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Irritable Bowel Syndrome

 

What is Irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a common gut disorder. The cause is not known. Symptoms can be quite variable, crampy pain, gassiness, bloating, and changes in bowel habits. Some people with IBS have constipation (difficult or infrequent bowel movements); others have diarrhea (frequent loose stools, often with an urgent need to move the bowels); and some people experience both. Sometimes, the person with IBS has a crampy urge to move the bowels but cannot do so.

Through the years, IBS has been called by many names -- colitis, mucous colitis, spastic colon, spastic bowel, and functional bowel disease. Most of these terms are inaccurate. Colitis, for instance, means inflammation of the large intestine (colon). IBS, however, does not cause inflammation and should not be confused with another disorder, ulcerative colitis.

The cause of IBS is not known, and as yet there is no cure. Physicians call it a functional disorder because there is no sign of disease when the colon is examined. IBS may cause discomfort and distress; however, IBS does not cause permanent harm to the intestines and does not lead to intestinal bleeding of the bowel or to a serious disease such as cancer. Most people with IBS are able to control their symptoms through lifestyle modifications and sometimes medications prescribed by physicians. Following a special diet and stress management also can help to control symptoms.

IBS has not been shown to lead to any serious, organic diseases. No link has been established between IBS and inflammatory bowel diseases such as Crohn's disease or ulcerative colitis. IBS does not lead to cancer. Some patients have a more severe form of IBS, and the pain and diarrhea may cause them to withdraw from normal activities. These patients need to work with their physicians to find the best combination of medicine, diet, counseling, and support to control their symptoms.

Who gets irritable bowel syndrome?

Up to 1 in 5 people in the uk develop IBS at some stage in their life. It can affect anyone at any age, but it commonly first develops in early adult life. Women are affected more often than men.

What are the symptoms of irritable bowel syndrome?

  • One or more of the following symptoms may occur.
  • Pain and discomfort
  • Pain may occur in different parts of your abdomen. Pain usually comes and goes for variable periods of time. The pain may be eased when you pass stools (motions or Faeces) or wind. Many people with IBS describe the pain as a 'spasm' or 'colic'. The severity of the pain can vary from mild to severe, both from person to person, and from time to time in the same person.
  • Bloating
  • You may notice swelling of your abdomen from time to time. You may pass more wind than usual.
  • Stools (motions or Faeces)
  • Some people have bouts of diarrhoea, and some have bouts of constipation. Some people have bouts of diarrhoea that alternate with bouts of constipation. Sometimes the stools become small and pellet like. Sometimes the stools become watery or ribbony.
  • At times, mucus may be mixed with the stools. Occasionally, you may pass mucus alone when you go to the toilet. Some people have urgency, which means you have to get to the toilet quickly at times. Many people have a feeling of not fully emptying their bowels after going to the toilet.

Other symptoms

  • These sometimes occur and include: nausea (feeling sick), headache, belching, poor appetite, and bladder symptoms (an associated 'irritable bladder').
  • Some people have occasional mild symptoms. Others have unpleasant symptoms for long periods. Many people fall somewhere in between, with flare-ups of symptoms from time to time. In some people a 'trigger' may set off symptoms for a while. For example: stressful life events, infections (such as food poisoning), or eating certain foods.
  • IBS does not shorten your expected life span, it does not lead to cancer of the bowel, and does not cause blockages of the bowel or other serious conditions.

Note : passing blood is not a symptom of ibs. You should tell a doctor if you pass blood as it may mean a different gut problem.

What causes irritable bowel syndrome?

 The cause is not known. It may have something to do with over activity of parts of the gut. The gut is a long muscular tube that goes from the mouth to anus. The small and large bowels (intestines) are parts of the gut inside the abdomen. Food is passed along by regular contractions (squeezes) of the muscles in the wall of the gut. Pain and other symptoms may develop if the contractions become abnormal or overactive. The area of over activity in the gut may determine whether constipation or diarrhoea develops.

