Irritable Bowel Syndrome Symptoms
What are the symptoms of Irritable Bowel Syndrome (IBS) and how is it diagnosed?
There is a set of criteria called the Rome III Criteria and if you have these symptoms, then you may well be diagnosed with IBS:
Recurrent abdominal pain or discomfort that is usually partly or completely relieved by passing a bowel movement.
The onset of the pain was associated with a change in frequency of bowel movements
The onset of the pain was associated with a change in the form (appearance ) of the bowel movements
Often there is abdominal bloating and excessive wind / gas
Plus, other troublesome symptoms including low energy or fatigue, headaches, muscle aches and / or low back pain.
How is IBS sub grouped?
IBS is often classified based on the predominant type of bowel movements a person has. There is IBS with constipation, IBS with diarrhea, IBS with alternating symptoms of constipation and diarrhea. Many people also acknowledge a further subgroup where the bowel movements are regular but pain is the predominant symptom.
What is constipation?
Constipation is usually diagnosed as fewer than 3 bowel movements a week and hard or lumpy stools, which can be difficult to pass, giving you straining when you pass a bowel movement. Some people also have a feeling of an incomplete bowel movement, as though there is more stool in the rectum but they are unable to pass it.
What is diarrhea?
Diarrhea usually means more than 3 bowel movements day, which can be watery or loose and there is usually a sense of urgency (having to rush to the restroom/ toilet).
What is alternating constipation and diarrhea?
Many people with IBS have alternating bowel movements. Some people have a week of constipation followed by a week of diarrhea.
Other people have a few days or a week of constipation (no bowel movement for up to 7 days) then have a day of several bowel movements where the stools start off hard and lumpy but get progressively looser and more urgent. The following day, their bowels return to constipation with no bowel movement for another few days. This may in fact be better treated as if it is IBS with constipation predominant symptoms.
Many women notice their IBS symptoms are cyclical and linked to their menstrual cycle with constipation in the week or two before menstruation and then diarrhea or daily bowel movements for the first day or two of menstruation. It is very common for changes in sex hormones to alter bowel movements.
Spastic colon is another name for Irritable bowel syndrome (IBS).
What is the cause of spastic colon or irritable bowel syndrome (IBS)?
It is a name that was first used to describe the IBS symptoms. At this stage, it was thought the reason for symptoms was purely due to the colon (also known as the large intestine or large bowel) going into spasms and creating erratic contractions of the intestinal muscles. Now it is known that IBS often involves a functional change in much of the intestinal tract including the small and large intestine.
The cause of IBS is not completely clear. An infection such as virus, parasite or bacteria infection can be the trigger for many people’s start of IBS symptoms. This is sometimes called Post infectious IBS.
For other people, taking antibiotics or other medications including non steroidal anti inflammatory drugs for pain or taking the oral contraceptive pill can trigger the start of the IBS symptoms. One mechanism causing IBS seems to involve a change in bacteria within the intestine, leading to a change in balance of healthy bacteria and unwanted pathogenic bacteria or yeasts.
IBS is thought to result when the intestinal muscles contract faster or slower than normal. Abnormal intestinal contractions can cause abdominal pain, cramping, flatulence and diarrhea and constipation. When the intestinal wall muscles contract faster than normal sudden, urgent and loose bowel movements result. Alternatively when the muscles contract slower than normal the person experiences constipation.
People with IBS may detect certain phases of digestion and may describe cramping or ‘tugging’ sensations consistent with an enhanced perception of pain. As IBS develops, the wall of the intestinal tract becomes more sensitive, so tolerance lowers to some foods and amounts of food and air in the stomach and small intestine.
For some people with IBS the immune cells of the intestinal tract can begin to react to a previously safe food and identify it now as something ‘foreign’ invading the body. Alternatively, the number of digestive enzymes may reduce in the small intestine or as bacteria change in the large intestine, increased fermentation of foods occurs.
These changes are the start of food intolerance and can cause a number of reactions triggering symptoms of IBS and often other symptoms including low energy or fatigue, headaches, muscle aches, low back pain, increased menstrual pain, altered mood, reduced concentration and memory and what people call ‘foggy brain’.
In IBS the intestinal muscles also become more sensitive to the effects of emotional and physical stress, which can trigger a change in muscle contractions, increasing bowel movement frequency and abdominal cramps, known as Spastic Colon
What is an Irritable Bowel Syndrome Diet?
There are many approaches for dietary treatment for IBS, seemingly with some conflicting information which can easily be confusing, when trying to seek advice on diet to treat IBS.
Early research into diet for IBS focused on changing the fiber in the diet, usually recommending to increase fiber to help symptoms of IBS. But many people actually feel their IBS symptoms worsen for eating more fiber and/ or certain types of fiber and more recent research proves this to be the case.
As the intestinal wall becomes more sensitive in IBS, tolerance changes to the amount of food per mealtime. IBS symptoms can be triggered by eating large meals and overfilling their stomach. There are also a number of other foods or drinks that if eaten in excess tend to trigger symptoms, including fat, spices, carbonated drinks and the action of swallowing excess air such as when chewing gum.
