irritable bowel syndrome

More Than Irritated with Irritable Bowel Syndrome

IBS or irritable bowel syndrome is thought to affect up to 15% of the population in the developed world.  IBS is also known as spastic colon or bowel.  This incurable disease strikes its victims with often debilitating symptoms such as gut pain, diarrhea, constipation, bloating, and gas.  Severe cases often force patients to shelter at home near a toilet and a heat pad, with some sufferers describing uncontrollable, embarrassing bouts of diarrhea, belching, and flatulence.  These symptoms occur over a long time, often years.   People with IBS often have gastroesophageal reflux (GERD), genitourinary symptoms, chronic fatigue syndrome, fibromyalgia, headache, backache, sexual dysfunction, and psychiatric symptoms such as depression and anxiety.  There is evidence that the gut flora (microbiome) of people who have IBS is altered.  Chronic low-grade inflammation is also common.  It is believed that psychological stress can further increase this inflammation and thereby cause IBS to progress in predisposed people. 

IBS Classification and Diagnosis

Making a diagnosis of IBS involves a process of elimination. A diagnosis is often made based on symptoms that don’t have worrisome features and once other serious conditions have been ruled out.  “Worrisome features”  include:

  • symptoms starting after 50 years of age 
  • weight loss                         
  • blood in the stool
  • a family history of inflammatory bowel disease

Other conditions that can cause similar symptoms include celiac disease, microscopic colitis, inflammatory bowel disease, bile acid malabsorption, and colon cancer.

IBS is classified into three types depending on whether diarrhea is most common (IBS-D), constipation is most common (IBS-C), or a mix of both (IBS-M).  Other conditions including anxiety, major depression, and chronic fatigue syndrome are also common among people with IBS. 

Small intestinal bacterial overgrowth (SIBO) happens more often in people with IBS when compared to healthy people.  SIBO happens most often in people with IBS-D but can occur in IBS-C or IBS-M as well.  Symptoms of SIBO are the same as IBS general symptoms.  Testing is required to diagnose the condition.   

What Causes IBS?

Though increasingly more common (and often undiagnosed), the cause of IBS is still unknown.  First described in 1820, it is thought the condition may be triggered by many things including a gastrointestinal infection, stressful life event, genetic factors, food sensitivities, alterations in pain sensation, altered gut motility, or a disturbance in the brain-gut axis. During and after a gut infection, the release of high levels of inflammatory cytokines can lead to a condition termed by some as “leaky gut syndrome.”  This condition results in a great deal of tissue damage, changes in bacterial colonies (microbiome), and malabsorption issues.  Increased gut permeability is strongly associated with IBS regardless of whether it was caused by an infection or not.  IBS may be the result of the immune system interacting badly with gut microbiota resulting in abnormal cytokine signaling.

Psychiatric illness or anxiety occurs before IBS symptoms in two-thirds of people.  These traits can lead to healthy people developing IBS after gastroenteritis.  Researchers have also found that genetic defects in immunity and the gut lining increase the risk.  Use of antibiotics also appears to be a risk factor.

Research into the role of the brain–gut axis in IBS disease first started in the 1990s.  Childhood abuse is often associated with its development.   Theorists believe that psychological stress may trigger IBS in these predisposed individuals.  People with IBS often have high levels of anxiety which can overlap with other conditions such as fibromyalgia and chronic fatigue syndrome.  This offers another potential explanation for IBS involving a disruption of the stress system. This response inside the body involves the hypothalamic–pituitary–adrenal axis (HPA) and the sympathetic nervous system.  Both have been shown to function abnormally in people with IBS.  

Genetic, environmental, and psychological factors seem to be important in the development of IBS. Studies have shown that IBS has a genetic component even though environmental factors play a large role.  Regardless of the cause, Western medicine has little to offer these patients.

Conventional Treatments for IBS

As noted, IBS has no known cure.  Western medicine has little to offer, with choices limited to managing symptoms and “just living”  with the condition.  Treatment options include dietary changes, medication, probiotics, and counseling. 

Diet

Symptoms in up to 90% of people with IBS are brought on by food intolerances.  Dietary changes include increasing soluble fiber intake and either a gluten-free diet, IBS diet, or a short-term “learning” diet called the low FODMAP diet (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols).  

Medication Options

  • Loperamide (brand name Imodium) may be used to help with diarrhea while laxatives may help with constipation.  Osmotics such as Miralax, sorbitol, or lactulose can help constipation sufferers avoid a “cathartic colon” or laxative dependence.
  • Other medications that may help in some people include antispasmodics such as hyoscyamine, dicyclomine, and otilonium ( these are estimated by the Cochrane Collaboration to help 1 in 7 people, or approximately 15% of people who try them) as well as certain antidepressants (although research is conflicted on the effectiveness of these). 
  • Lubiprostone (brand name Amitiza) is a gastrointestinal drug used for the treatment of IBS-C in women.  Linzess is another option for IBS-C treatment. 
  • Rifaximin can be useful as a treatment for IBS-D and is used in the treatment of small intestinal bacterial overgrowth (SIBO).
  • Probiotics can be helpful in IBS treatment.  Probiotics help repair the mucosal lining and stop “leaky gut,” repopulate the microbiome, reduce numbers of “bad bacteria” and yeast overgrowth, and may help with immunity and counteract the effects of stress on gut function.
  • Stopping PPIs (proton pump inhibitors such as Prilosec) if possible is recommended since it may help relieve or resolve IBS symptoms.

Other Suggestions and Alternative Therapies

Some evidence suggests that vitamin D may improve symptoms as many sufferers are low on this vitamin.  Stress reduction techniques may help to limit the frequency and severity of symptoms.

Hypnosis and cognitive behavioral therapy (CBT) can provide coping strategies for dealing with distressing symptoms and help suppress thoughts/behaviors that may contribute to the problem.

Peppermint oil or tea is a number one treatment choice for IBS symptoms.  Enteric coated capsules are recommended to help prevent reflux from relaxation of the lower esophageal sphincter above the stomach.  Iberogast, a multi-herbal extract out of Germany containing peppermint leaves, has been used for decades for the treatment of IBS symptoms.  Other herbal treatment options include fennel seed/tea, slippery elm, chamomile, and more.

Although research is not yet available on the subject, cannabis medication may be a possible answer for controlling the symptoms and pathophysiology of IBS disease.  Recent research has shown exciting improvements in colitis and inflammatory bowel disease (IBD) when treated with cannabis.  Cannabis has already been shown effective against many of the underlying issues that contribute to the disease such as anxiety, inflammation, and pain.  It is not a stretch to imagine the role it could play in giving these patients back their quality of life. 

Written By: Melissa Cornwell

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