IRRITABLE BOWEL SYNDROME (IBS)

WHAT IS IRRITABLE BOWEL SYNDROME (IBS)?

Irritable bowel syndrome, often referred to by the initials IBS, is a functional disorder of the colon or large intestines.  It is classified as a functional disorder because the colon shows no evidence of disease.  IBS is diagnosed after all other possible digestive disorders and diseases are ruled out (1).  Although IBS sufferers can experience immense pain, the condition is not believed to permanently damage the colon or sections of the digestive tract (1).

IBS is different from IBD (inflammatory bowel disease).  IBD refers to chronic conditions that cause inflammation in a part of the intestines.  People with IBD have inflammation, ulcers, and other damage visible inside the digestive tract (2).

RISK FACTORS FOR IBS

Scientists are still unsure what causes the condition and do not have a definitive cure.  Researchers have concluded that IBS is not caused by stress or strong emotions; however, stress and strong emotion can aggravate the symptoms of IBS.

Research has shown that the nerves and muscles in the bowel tend to be extra sensitive in people with IBS.  This can cause excessive muscle contraction if too much food is consumed causing the bowel to overreact with cramping and severe pain when the bowel stretches.

Despite the lack of one clear cause, the following risk factors have been identified:

• Food: eating or drinking certain foods or beverages including wheat, dairy products, citrus fruits, beans, cabbage, milk, and carbonated drinks.
• Stress
• Hormones: women have a higher chance of developing IBS than men, suggesting hormone changes play a role.  Also, IBS seems to be worse during or around menstrual periods (3).

SYMPTOMS OF IBS

Irritable bowel syndrome is a collection of symptoms relating to a disturbance of the large bowel, also known as the colon. These symptoms may include:

• Abdominal pain or discomfort, often relieved by defecation
• Chronic diarrhea or loose or watery stools
• Constipation or a combination of constipation and diarrhea
• Off-white mucus in stools
• A bloated or swollen abdomen
• A sensation of incomplete bowel movement
• For women, an increase in symptoms during menstrual cycles
• Excessive intestinal gas
• Continuous unease around the abdomen
• Urgency – a need to rush to the toilet (3,4)

For more information on IBS and diagnosis:  1. Talk to your doctor  2. Visit the International Foundation for Functional Gastrointestinal Disorders website  3. Visit the Mayo Clinic website 

IBS FACTS AND STATISTICS

IBS is one of the most common gastrointestinal conditions in the United States, affecting between 10-15% of Americans.  It is often misdiagnosed as colitis, nervous diarrhea, nervous colon, nervous bowel, or spastic colon.  A study by the International Foundation for Functional Gastrointestinal Disorders found that 78% of those diagnosed with IBS reported having continuous or frequent reoccurring abdominal pain in the six months leading up to the study. The study also reported that those suffering from IBS restricted their usual activities for about 20% of the calendar year due to their condition (5).

MEDICAL TREATMENT OF IBS

There is no known cure for IBS; however, there are several treatments available for the different symptoms of the condition. It is important that you seek advice from your doctor for the best treatment for you as some drugs can make the condition worse. Drugs that may help target certain symptoms include (4):

• Antispasmodics: work by relaxing the muscles of the stomach and intestines.  Possible side-effects include heartburn, constipation, dry mouth, and difficulty passing urine (6).
• Medications for diarrhea: such as Imodium, Lomotil or Questran.  Possible side-effects include dizziness, fatigue, abdominal pain, constipation, nausea, dry mouth, and angioedema (7).
• Laxatives: work to relieve constipation.  Marketed as such as Fybogel, Regulan, Celevac, and Duphalac.  Possible side-effects include flatulence, cramps, diarrhea, feeling sick, and bloating (8).
• Tricyclic antidepressants: block the absorption serotonin and norepinephrine.  Possible side-effects include dry mouth, constipation, sweating, slight hesitancy in passing urine and slight blurring of vision (9,10).
• SSRI antidepressants: specifically targets the neurotransmitter serotonin.  Possible side-effects include nausea, headache, and rarely, changes in liver chemistry tests (10).

NATURAL WAYS TO SUPPORT GASTROINTESTINAL HEALTH

Practices to Help Support Gastrointestinal Health:

• Use the low FODMAP diet
• Identify and avoid food triggers
• Eat high-fiber foods
• Drink plenty of fluids
• Exercise
• Get sufficient sleep (3,4)

Natural Supplements That Support Gastrointestinal Health:

• Peppermint oil (11)
• PHGG (Partially Hydrolyzed Guar Gum) (12,13)
• Probiotics (14,15,16)
• Vitamin B12 (17)
• Vitamin D3 (as cholecalciferol) (18,19)
• Chamomile flower extract (Maticarla recultila) (20,21)
• Lemon balm leaf (Melissa offinalis) (22,23)

