Irritable Bowel Syndrome- The Back End Story

Sarah Matacale, BSN, RN

Any of you who have read my articles know that I choose to write about things I know from first hand experience or something of particular interest to me. Irritable bowel syndrome (IBS) is a subject matter that I wish I did not have experience with. IBS is a super pain in the butt...literally! It gets in the way of everything from the fantastic food I love to eat, to work, to shopping adventures and vacations, weddings etc. It makes you a 24/7 hot mess (as we say in the south)! Since this is a syndrome that affects so many people, I decided to write about it and divulge my own "dirty secret".

What is IBS?

By definition Irritable bowel syndrome is "a common disorder that affects the large intestine (colon). Irritable bowel syndrome commonly causes cramping, abdominal pain, bloating, gas, diarrhea and constipation. IBS is a chronic condition that you will need to manage long term." One in every 5 Americans is said to have some degree of IBS. but less that 1% actually seek treatment due to the severity of their discomfort or symptoms. The symptoms and severity vary from person to person but the primary issues include:

Abdominal pain or cramping
Feeling bloated
Gas
Diarrhea or constipation- sometimes varying between both
Mucus in stool

While these symptoms resemble other diseases like Crohn's disease and ulcerative colitis, irritable bowel syndrome does not cause changes in bowel tissue or increase risk of colorectal cancer.

Various factors play a role with irritable bowel syndrome. With "normal bowel function", muscles in the intestines contract and relax in a coordinated rhythm to move food along from the stomach through to the rectum. With Irritable bowel syndrome one of two problems can occur.

IBS-D (Irritable bowel syndrome-Diarrhea) occurs when contractions are stronger and last longer than normal causing gas, bloating and diarrhea.
IBS-C (Irritable bowel syndrome-Constipation) occurs when the muscle contractions of the intestines are weak, slowing the passage of food through the gastrointestinal tract leading to dry hard stools.

Another key factor that research has been focusing on is the gastro-nervous system and the connection between the brain and intestinal tract. When the gastro nervous system is not functioning properly, it causes increased discomfort (above the norm) when the abdomen stretches from gas or stool. Poorly controlled signals between the intestines and the brain cause the body to overreact, creating diarrhea and pain.

Risk Factors

There are a few risk factors associated with Irritable Bowel Syndrome.

Family history plays a role in development of IBS. If you have family members with this disorder, you are more likely to have it yourself.
Youth is another known risk. IBS is usually diagnosed in persons under 45 years old
Females are twice as likely to develop Irritable Bowel Syndrome. Researchers believe that there is some connection between IBS and hormones.
Mental Health disorders such as depression, anxiety, and personality disorders have been linked to IBS.

Triggers

Research has made links between common triggers for symptoms of irritable bowel syndrome.

Food: high gas producing foods and dairy are major culprits. (we will discuss this in greater depth)
Stress: while higher levels of stress do aggravate irritable bowel syndrome, it does not cause the disorder itself.
Hormones: as mentioned earlier, females are twice as likely to have IBS. Menses does worsen the symptoms, due to the change in hormones during that time of the month.
Other Illness: Acute gastrointestinal illness and high bacterial overgrowth can trigger the symptoms of IBS.

Treatments

There are a number of treatment options for Irritable bowel syndrome. For most people a balance of diet, lifestyle and stress, is all it takes to manage the symptoms of mild to moderate IBS. For the rest of us with severe IBS, multiple treatments are prescribed to balance symptoms from day to day.

Dietary

Eliminate high gas producing foods that create bloating such as cabbage, broccoli, raw fruits etc
Gluten- some people note improvement by eliminating gluten (wheat, barley, and rye)
FODMAPS- some people are sensitive to certain types of carbohydrates such as fructose, fructans, lactose and others. (FODMAPS= fermentable oligo-, di-, and monosaccharides and polyols). FODMAPS are in certain grains, vegetables, fruits and dairy. Not all FODMAPS foods are a problem for everyone. It is recommended to eliminate all FODMAPS and reintroduce foods groups one at a time to see if you are sensitive to that type.
Eat at regular times
Drink lots of water

Medications

Fiber supplements help most IBS sufferers- fiber supplements such as Metamucil and Citrucel along with increased fluids help to control constipation. For some it does add an increase in gas production but usually less than fiber itself.
Antidiarrheals for those who have IBS-D- Imodium is one of many over the counter medications that help to control diarrhea.
Anticholinergics/ Antispasmodics-Medications such as Bentyl or Levsin are helpful in preventing or alleviating painful bowel spasms that lead to gas and bloating. Again, an increase in fluid intake is necessary to keep from getting constipated.
Antidepressants- If pain is a problem tricyclic antidepressants or a selective serotonin reuptake inhibitor (SSRI) may be prescribed to inhibit the activity of neurons that control the intestines.
Laxatives are used on occasion for IBS-C. Both laxatives and antidiarrheals are to be used on occasion and with caution and they can cause bowel dependance

There are medications being marketed specifically for use in IBS (constipation and diarrhea). These medications have not been used long enough to determine how well they work. Your physician may need to be enrolled in a special program to prescribe these medications.

Exercise

Regular exercise helps to maintain healthy bowel function.

There is continuous research and developments made in the cause, treatments and aggravating factors in Irritable Bowel Syndrome. While there are multiple lifestyle changes and medications accessible to those of us who suffer with this disorder, nothing is available to completely rid us of the symptoms of IBS. It can be a major intrusion in lifestyle. Symptoms seem to arise at the worst possible time, during weddings, shopping trips, vacations etc. We feel tired, bloated, not hungry, irritable, anxious (as to when symptoms may hit). Someone with IBS is always aware of where the nearest bathrooms are. The symptoms themselves can cause worsening of other symptoms. It is a challenge on a daily basis dealing with the symptoms of Irritable Bowel Syndrome. Until researchers develop or advance technology in the treatment of IBS, we must forge on with a bottle of water always in hand, our travel toilet seat covers, toilet paper, and Poopourri.

Irritable bowel syndrome - Mayo Clinic