peppers are a common ingredient in those spicy foods that set your mouth aflame.

Nuts and Seeds

Perhaps because of their high fat content, nuts present a problem for some IBS sufferers. If you have also been diagnosed with diverticulosis, your doctor may have told you to avoid nuts and seeds. Although there has been no medical research to support this theory, patients have often noted that eating nuts and seeds has led to painful flare-ups.

Chocolate

I left this item for last, as it breaks my heart to add such a delicious item to this list. However unfortunate it may be, the reality is that many people do find that chocolate aggravates their digestive tract and therefore it should be avoided.

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