The cause of over activity in parts of the gut is not understood. One or more of the following may play a part: over activity of the nerves or muscles of the intestine; sensitivity of the gut to certain foods; stress or emotional upset. Ibs is possibly several different conditions all resulting in similar symptoms, but with different underlying causes.

Ordinary events, such as eating and distention from gas or other material in the colon, can cause the colon to overreact in the person with IBS. Certain medicines and foods may trigger spasms in some people. Sometimes, the spasm delays the passage of stool, leading to constipation. Milk products, caffeine, or alcohol can aggravate these symptoms in some cases. Researchers also have found that women with IBS may have more symptoms during their menstrual periods. These findings suggest that reproductive hormones may be associated with IBS symptoms

Diet & stress management are effective in IBS?

The potential for abnormal function of the colon is always present in people with IBS, but a trigger also must be present to cause symptoms such as diet and emotional stress. Many people report that their symptoms occur following a meal or when they are under stress. No one is sure why this happens, but scientists have some clues.

Eating causes contractions of the colon. Normally, this response may cause an urge to have a bowel movement within 30 to 60 minutes after a meal. In people with IBS, the urge may come sooner with cramps and diarrhea.

The strength of the response often relates to the number of calories in a meal and especially the amount of fat in a meal. Fat in any form (animal or vegetable) is a strong stimulus of colonic contractions after a meal. Many foods contain fat, especially meats of all kinds, poultry skin, whole milk, cream, cheese, butter, vegetable oil, margarine, shortening, avocados, and whipped toppings.

Stress also stimulates colonic spasm in people with IBS. This process is not completely understood, but scientists point out that the colon is controlled partly by the nervous system. Stress reduction helps to relieve IBS symptoms in some people.

Effect of diet

For many people, eating a proper diet lessens IBS symptoms. Before changing your diet, keeps a journal noting which foods seem to cause distress. Discuss your findings with your physician. You also may want to consult a registered dietitian, who can help you make changes in your diet. For instance, if dairy products cause your symptoms to flare up, you can try eating less of those foods. Yogurt might be tolerated well because it contains organisms that supply lactase, the enzyme needed to digest lactose, the sugar found in milk products. Because dairy products provide calcium and other nutrients that your body needs, be sure to get adequate nutrients in the foods that you eat as substitutes.

Dietary fiber may lessen IBS symptoms in many cases. Whole grain breads and cereals, beans, fruits, and vegetables contain fiber. Consult your doctor before using an over-the-counter fiber supplement. High-fiber diets keep the colon mildly distended, which may help to prevent spasms from developing. Some forms of fiber also keep water in the stools, thereby preventing hard stools that are difficult to pass. Physicians usually recommend that you eat just enough fiber so that you have soft, easily passed, and painless bowel movements. High-fiber diets may cause gas and bloating, but, within a few weeks, these symptoms often go away as your body adjusts to the diet.

Large meals can cause cramping and diarrhea in people with IBS. Symptoms may be eased if you eat smaller meals more often or just eat smaller portions. This should help, especially if your meals are low in fat and high in carbohydrates such as pasta, rice, whole-grain breads and cereals, fruits, and vegetables.

Do i need any tests?

Not usually. There is no tests that confirms IBS. IBS is usually diagnosed by the typical symptoms, and no further tests are then needed. Sometimes tests are advised if symptoms are not typical. This is to rule out other conditions such as ulcers, colitis, etc. The tests are all normal if you have IBS.

What are the treatments for irritable bowel syndrome?

Reassurance

Many people are reassured that their condition is IBS, and not something more serious such as colitis. Understanding IBS often helps, and may ease the severity of your symptoms. Symptoms often settle for long periods without any specific treatment.

Fiber may help

Fiber (roughage) is the part of the food which is not absorbed into the body. It remains in your gut, and is a main part of the stools. It may help if you eat more fiber (or take fiber supplements). Fiber gives the gut more to 'work on', and also helps to relieve constipation.

