Understanding Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) is a reasonably prevalent disorder that affects the digestive system. It also seems to have become a little bit of a cop-out diagnosis, in my opinion. IBS is very real but I’ve seen cases where someone has been told very quickly, without much investigation, that they have it but they actually have another gut disorder. It needs a properly considered approach, not just a quick prescription.

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Irritable Bowel Syndrome

There is no definitive diagnostic for IBS, it’s diagnosed based on the existence of a number of symptoms. I would always want to see other conditions eliminated before settling on an IBS diagnosis. People are often sent away with a prescription for peppermint pills or another medication to address a particular symptom, such as diarrhoea or constipation. But that’s like getting a thorn in your thumb and sticking a plaster over it hoping it’ll go away.

When IBS is the issue there is always a cause and it’s important to seek out and address the cause alongside addressing the symptoms.

Stress, anxiety, pressure and overload

Stress is known to trigger or exacerbate IBS symptoms. When someone experiences stress, the body’s “fight or flight” response is activated, which can lead to changes in how their gut operates. Stress hormones, such as cortisol, can affect gut function and contribute to the development of symptoms like abdominal pain, cramping, and altered bowel habits. It’s important to remember that one person’s stress is another one’s breeze, and vice versa – we are all wired up differently when it comes to psychology.

When I say stress I mean the many forms of stress that are part of modern life, including overload and lack of down-time – always having your time filled with some activity or expectation. Also relationship issues, living in an environment of conflict, overwork, over-studying, pressure to perform and be perfect and all the other stressors we experience in life.

And being stressed can lead to other behaviours that affect gut function, such as snacking, drinking alcohol, smoking, overeating, not giving their gut a rest, eating poor quality food and compromising on sleep and physical activity. This leads to worsening symptoms and people get locked into a vicious cycle.

Association of anxiety-depressive disorders with irritable bowel syndrome

Our brains are closely connected with the gut, via a pathway called the vagus nerve. Recall a time when you have felt really nervous about something and had to keep going to the loo. That’s the gut-brain axis in action, the fight-or-flight response. At other times, like when staying somewhere new, we can’t go to the loo – the brain has told the gut that everything is unfamiliar, and the gut has responded by slightly going on strike.

We have evolved to deal with physical danger by off-loading some weight via sudden defecation or by shutting that system down and diverting blood to the legs so we can run away. Our brains haven’t yet learnt that physical and mental stress are different, so they elicit the same responses in the gut.

The exact mechanisms of IBS are not fully understood, but can include:

  • Abnormal gut motility: One of the main theories is that IBS involves abnormal contractions of the muscles in the gastrointestinal tract, leading to spasms – speeding up and slowing down of the normal contractions that push food through the system.
  • Visceral hypersensitivity: Increased sensitivity to abdominal pain. Normal bowel sensations that might not bother most people can cause discomfort or pain in those with IBS.
  • Intestinal inflammation: Some studies suggest that low-level inflammation in the intestines might contribute to IBS symptoms – we know that stress and inflammation are closely linked. However, this inflammation is not the same as the inflammation seen in inflammatory bowel diseases like Crohn’s disease or ulcerative colitis.
  • Gut-brain axis dysfunction: The gut and the brain communicate through a two-way pathway known as the gut-brain axis. Break-downs in this communication can play a starring role in IBS.
  • Microbiome imbalance: Emerging research indicates that the gut microbiome, the community of microorganisms living in the digestive tract, could play a role in IBS development. With changes in the make-up of the microbiome contributing to symptoms. These microbial changes can occur because of diet, medications, stress and other environmental influences.

Diagnosis

Diagnosing IBS involves a combination of clinical assessment, symptom evaluation, and ruling out other potential conditions. There is no specific test that definitively diagnoses IBS. The Rome criteria, a set of symptom-based guidelines, are often used to help diagnosis. These criteria include:

  • Recurrent abdominal pain or discomfort for at least six months, with symptoms occurring on average at least three days per month.
  • The pain or discomfort is associated with two or more of the following:
  • Improvement with defecation
  • Onset associated with a change in frequency of stool.
  • Onset associated with a change in appearance and consistency of stool.

The presence of other conditions that could explain the symptoms should be ruled out.

Symptoms

IBS is characterised by a variety of symptoms, including abdominal pain, bloating, excessive wind and changed bowel habits. It can involve diarrhoea, constipation or a mix of both. IBS is a chronic condition, that means it can exist long-term, that can seriously affect a person’s quality of life.

  • Abdominal pain and Discomfort: Cramping, sharp, or dull pain in the abdomen is a hallmark symptom. The pain is often relieved by passing wind or having a bowel movement.
  • Altered bowel habits: IBS can lead to changes in bowel movements, including diarrhoea, constipation, or a mix of both. Some individuals experience urgent and frequent bowel movements.
  • Bloating and wind: Excessive gas production and a feeling of abdominal fullness or bloating are common.
  • Mucus in stool: Some people may notice mucus in their stool, which can be a result of the irritated bowel lining.
  • Impact on quality of life: IBS symptoms can significantly affect daily life, causing or increasing anxiety, stress, and disruptions in work, social activities, and relationships.

Managing Irritable Bowel Syndrome

You should always see your doctor if you have gut symptoms. They may diagnose IBS and prescribe medications and you should follow their advice. There are other things you can do alongside:

  • Seek the cause. Are you stressed or overloaded, lacking free time/downtime, under pressure at school, college or work, having relationship issues, over-exercising, or are there other forms of pressure and anxiety in your life?
  • Schedule time to relax, meditate, walk in nature, sleep well, switch off, spend time with people who make you happy.
  • Seek counselling for emotional and psychological issues.
  • Work with a nutrition professional to make your diet and lifestyle supportive of healing and good health.

In Conclusion

Irritable Bowel Syndrome is a complex disorder that can arise because of a number of reasons. While it lacks a single definitive diagnostic test, it is diagnosed based on symptom patterns and the exclusion of other conditions. Proper management involves a holistic approach that addresses lifestyle factors, psychology, diet, stress management and, in some cases, medications. 

People experiencing persistent digestive symptoms should always seek medical advice.

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