Irritable Bowel Syndrome

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome is a type of functional gastrointestinal disorder that manifests as a set of symptoms affecting the digestive system. IBS is quite widespread in Malaysia, with up to 14% of the population suffering from it. One of the most common conditions found in gastroenterology clinics is this one.
Symptoms of IBS include abdominal pain, bloating, abdominal discomfort, and diarrhoea/constipation, all of which have a negative impact on the patients' quality of life. These tend to come and go throughout time, lasting days, weeks, or even months at a time.

What are the types of IBS?

IBS is divided into subgroups based on the consistency of one's faeces.

IBS-D (diarrhoea) is a condition in which the digestive system contracts at a faster pace, causing the digestive contents to pass through the body swiftly with lesser absorption, leading to recurrent, watery bowel movements.
IBS-C (constipation) is when the contracting mechanism of the digestive system decelerates, slowing the passage of digestive contents, leading to hard and lumpy stools (constipation).
IBS-M (mixed) is a condition in which the passage time of food through the digestive tract varies, causing patients to have a mixture of diarrhoea and constipation, which often alternates. In severe cases, the stool variations may happen during the same episode of stool passing.

What causes of IBS?

Despite the fact that numerous explanations have been proposed, the specific cause of IBS remains unknown. The most common causes linked with IBS are:
1) Altered gastrointestinal motility: This is a digestive issue that occurs when the nerves and muscles of the gut do not operate hand in hand. As a result of the aberrant and ineffective intestinal contractions, diarrhoea or constipation may occur.
2) Excessive pain sensitivity. When the intestine is stretched, those with IBS experience more pain than individuals who do not have IBS. They may have a reduced pain threshold.
3) Microbes in the intestines: Changes in bacteria, fungi, and viruses, which ordinarily reside in the intestines and play an important role in health. Research has shown that the microbes in people with IBS differ from those in healthy people.
4) Brain-gut interaction: The gut produces a lot of our stress chemicals. When the brain is under stress, the gut sends a signal to the brain via neurons that run between them, causing GI symptoms.

What are the symptoms of IBS?

Symptoms may differ from one individual to the next. Generally, they may include:

Abdominal pain that may subside after passing stools
Change in stools: Some persons get diarrhoea, while others experience constipation, and some may even experience both.
Burning sensation in the chest
Nausea and vomiting
Bloating
Loss of appetite
Headache
Fatigue
Increased urinary frequency and urgency

If you experience night-time diarrhoea, severe abdominal discomfort, fever, bloody stools, weight loss, or a sudden onset of symptoms, you should seek immediate medical attention.

How is IBS diagnosed?

IBS does not have any specialised testing. When no other medical disorders can be found to explain the symptoms, IBS is diagnosed by a process of elimination. To rule out other possibilities, your doctor may conduct normal blood and stool testing. An ultrasound, a colonoscopy, and allergy tests may be used by doctors to check for a variety of disorders. When all tests are unremarkable, your doctor may diagnose you with IBS.
A set of Rome IV-based criteria must be met before the diagnosis is confirmed:
Repeated abdominal pain that occurs at least once a week on average during the previous three months and is linked to two or more of the following:
i) Pain related to passing stools
ii) Stool frequency change
iii) Stool form or appearance change

How can IBS be treated?

To treat IBS, it's crucial to understand the nature of your symptoms and causes, if at all feasible. There are three aspects to which we can delve further:
i) Diet: The way we eat, what we consume, and when we eat all have a significant impact on our bowel movements. Regular, well-balanced, moderately sized meals are essential. It is recommended that you drink plenty of water and eat foods that are high in fibre.
Removing troublesome foods from your diet can also help. In other words, avoiding foods that aggravate your disease can significantly reduce symptoms.
The low FODMAP diet, which we advocated as a treatment for IBS, is attracting attention. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, as portrayed in the diagram. These foods are poorly absorbed in the intestines, causing luminal distension and bloating.

ii) Psychological: IBS is not a psychological disorder, although it has been demonstrated that negative thinking disrupts gut-brain communication. When you feel anxious, the gut receives a signal from the brain that the body is in danger. As a result, symptoms of functional gastrointestinal diseases, such as bloating, may get worse.

Exercising regularly and rest can help to reduce stress and improve IBS symptoms.
The importance of good sleep quality should not be downplayed.
Alternatively, you can seek assistance from healthcare professionals who can offer therapies including cognitive behavioural therapy, hypnosis, and relaxation breathing techniques.

iii) Medications: There are medications that aid reinstate the normal contraction mechanism of the bowel, minimising the symptoms of constipation and diarrhoea.

Anti-diarrheal medications include loperamide and anti-spasmodic agents that function by modifying the muscle activity of the intestine, and hence delaying the transit time.
Constipation medications, such as over-the-counter laxatives or stronger prescription laxatives, whose primary goal is to make faeces easier to pass out of the body.

Takeaway message from My Gut Brain Centre

It's important to remember that you're not alone if you're suffering from the symptoms of irritable bowel syndrome (IBS). Don't give up hope. What you have is real, and it has an impact on your life. With so many options, you can collaborate with your doctor to devise a strategy and reclaim control. Because the effectiveness of each medication varies from patient to patient, it's critical to have open lines of communication with your doctor.