However, you need to be cautious if you increase the fiber in your diet, particularly with bran and wheat products. In some people with IBS, especially those with diarrhoea, extra fiber may make symptoms worse (particularly bloating). Increasing fiber is worth a try, and if your symptoms improve, then keeping to a high fiber diet will help. However, if symptoms become worse, then extra fiber may not be a good idea.

Other foods and drinks

Some people with IBS can identify one or more foods that cause symptoms. These are typically dairy or wheat products. It may be worth trying a very bland diet if symptoms are difficult to control. For example, one meat, one fruit, and one vegetable. You can then add different foods gradually to see if any cause the symptoms. It may be possible to identify one or more foods that cause symptoms. This can be a tedious process, and no problem food may be found. However, some people claim success in controlling their symptoms by identifying food(s) that cause symptoms, and then not eating them.

Some people report that cutting down on tea, coffee, and fatty foods helps to ease symptoms.

Antispasmodics

These are medicines that relax the muscles in the wall of the gut. Your doctor may advise one if you have spasm-type pains. There are several types of antispasmodics, and they work in slightly different ways. Therefore, if one does not work well, it is worth trying a different one. If one is found to help, then you can take it 'as required' when symptoms flare-up. Many people take an antispasmodic medicine for a week or so at a time to control symptoms when they flare-up.

Treating diarrhoea and constipation

Short courses of an anti-diarrhoea medicine, such as loperamide, may be useful if diarrhoea is a main symptom. If constipation develops, increasing your dietary fiber, or taking fiber supplements usually helps. Also, have plenty to drink to help ease constipation. Sometimes a laxative is advised for short periods if extra fiber is not enough to ease constipation.

Antidepressant medicines

An antidepressant medicine in the 'tricyclic' group is sometimes used to treat IBD. In particular, it tends to work best if pain and diarrhoea are the main symptoms. (Tricyclic antidepressants have other actions separate to their action on depression. They are used in a variety of painful conditions, including IBD.) Unlike antispasmodics, you need to take an antidepressant regularly rather than 'as required'. Therefore, an antidepressant is usually only advised if you have persistent symptoms, or frequent bad flare-ups.

Talking treatments

Situations such as family problems, work stress, exams, etc, may trigger symptoms of IBD in some people. People with anxious personalities may find symptoms difficult to control. The relationship between the mind, brain, nervous impulses, and over activity of internal organs such as the gut is complex. Some people have found such things as relaxation techniques, stress counseling, cognitive therapy, psychotherapy, and similar therapies useful in controlling symptoms of IBD. 

IBS in children

Irritable bowel syndrome (IBS) is a digestive disorder that causes abdominal pain, bloating, gas, diarrhea, and constipation--or some combination of these problems. IBS affects people of all ages, including children.

IBS is classified as a functional disorder because it is caused by a problem in how the intestines, or bowels, work. People with IBS tend to have overly sensitive intestines that have muscle spasms in response to food, gas, and sometimes stress. These spasms may cause pain, diarrhea, and constipation. In children, IBS tends to be either diarrhea-predominant or pain-predominant. Diarrhea-predominant IBS is most common in children under age 3. The diarrhea is usually painless and alternates with bouts of constipation.

These children usually have fewer than five stools a day and the stools tend to be watery and soft. Pain-predominant IBS mainly affects children over age 5. In the younger children the pain tends to occur around the navel area, and in older children, in the lower left part of the abdomen. The pain is crampy and gets worse with eating and better after passing stool or gas.

In addition to the symptoms described above, children with IBS may also have headache, nausea, or mucus in the stool. Weight loss may occur if a child eats less to try to avoid pain. Some children first develop symptoms after a stressful event, such as teething, a bout with the flu, school problems, or problems at home. Stress does not cause IBS, but it can trigger symptoms.

To diagnose IBS, the doctor will ask questions about symptoms and examine the child to rule out the possibility of more serious problems or diseases. IBS is not a disease--it is a syndrome, or group of symptoms that occur together. It does not damage the intestine, so if the physical exam and other tests show no sign of disease or damage, the doctor may diagnose IBS.