REFERENCES

1. Irritable Bowel Syndrome. International Foundation for Functional Gastrointestinal Disorders. https://www.iffgd.org/lower-gi-disorders/irritable-bowel-syndrome.html. Accessed July 11, 2018.
2. IBS vs. IBD: What Are the Differences Between Symptoms? MedicineNet. https://www.medicinenet.com/ibs_vs_ibd_differences_and_similarities/article.htm. Accessed July 11, 2018.
3. Irritable bowel syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016. Accessed July 11, 2018.
4. Symptoms & Causes of Irritable Bowel Syndrome. National Institute of Diabetic and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/symptoms-causes. Accessed July 11, 2018.
5. IBS Patients: Their Illness Experience and Unmet Needs. International Foundation for Functional Gastrointestinal Disorders. https://iffgd.org/images/library/General_Interest/IBSUnmetNeeds_Final.pdf. Accessed July 11, 2018.
6. Antispasmodic Medicines. Patient. https://patient.info/health/irritable-bowel-syndrome-leaflet/antispasmodic-medicines. Accessed July 11, 2018.
7. Antidiarrheals. Medscape. https://reference.medscape.com/drugs/antidiarrheals. Accessed July 11, 2018.
8. Laxatives. Patient. https://patient.info/health/constipation/laxatives. Accessed July 11, 2018.
9. Antidepressants. Patient. https://patient.info/health/depression-leaflet/antidepressants. Accessed July 11, 2018.
10. Antidepressants. IBS. https://irritablebowelsyndrome.net/medications/antidepressants-how-well-it-works-and-side-effects/. Accessed July 11, 2018.
11. Merat S, Khalili S, Mostajabi P, Ghorbani A, Ansari R, Malekzadeh R. The effect of enteric-coated delayed release peppermint oil on irritable bowel syndrome. Dig Dis Sci. 2010 May;55(5):1385-90. doi: 10.1007/s10620-009-0854-9.
12. Giannini EG, Mansi C, Dulbecco P, Savarino V. Role of partially hydrolyzed guar gum in the treatment of irritable bowel syndrome. Nutrition. 2006 Mar;22(3):334-42. DOI: 10.1016/j.nut.2005.10.003
13. Russo L, Andreozzi P, Zito F P, Vozzella L, Savino I G, Sarnelli G, Cuomo R. Partially Hydrolyzed Guar Gum in the Treatment of Irritable Bowel Syndrome with Constipation: Effects of Gender, Age, and Body Mass Index.  Saudi J Gastroenterol. 2015 Mar-Apr; 21(2): 104–110. doi:10.4103/1319-3767.153835
14. O’Mahony L, McCarthy J, Kelly P, Hurley G, Luo F, Chen K, O’Sullivan GC, Kiely B, Collins JK, Shanahan F, Quigley EM. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology. 2005 Mar;128(3):541-51. 
15. Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O’Mahony L, Kiely B, Shanahan F, Quigley EM. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol. 2006 Jul;101(7):1581-90. DOI:10.1111/j.1572-0241.2006.00734.x
16. Spiller R. Review article: probiotics and prebiotics in irritable bowel syndrome.  Aliment Pharmacol Ther. 2008 Aug 15;28(4):385-96. doi:10.1111/j.1365-2036.2008.03750.x. 
17. Mazzawi T, Hausken T, Gundersen D, El-Salhy M. Effects of dietary guidance on the symptoms, quality of life and habitual dietary intake of patients with irritable bowel syndrome. Mol Med Rep. 2013 Sep;8(3):845-52. doi:10.3892/mmr.2013.1565.
18. Williams C, Williams E, Corfe B.  Vitamin D status in irritable bowel syndrome and the impact of supplementation on symptoms: what do we know and what do we need to know?  European Journal of Clinical Nutrition. 2018. doi:10.1038/s41430-017-0064-z.
19. Abbasnezhad A, Amani R, Hajiani E, Alavinejad P, Cheraghian B, Ghadiri A. Effect of vitamin D on gastrointestinal symptoms and health-related quality of life in irritable bowel syndrome patients: a randomized double-blind clinical trial. Neurogastroenterol Motil. 2016 Oct;28(10):1533-44. doi:10.1111/nmo.12851
20. Albrecht U, Müller V, Schneider B, Stange R. Efficacy and safety of a herbal medicinal product containing myrrh, chamomile and coffee charcoal for the treatment of gastrointestinal disorders: a non-interventional study. BMJ Open Gastroenterol. 2014; 1(1): e000015. doi:10.1136/bmjgast-2014-000015.
21. Simmen U, Kelber O, Okpanyi SN, Jaeggi R, Bueter B, Weiser D. Binding of STW 5 (Iberogast) and its components to intestinal 5-HT, muscarinic M3, and opioid receptors. Phytomedicine. 2006;13 Suppl 5:51-5. DOI:10.1016/j.phymed.2006.03.012.
22. Aiysha Thompson, et al. Comparison of the antibacterial activity of essential oils and extracts of medicinal and culinary herbs to investigate potential new treatments for irritable bowel syndrome. BMC Complement Altern Med. 2013; 13: 338. doi: 10.1186/1472-6882-13-338
23. Dolatabadi F, et al. The Protective Effect of Melissa officinalis L. in Visceral Hypersensitivity in Rat Using 2 Models of Acid-induced Colitis and Stress-induced Irritable Bowel Syndrome: A Possible Role of Nitric Oxide Pathway. J Neurogastroenterol Motil. 2018 Jul 30;24(3):490-501. doi:10.5056/jnm17035.