Irritable Bowel Syndrome (IBS) and Symptoms
Irritable Bowel Syndrome (IBS) is a relatively modern phenomenon that came about from an increasing number of individuals developing a functional disorder of their bowels.
What does that mean???
If you go back into the history of medicine – there was no Irritable Bowel Syndrome 50 years ago.
If there was – we, mainstream medicos – had no idea that this was around and if so hadn’t yet understood what it means or described it.
The criteria for diagnosing Irritable Bowel Syndrome was underway when I was a medical student!
So if we look at Irritable Bowel Syndrome it can best be described as an issue with “how” the bowel works (or functions).
The structure of the bowel or intestine doesn’t change. I.e. if an Irritable Bowel Syndrome sufferer was to have a colonoscopy (or camera on the inside) of their bowel it would look normal.
It doesn’t lead to a serious condition such as bowel cancer.
Unlike INFLAMMATORY BOWEL DISEASE (IBD), such as Crohn’s Disease or Ulcerative Colitis where there is inflammation of the bowel or intestinal wall. This inflammation causes a pathological change in the intestinal wall, thereby affecting the structural integrity of the intestinal wall, leading to the development of symptoms and signs. Such as pain (symptoms) associated with passing blood in stools with mucous (sign).
With Irritable Bowel Syndrome, there is dysfunction leading to a number of symptoms that create discomfort/inconvenience for those that suffer from this. For some, the symptoms can be highly debilitating and distressing.
It is thought to affect the large bowel or intestine mainly and as many as 1 in 5 Australians now suffer from Irritable Bowel Syndrome.
Up to 50% of those that suffer from Irritable Bowel Syndrome can have symptoms that affect them physically and mentally with associated anxiety and depression.
It tends to occur more in women than in men.
It has a spectrum or variety in its presentation in that it can range from:
- Bowel habit that ALTERNATES from diarrhoea to constipation (mixed type).
- Bowel habit that is mainly CONSTIPATED (IBS Type C).
- Bowel habit that is mainly DIARRHOEA (IBS Type D).
Diagnosis of Irritable Bowel Syndrome relies on a patient’s symptoms.
The cause of Irritable Bowel Syndrome is unknown. Although several mechanisms have been implicated in its pathophysiology or development and can be considered as multifactorial. It is thought to result from:
a. Abnormal gastrointestinal tract movements – see Transit Time below.
b. Gut – Brain miscommunication is thought to play a role in Irritable Bowel Syndrome. There are issues leading to a disruption in communication or signalling between these two areas and these signalling issues go both ways.
- Central sensitisation: refers to altered pain perception in IBS sufferers.
2. Visceral sensitisation: IBS sufferers have a lower threshold for pain in their abdomen
c. Heightened awareness of or sensitivity to how one’s body functions.
d.The inflammatory reaction occurring in the intestinal mucosa (gut lining).
e. Changes in gut microflora (or gut bugs).
IBS/Irritable Bowel Syndrome can be triggered by:
- Infection: bowel symptoms can occur after having had gastroenteritis. They cause is unknown and may involve changes in how the nerves work in the bowels or possibly changes in gut flora/bacteria
- Stress: some individuals have a heightened stress response when anxious or under duress.
- Poor sleep
- Food intolerance: symptoms may be exacerbated or worsened by impaired absorption of Lactose (the sugar found in dairy), fructose (the sugar found in fruit) or another sugar called sorbitol which is used as an artificial sweetener. A diet low in fibre may aggravate constipation.
- Hormonal factors such as menstruation
- Medications: certain medications can contribute to aggravating Irritable Bowel Syndrome symptoms such as antibiotics – may cause diarrhoea, painkillers – may cause constipation, and antacids.
The triggers for IBS can vary according to an individual. What may trigger one person may not necessarily trigger another.
Understandably recurring pain over time is distressing with gut bloating, pain and cramps being some of the leading symptoms of Irritable Bowel
Normal Gut-Brain function relies on a coordinated signalling system between both systems for normal digestion to occur. The signals between the two systems use a combination of input from the autonomic nervous system, hormones and to some degree gut flora (gut bacteria) to communicate so that healthy digestion can occur.
Irritable Bowel Syndrome sufferers appear to have their own specific signalling patterns or circuits involving these systems that impact on their Gut-Brain axis that is unique to them. See Central Sensitisation – above.
This describes that time it takes food to go from the mouth and to come out at the bottom as a “poo” (stool).
Normally this process takes 8-12 hours.
You can time this by eating corn and seeing how long it takes for this to come out of the rectum (bottom).
The symptoms of Irritable Bowel Syndrome occur due to an alteration in the transit time of the sufferers’ bowels.
The longer the stool takes to pass through the bowel leads to increased extraction of water. Making the stool dry and hard to pass. Hence making constipation worse.
Leaves less time for water to be extracted and the stool tends to be looser. Hence diarrhoea.
What are Irritable Bowel Syndrome Symptoms?
Symptoms of Irritable Bowel Syndrome may vary in their presentation in one person and be completely different in another person. There is no “one size fits all”. They can last for several days or weeks. Flaring up at times and then settling down.
Irritable Bowel Syndrome is characterised by the following symptoms:
- Abdominal PAIN; often relieved by passing wind or bowel motion.
- Abdominal BLOATING; can occur straight after eating – this tends to suggest gastric bloating, or delayed bloating (1-2 hours after eating) – suggests intestinal origin.
- Chronic or recurrent DIARRHOEA. (IBS Type D)
- Chronic or recurrent CONSTIPATION. (IBS Type C)
- ALTERNATING bowel habit. (IBS – Mixed)
- Mucous in the stool.
- Sleep difficulties.
- Anxiety and Depression.
The 3 Types of Irritable Bowel Syndrome are:
- IBS Type C – constipated IBS
- IBS Type D – diarrhoea type IBS
- IBS Mixed – where the bowel motion can alternate from constipation to diarrhoea.
Take a look at our other blog about How to treat Irritable Bowel Syndrome.