In children, IBS is treated mainly through changes in diet--eating more fiber and less fat to help prevent spasms--and through bowel training to teach the child to empty the bowels at regular, specific times during the day. Medications like laxatives are rarely prescribed because children are more susceptible to addiction than adults. When laxatives are necessary, parents must follow the doctor's instructions carefully. Learning stress management techniques may help some children.


IRRITABLE BOWEL SYNDROME

IBS is one of the most common disorders. It is exactly a functional disorder. It is more common in women between the age of 20 and 40.IBS is often mixed up with ulcerative colitis or chronh's disorders. Though IBS is not life threatening disorder & usually doesnot lead to serious disorders like cancer of the colon. If disorders can cause a lot of discomfort and distress owing to its nature of.

Causes 

Causes of IBS are not known.

Sensitivity to certain foods & drugs, mental stress, emotional upsets may cause abnormalities in the activity of the alimentary canal, leading to IBS, specific foods, milk products, alcohol, irritant spicy foods, excess of fats in food, menstrual periods may aggravate existing symptoms.

Symptoms

The symptoms of IBS Varies Greatly.

  • Abdominal pain, pain in the lower abdomen, the site may vary left right of middle. & some times may be shifting from site to site. The pain sometimes precipitates on eating & is relived on defecation. The intensity of pain varies from mild to severe & may vary from person to person & time to time in the same person.

  • There may be swelling, bloating distension of passage of wind feeling of not passing stool satisfactorily.

  • Bowel habit too is variable.
  • The patient may suffer from boots of constipation or diarrhea occurring alone or alternating.
  • There may or may not be mucus discharge with the stool but never blood discharge.

  • Feeling of urgency to evacuate meaning the patient is not able to wait for some time often he feels the urge to go to the toilet.
  • The stool may be sometimes ribbon like or pellet like.

  • Other symptoms are nausea, loss of appetite, headache, and fatigue.

  • Often patients suffering from IBS have symptom free periods or periods with minimal symptoms only to experience sudden flare ups on being exposed to mental stress or spicy & fat rich foods.

Investigations

The diagnosis can usually be made on clinical symptoms alone. Since IBS is a functional disorder investigations of blood /stool/urine show no abnormalities. Proctoscopy & Sigmoidiscopy, Barium Enema are useful to rule out similar diseases like ulcerative colitis, chron's disease etc.

Treatment

  • Modern medical science does not provide any definite treatment for IBS. The first thing to do is to reassure the patient that his/her condition is not serious or life threatening. This will reduce his/her stress level, which will go long way in lowering the intensity of the symptoms.

  • Managing stress is an important part of the treatment. Symptomatic treatment like giving antispasmodic drugs to reduce pain are helpful drugs to control diarrhea or to correct constipation are given as and when necessary.

  • Eliminating certain foods to which the patient is sensitive is of some value. However the patient has to observe & find out the food that does not suit him.

  • Increasing fiber in the daily meals is very helpful. Fiber is that part of the food, which is not absorbed, but gives bulk to the feaces & facilitates its elimination. It also retains water & makes the stools soft.
  • Antidepressants
  • Ayurveda treats IBS as per the predominance of the vitiated doshas in the condition. The symptoms of IBS are similar to certain conditions or types of PRAVAHIKA.

  • Many poly-herbal formulations & some mineral are used to correct thus conditions specific diets are also prescribed.

  • Yoga and Meditation not only help to relieve stress but specific yogasanas show benefits in different conditions of IBS by correcting indigestion & by regulating the bowel movements.

Ayurveda formulations for IBS

  • VATA pre
  • PITTA pre
  • KAPHA pre
  • V.P. pre
  • V.K. pre
  • K.P. pre
  • V.P.K. pre

Causes

Causes of IBS are not known.

Sensitivity to certain foods & drugs, mental stress, emotional upsets may cause abnormalities in the activity of the alimentary canal, leading to IBS, specific foods, milk products, alcohol, irritant spicy foods, excess of fats in food, menstrual periods may aggravate existing symptoms.

Irritable bowel syndrom