The role of allergy and intolerance to food as a trigger of IBS symptoms is a complex and confusing area for many people including health practitioners and the people themselves with IBS.
Research shows that up to 70% of people with IBS do have an intolerance to one or more foods. But the tests for identifying food intolerance are varied and most have a poor level of accuracy, which makes the process of diagnosing food intolerance more difficult.
Theoretically it is possible to develop an intolerance to any food eaten regularly in the diet. The food involved will also depend on the underlying change and mechanism in the intestinal wall that is causing the food intolerance.
Elimination diets remain the most common method for identifying food intolerance. The Elimination diet involves removing the suspected food from the diet for a period of time (usually 2 to 6 weeks) and then re challenging the food in the diet to confirm whether it triggers the unwanted symptom(s) back.
There are many forms of elimination diet and methods for the re challenges of foods to confirm food intolerances. These include the ‘Few Foods Diet’ removing all foods except 4 foods (1 protein rich food, carbohydrate rich food, 1 vegetable and 1 fruit), the Stone Age diet which remove all except about 16 basic foods, the ‘Low Starch Diet’ which removes all starch rich foods, ‘The Specific Carbohydrate Diet’ which removes certain carbohydrates , ‘The Low Sugar low Yeast Diet’ and Elimination diets which remove just one food at a time.
There has been some excellent quality research since 2003 mainly pioneered by Dr Sue Shepherd and Dr Peter Gibson in Melbourne, Australia on food intolerance and IBS. Their research including double blind placebo controlled trials, has identified a group of foods that up to 75% of people with IBS are intolerant to and once removed from the diet are resulting in highly significant freedom of IBS symptoms. This group of foods is known by the acronym FODMAPs, a group of carbohydrates which when eaten are often poorly absorbed and therefore highly fermentable, triggering IBS symptoms.
The same group of researchers have also refined a means of testing malabsorption of two of these carbohydrates i.e. fructose and lactose. The test is known as Diagnostic Breath Hydrogen and Methane testing for fructose and lactose malabsorption. The results of this test often form the basis for an Irritable Bowel Syndrome Diet.
Irritable Bowel Syndrome Treatment – Probiotics
Probiotics in the Treatment of IBS
Micro-organisms include bacteria, which are prevalent in several regions of the body, including the mouth, nose, pharynx, intestinal tract, vaginal tract, and skin.
The stomach is not heavily colonized because of its low pH. The duodenum, or first part of the small intestine, also has low microbial populations because of both the quick transit of contents through it and the presence of pancreatic secretions that create a hostile environment for microbes.
There is a progressive increase in both numbers and species of microbes, however, along the remaining part of the small intestine in the jejunum and ileum. The large intestine (large bowel / colon) is the most heavily populated area of the gastrointestinal tract. These bacteria are vital to health. They help digestion of foods, production of some nutrients, maintain regular bowel movements and a healthy immune system.
The numbers and types of healthy bacteria can be altered by a change in diet, taking antibiotics, certain medications including the oral contraceptive pill and a virus, parasite or bacterial infection. The resulting change in bacteria numbers and strains within the large intestine and is often called ‘gut dysbiosis’ and can result in less resistance to colds and infections, less protection against bowel cancer and / or symptoms of IBS.
To restore and maintain levels of healthy gut bacteria, there are foods and supplements containing what are called Probiotics. The term Probiotic means ‘live’ microorganisms that when taken in adequate amounts provides a health benefit on the host. i.e us the human being.
In traditional diets, ‘cultured’ or ‘fermented’ foods were commonly eaten most days. Culturing or fermenting food was useful as a way of preserving food for longer, so that it could be eaten over several days or weeks. But this food also provided a regular dose of healthy bacteria to maintain health.
In the ‘Western’ diet, the intake of cultured foods has reduced to very few or none at all, as foods are preserved now by canning, freezing or drying. Fortunately there is a resurgence happening in eating these ‘cultured’ or ‘fermented’ foods in the diet. Some of the traditional cultured foods are yoghurt, sauerkraut, kefir and kimchi.
Yogurt is perhaps the most common probiotic carrying food, but the market has expanded beyond yogurt. Cheese, fermented and unfermented milks, juices, smoothies, cereal, nutrition bars, and infant/toddler formula all are food vehicles for probiotic delivery.
In addition to being sold as foods, probiotics are sold as dietary supplements, medical foods, and drugs. Often these products are composed of concentrated, dried microbes packaged into capsules, tablets, or sachets. This format is convenient for the delivery of large numbers of microbes that, if manufactured and stored properly, can be quite stable even at room temperature.
The basic criteria for probiotics is that they:
must be shown to exert a beneficial effect on the consumer, preferably with a mechanistic explanation of how this occurred;
are nonpathogenic, nontoxic, and free of significant adverse side effects;
retain stability during the intended shelf life of the product;
contain an adequate number of viable cells to confer the health benefit;
are compatible with product format to maintain desired sensory properties;
and are labeled in a truthful and informative manner to the consumer.
There are plenty of research trials into Probiotics for treatment of IBS symptoms and certain strains of bacteria have been identified to be particularly helpful in treatment of IBS.