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Understanding Irritable Bowel Syndrome (and how to treat it)

IBS is a complex condition that can significantly affect your health. But, with the right diagnosis and treatment, you will be on your way to restoring your health. 

Irritable Bowel Syndrome or IBS is a condition that affects the colon, characterised by abdominal pain, bloating, diarrhea, constipation and discomfort, among other symptoms.

IBS is a common problem, affecting up to 15% of the world population. In Australia, as many as one in five adults experience IBS-related symptoms at some point of their lives. IBS is also more common in women, who are twice as likely to develop it.

IBS is a serious condition that can impair your everyday functioning, limiting your productivity. It is estimated that people with IBS are three times more likely to develop depression or anxiety1.

IBS is not the same as inflammatory bowel disease (IBD), characterised by chronic inflammation of all or parts of the digestive tract and includes conditions like Crohn’s disease and ulcerative colitis. In contrast, IBS specifically occurs in the colon and does not necessarily involve inflammation.

 

What causes IBS?

 

The underlying causes of IBS are not fully understood but the condition is likely to have a genetic basis1-2. It may also be influenced by the composition of your gut microbiota, increased intestinal permeability as well as by environmental factors like diet3, 5, 21-22. Hence, it can be difficult to identify IBS and mainstream medical approaches often struggle to identify and accurately treat this condition. Instead, medications are given to ameliorate specific symptoms, without targeting the root of the problem.[KG1]

 

Common IBS symptoms

 

Most people with IBS suffer from chronic diarrhoea or constipation, bloating, and/or gut pain. Many of these symptoms may be more common in women than in men and for women some symptoms may worsen near menstruation. IBS can also lead to depression and anxiety in some people1.

 

Generally, IBS can be classified into five major subtypes6:

  • IBS-D, characterised by chronic diarrhea
  • IBS-C, characterised by chronic constipation
  • IBS-M, where patients alternate between diarrhea and constipation
  • Post-infectious IBS, this type of IBS occurs after an infection.
  • IBS-U, this is called unspecified IBS, and it applies to people who experience IBS symptoms but do not fit with any of the previous IBS types.

 

Do you have IBS?

 

IBS is commonly diagnosed when a patient suffers from two or more IBS-related symptoms. According to current standards, IBS should be considered as a possible diagnosis when a patient has been suffering from recurrent abdominal pain at least three times per month over the past three months4. In addition, the patient must be experiencing improvement of his symptoms with defecation, and/or changes in the consistency and frequency of stools.

However, it can also happen that an entirely other condition, not IBS, is at play. Other conditions, like Small Intestine Bacterial Overgrowth (SIBO) or parasitic infections can produce similar symptoms.

Accurate diagnosis of requires a complete evaluation from a health practitioner. A full medical check-up along with specific tests will help identify what is causing your IBS problems. A test of your gut microbiota might also be performed, as gut dysbiosis and SIBO have been linked to IBS7.

Altogether, these tests are meant to help identify a potential role for other conditions that produce similar symptoms, such as:

  • Coeliac disease
  • Bowel cancer
  • Inflammatory bowel disease
  • Diverticulitis
  • Polyps
  • Small Intestine Bacterial Overgrowth (SIBO)
  • Parasite infections

Once your test results have been assessed, a diagnosis can be made, and a treatment plan can be designed.

 

Avoiding IBS triggers

 

While the underlying causes of IBS are not fully understood, we know that certain factors act as triggers in some people. These include,

  • Diet – A low-fibre diet is known to worsen constipation in IBS patients.
    • Recent studies propose following a low-FODMAP diet to reduce symptoms but consult with your healthcare specialist first before embarking on a new diet. More on the FODMAP diet below.
    • Check for food intolerance. If you suffer from lactose, fructose or sucrose intolerance, for example, you may be more likely to develop IBS8-9.
  • Infections – episodes of gastroenteritis (inflammation of the stomach and intestines) can trigger IBS, as well as other infections, such as:
    • Clostridium difficile – Infection by this pathogen can leave patients susceptible to developing IBS10.
  • Medications use – the use of broad-spectrum antibiotics, such as macrolides or tetracyclines, has been shown to be associated with the development of IBS.
    • Excessive use of antibiotics can also have negative effects on the gut microbiota, potentially leading to dysbiosis11.
    • Antibiotics aside, medications such as antacids or painkillers can have negative effects on some IBS-related symptoms, such as constipation or diarrhoea12-14.
  • Stress – people suffering of high levels of stress and / or anxiety are more likely to develop episodes of IBS15-16.

