When your guts are irritated

IRRITABLE Bowel Syndrome (IBS) is a disorder of the large intestines that interferes with the normal functions of the colon.

Although IBS is not deadly, it can put a crimp on your lifestyle and make it a constant cycle of discomfort and distress. Some people with IBS are unable to work, attend social events, or even travel short distances.

IBS is common in the West. In fact, it is one of the most common disorders diagnosed by gastroenterologists. And sad to say, this disorder is now affecting more and more people in the Asia Pacific region.

It usually strikes younger people and women (two times more common than in men), especially young women, who may exhibit more symptoms during their menstrual period or when they are under stress.

What causes IBS?

The exact cause of IBS is not known. Individuals with IBS have a colon that is particularly sensitive to certain food. Abnormal bowel motility may account for diarrhoea (bowel moving too fast) and constipation (bowel moving too slow).

Causes that have been proposed include abnormalities in the brain gut axis (a chemical from the gut that sends signals from nerve endings from the intestine to the brain and vice versa), small bowel transit time (motility of small bowel in relation to a hormone) and previous gut infection (post-infectious IBS).

The disorder can also result from the interplay between environmental and genetic factors (it may be more likely to occur in people with a family history of the disorder).

Lifestyle factors, e.g. too much fatty foods and a lack of exercise, probably play a role, as could an increase in your fibre intake.

What are the symptoms?

What are the symptoms?

The most common symptoms of IBS are abdominal pain, bloating, and discomfort. However, symptoms can vary from person to person. For example, some people predominantly suffer from diarrhoea, while others find constipation a constant plague. Some others go back and forth between having constipation and diarrhoea.

Your doctor could diagnose you as suffering from IBS if you've been having the symptoms for at least six months, or, if you've had abdominal pain or discomfort for at least three days a month over the span of three months. This is based on the Rome III Criteria, which has been developed by a group of IBS experts over the last 15 years.

Symptoms of IBS may mimic those of colon cancer and other bowel diseases and infections that include inflammatory bowel disease (IBD) or coeliac disease (where an individual is unable to digest gluten, a substance found in rye, barley, and wheat).

Don't be too quick to brush off any discomfort or symptoms and assume you have IBS. If you are wrongly diagnosed with IBS when you have some other serious disease, it may cost you your life!

See a doctor for a thorough examination if you are experiencing symptoms of IBS, especially when you have accompanying symptoms such as blood in your stools, high fever, extreme fatigue, anaemia, or unexplained weight loss.

These symptoms could indicate that you're facing a more serious bowel disorder or disease instead of IBS.

Your doctor may diagnose IBS after taking a thorough history and physical examination. He or she may also conduct further investigations to rule out other diagnoses. These tests may include:

  • Blood tests (for anaemia)
  • Stool sample testing -  may include testing for blood in the stool, infection, or parasites
  • Colonoscopy - which allows a doctor to look at the entire large intestine (rectum and colon) via a thin, flexible tube with a camera at the end called a colonoscope. A colonoscopy helps detect polyps, tumours, and inflammation or infection.

However your doctor may also make a positive diagnosis if you have the classical symptoms of IBS with no alarming symptoms, especially if you are young.

Treating IBS

Treating IBS

IBS is treatable and controllable, but not curable.

Treating IBS depends on the types of symptoms you have and their frequency, severity, as well as how they affect your daily life. There is no specific medication or drug to treat IBS. Instead, IBS treatment is aimed at reducing the frequency and the severity of symptoms.

Anti-spasmodic agents (drugs to stop gut spasm), tricyclic antidepressants, or serotonin selective reuptake inhibitors (drugs to treat the function of the colon), laxatives (to treat constipation), and anti-diarrhoea drugs are the basis of the treatment for IBS.

Increasing fibre intake or supplements may help some patients with constipation but may cause bloating in others. Probiotics have been useful in some patients.

Keep in mind, however, that no single type of treatment works well for everyone. You will need to work together with your doctor to determine the best course of treatment. You may also have to make some changes to your lifestyle, i.e. your diet and exercise habits.

Living with IBS

Living with IBS

IBS affects your quality of life if you don't take the necessary measures to prevent it or have your symptoms treated.

Here's what you can do to reduce the risk of IBS:

  • Live a healthy lifestyle - Get regular exercise, adequate sleep, and quit smoking.
  • Eat healthily - Practise balance, moderation, and variety whenever you eat.

And here's what you can avoid:

  • Consuming large meals
  • Foods that you may be sensitive to
  • Getting stressed - Stress can stimulate muscle contractions or spasms in people with IBS.

Irritable bowel syndrome is not a trivial disease. It affects the quality of life of the patient and her ability to function in a society.

It is important for patients to understand that this is a chronic disease, but the prognosis is generally good.

Dr Tan Huck Joo is the president of the Malaysian Society of Gastroenterology & Hepatology. The author is not associated with and does not endorse any brand or product. This article is courtesy of the Malaysian Society of Gastroenterology & Hepatology and supported by the VITAGEN Healthy Tummies Programme.