Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a chronic (long-term) digestive disorder causing abdominal pain, diarrhoea and constipation.

Irritable bowel syndrome (IBS) is a common 'functional' digestive disorder. A functional disorder means there is a problem with the function of a part of the body. In IBS, the function of the digestive system is upset, but all the parts of the gastrointestinal tract, including the bowel, look normal, even when looked at under a microscope.

It is estimated that up to 30% of the population may experience symptoms of IBS at some time in their life. IBS is twice as common in women as it is in men. The condition normally develops in people who are between 20 and 30 years of age, but it can affect people of any age

CAUSE
The exact cause of IBS is unknown. It may have something to do with overactivity of part or parts of the digestive tract or gut. The gut is a long muscular tube that goes from the mouth to the anus. The small and large bowel (also called the small and large intestine) 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 overactivity in the gut may determine whether constipation or diarrhoea develops. One or more of the following factors may contribute to overactivity in parts of the gut.

Association with gastroenteritis
In up to 25% of cases, symptoms of IBS start to occur after a gastroenteritis infection (a gut infection which can cause diarrhoea and vomiting). It is possible that a virus or other germ may 'sensitise' or 'trigger' the gut in some way to cause persisting symptoms of IBS.

Altered gut sensitivity
Tests have shown that in people with IBS different parts of the gut are extra sensitive to distension (stretching) or pain. The cause is unknown.

Stress and anxiety
Stress may cause an overactivity of messages being sent from the brain to the gut. About half of people with IBS can relate the start of symptoms to a stressful event in their life. Symptoms tend to become worse during times of stress or anxiety.

Food intolerance
Sensitivity to certain foods may play a part in some cases. However, this is thought to be only in a small number of cases.

Also, in some cases, symptoms get worse after taking a course of antibiotics. Antibiotics kill certain harmless or 'good' bacteria in the gut, which changes the balance of bacteria types in the gut. There may also be other environmental and genetic factors that contribute to IBS that are not yet understood.

SIGNS AND SYMPTOMS
The symptoms of IBS are usually worse after eating. Most people will experience a 'flare-up' of symptoms, lasting between 2-4 days, after which the symptoms improve, or disappear altogether. The most common symptoms of IBS are:
• Abdominal pain and cramping which is often relieved by emptying your bowel
• A change in bowel habits, e.g. diarrhoea or constipation or both.
• Bloating and swelling of your abdomen.
• Excessive wind (flatulence) which may have an offensive smell.
• Experiencing an urgent need to go to the toilet. If muscular damage to the anus has occurred e.g. in childbirth, faecal incontinence may occur.
• A feeling that you have not fully emptied your bowel.

TREATMENT OPTIONS
As with all medical conditions it is advisable to consult your GP for an accurate diagnosis and treatment. There is no cure for IBS, but symptoms can often be eased with lifestyle changes and treatment. Once your Doctor has excluded other conditions, a variety of therapies may be of value.

Lifestyle
Lifestyle changes may include stress management, introducing a healthy diet and exercise program and/or reducing alcohol intake. Your GP can help you to identify and then avoid the triggers for IBS. A high-fibre diet may be helpful. See the Diet Hints section of this topic for more information.

Probiotics
Some people find that taking probiotics, such as acidophilus and bifidus help to relieve the symptoms of IBS. Probiotics are dietary supplements that contain healthy bacteria for your digestive system. Probiotics may need to be taken for at least four weeks to see if they have a beneficial effect. .

Medication
A number of different medications are used to help treat IBS. These are:
• Antispasmodic medicines, which help to reduce abdominal pain and cramping.
• Laxatives, which help to treat the symptoms of constipation.
• Antimotility medicines, which help to treat the symptoms of diarrhoea.
• Tricyclic antidepressants (TCAs) may also help to reduce the feeling of abdominal pain and cramping.

DIET HINTS
Making dietary changes can help to control the symptoms of IBS. Each person will need to modify their diet based on their individual situation. For example, some people may need to reduce their intake of insoluble fibre found in wholemeal bread, cereals and wholegrains. Other people with IBS may need additional fibre in their diet, usually soluble fibre. This may mean taking a fibre supplement, or eating more foods that are high in soluble fibre, such as oats. People with IBS should avoid unprocessed bran as it can worsen the symptoms of IBS.

Your doctor will be able to advise you about what your recommended fibre intake should be. The dietary advice listed below may also help you to control your symptoms of IBS.
• Have regular meals, and take your time when eating.
• Avoid missing meals, or leaving long gaps between eating.
• Drink at least eight cups of fluid a day, particularly water, or other non-caffeinated drinks, such as herbal teas.
• Restrict tea and coffee to three cups a day.
• Reduce your intake of alcohol and fizzy drinks.
• Reduce your intake of 'resistant starch' (starch that resists digestion in the small intestine and reaches the colon intact). It is often found in processed, or re-cooked, foods.
• Limit fresh fruit to three portions (80 g each) a day; a suitable portion would be half a grapefruit, or one apple.
• If you have diarrhoea, avoid sorbitol, which is an artificial sweetener that is found in sugar-free sweets (including chewing gum) and drinks, and in some diabetic and slimming products.
• If you have wind and bloating, consider increasing your intake of oats, for example, oat-based breakfast cereal, or porridge, and linseeds (up to one tablespoon a day).
• Do not exclude a food or food group, such as dairy, from your diet unless you are under the supervision of a Dietician. .

VITAMINS/MINERALS/HERBS
Vitamin, mineral and herbal treatment of IBS usually requires the advice of a qualified health professional.
• Acidophilus such as lactobacillus acidophilus and bifidus may assist with digestion and prevent the overgrowth of candida and other harmful microbes.
• Slippery elm consists of an abundance of mucilage with can sooth inflammation and stop irritation of the mucous membranes lining the stomach and intestines.
• Psyllium is a soluble fibre and has a gentle bulk forming effect on the stool. It can assist in normalizing stool consistency and frequency in ibs and improving frequency and reduction in abdominal distention.
• Digestive enzyme may assist in promoting digestion.
• Ginger may reduce gas, bloating and diarrhoea and improve functioning of the stomach.
• Peppermint oil may reduce gas and cramping and studies show it is effective in the treatment of IBS. Enteric-coated peppermint oil capsules are recommended.
• Herbal teas such as chamomile, peppermint, rosemary and lemon balm may have anti-spasmodic activities for relief of abdominal pain and cramping.

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. Follow the Diet Hints
2. Avoid stress by including regular exercise, rest and relaxation.
3. If a fibre supplement is required, ask your Pharmacist to recommend the most suitable type
4. Ask your MedAux Pharmacist for advice if you have any questions about medication you are taking.
5. Smoking can increase the risk of IBS, especially following gastroenteritis. Ask your Pharmacist for advice about quitting smoking.
6. If the diet is inadequate consider some nutritional supplements.
7. Probiotics may help to manage the symptoms of IBS. Probiotic supplements are available from your Pharmacy.