 

 

IBS Treatment and cure

 

There is no simple cure for IBS and accurate diagnosis is key. Treatment for this condition usually involves a combination of medications and lifestyle changes, depending on the underlying problems.

Taking care of the gut microbiota and avoiding episodes of dysbiosis has been shown to have various benefits in gut and overall health17-21. Current research linking the gut microbiota with the development and maintenance of IBS is ongoing and, so far, studies have shown that at least some people with IBS experience gut dysbiosis5, 21. Studies exploring the use of probiotics as treatment for IBS have, so far, obtained mixed results, with only some studies reporting improvements of IBS symptoms, whereas others report no significant effect22-24.

In terms of diet, some IBS patients have obtained benefits from a diet low in Short-chain fermentable carbohydrates (commonly known as FODMAPs). A low FODMAP diet is commonly advocated to help reduce IBS symptoms, and various studies support the benefits of its use in IBS, particularly for symptoms like abdominal pain and bloating25-26.

However, care should be taken before undertaking a low FODMAP diet, as it may cause significant changes in your gut microbiota and may affect other health aspects due to the strict dietary restrictions it involves. For example, a low FODMAP diet may result in low intake of fibre, calcium, iron, zinc, folate, B and D vitamins, and antioxidants27-29.

At the Australian Centre of Functional Medicine, we take a comprehensive approach that includes multiple testing, which will help design a personalised treatment plan.

IBS infographic

 

References

 

  1. Zamani M, Alizadeh‐Tabari S, Zamani V. Systematic review with meta‐analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Alimentary pharmacology & therapeutics. 2019 Jun 3. Read it!
  2. Saito YA. The role of genetics in IBS. Gastroenterology Clinics. 2011 Mar 1;40(1):45-67. Read it!
  3. Henström M, D’Amato M. Genetics of irritable bowel syndrome. Molecular and cellular pediatrics. 2016 Dec;3(1):7. Read it!
  4. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clinical epidemiology. 2014;6:71. Read it!
  5. Rajilić-Stojanović M, Jonkers DM, Salonen A, Hanevik K, Raes J, Jalanka J, De Vos WM, Manichanh C, Golic N, Enck P, Philippou E. Intestinal microbiota and diet in IBS: causes, consequences, or epiphenomena?. The American journal of gastroenterology. 2015 Feb;110(2):278. Read it!
  6. Saha L. Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. World Journal of Gastroenterology: WJG. 2014 Jun 14;20(22):6759. Read it!
  7. Casen C, Vebø HC, Sekelja M, Hegge FT, Karlsson MK, Ciemniejewska E, Dzankovic S, Frøyland C, Nestestog R, Engstrand L, Munkholm P. Deviations in human gut microbiota: a novel diagnostic test for determining dysbiosis in patients with IBS or IBD. Alimentary pharmacology & therapeutics. 2015 Jul;42(1):71-83. Read it!
  8. Jones VA, Shorthouse M, McLaughlan P, Workman E, Hunter JO. Food intolerance: a major factor in the pathogenesis of irritable bowel syndrome. The Lancet. 1982 Nov 20;320(8308):1115-7. Read it!
  9. Lea R, Whorwell PJ. The role of food intolerance in irritable bowel syndrome. Gastroenterology Clinics. 2005 Jun 1;34(2):247-55. Read it!
  10. Bassotti G, Macchioni L, Corazzi L, Marconi P, Fettucciari K. Clostridium difficile-related postinfectious IBS: a case of enteroglial microbiological stalking and/or the solution of a conundrum?. Cellular and molecular life sciences. 2018 Apr1;75(7):1145-9. Read it!
  11. Villarreal AA, Aberger FJ, Benrud R, Gundrum JD. Use of broad-spectrum antibiotics and the development of irritable bowel syndrome. Wmj. 2012 Feb;111(1):17-20. Read it!
  12. Felder JB, Korelitz BI, Rajapakse R, Schwarz S, Horatagis AP, Gleim G. Effects of Nonsteroidal Antiinflammatory Drugs on Inflammatory Bowel Disease: A Case-Control Study. American Journal of Gastroenterology. 2000 Aug 1;95(8):1949-54. Read it!
  13. Singh S, Graff LA, Bernstein CN. Do NSAIDs, antibiotics, infections, or stress trigger flares in IBD?. The American journal of gastroenterology. 2009 May;104(5):1298. Read it!
  14. Forrest K, Symmons D, Foster P. Systematic review: is ingestion of paracetamol or non‐steroidal anti‐inflammatory drugs associated with exacerbations of inflammatory bowel disease?. Alimentary pharmacology & therapeutics. 2004 Nov;20(10):1035-43. Read it!
  15. Konturek PC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011 Dec 1;62(6):591-9. Read it!
  16. Singh S, Graff LA, Bernstein CN. Do NSAIDs, antibiotics, infections, or stress trigger flares in IBD?. The American journal of gastroenterology. 2009 May;104(5):1298.
  17. Thevaranjan N, Puchta A, Schulz C, Naidoo A, Szamosi JC, Verschoor CP, Loukov D, Schenck LP, Jury J, Foley KP, Schertzer JD. Age-associated microbial dysbiosis promotes intestinal permeability, systemic inflammation, and macrophage dysfunction. Cell host & microbe. 2017 Apr 12;21(4):455-66. Read it!
  18. Zmora N, Suez J, Elinav E. You are what you eat: diet, health and the gut microbiota. Nature reviews Gastroenterology & hepatology. 2019 Jan;16(1):35-56. Read it!
  19. Wu ZA, Wang HX. A Systematic Review of the Interaction Between Gut Microbiota and Host Health from a Symbiotic Perspective. SN Comprehensive Clinical Medicine. 2019 Mar 1;1(3):224-35. Read it!
  20. Tilg H, Zmora N, Adolph TE, Elinav E. The intestinal microbiota fuelling metabolic inflammation. Nature Reviews Immunology. 2019 Aug 6:1-5. Read it!
  21. Collins SM. A role for the gut microbiota in IBS. Nature reviews Gastroenterology & hepatology. 2014 Aug;11(8):497. Read it!
  22. Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein AE, Brandt LJ, Quigley EM. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010 Mar 1;59(3):325-32. Read it!
  23. Zhang Y, Li L, Guo C, Mu D, Feng B, Zuo X, Li Y. Effects of probiotic type, dose and treatment duration on irritable bowel syndrome diagnosed by Rome III criteria: a meta-analysis. BMC gastroenterology. 2016 Dec;16(1):62. Read it!
  24. Sánchez AC, Castilla‐Peon MF, Pizarro‐Castellanos MP, Frias RV, Barajas‐Nava LA. Probiotics for the treatment of irritable bowel syndrome in children. The Cochrane Database of Systematic Reviews. 2018 Aug;2018(8). Read it!
  25. Staudacher HM, Irving PM, Lomer MC, Whelan K. Mechanisms and efficacy of dietary FODMAP restriction in IBS. Nature reviews Gastroenterology & hepatology. 2014 Apr;11(4):256. Read it!
  26. Altobelli E, Del Negro V, Angeletti P, Latella G. Low-FODMAP diet improves irritable bowel syndrome symptoms: a meta-analysis. Nutrients. 2017 Sep;9(9):940. Read it!
  27. Catassi G, Lionetti E, Gatti S, Catassi C. The low FODMAP diet: many question marks for a catchy acronym. Nutrients. 2017 Mar;9(3):292. Read it!
  28. Khan MA, Nusrat S, Khan MI, Nawras A, Bielefeldt K. Low-FODMAP diet for irritable bowel syndrome: is it ready for prime time?. Digestive diseases and sciences. 2015 May 1;60(5):1169-77. Read it!
  29. Staudacher HM, Whelan K. Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: probiotics, prebiotics and the low FODMAP diet. Proceedings of the Nutrition Society. 2016 Aug;75(3):306-18. Read it!

[KG1]Rob, are you happy with this statement?

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