Is irritable bowel syndrome lifelong??

Irritable bowel syndrome (IBS) is not as simple as just having an unhappy gut, its not all in our head either. IBS not only manifest as painful gut but it also affects patients confidence, body image and mental health.

Irritable bowel syndrome (IBS) is the most common chronic functional disease of the digestive system. Around 20% of the world population is affected by this order. Women are around 2 to 3 times more likely to be diagnosed with IBS and 4 to 5 times more likely to seek specialty care for it than men.

A variety of gastrointestinal and extraintestinal factors are likely to influence the manifestation of IBS. Dysregulation of the brain-gut axis, gastrointestinal infection, low-grade infiltration and activation of mast cells in the intestinal mucosa with consequent release of bioactive substances, and altered serotonin metabolism are the emerging factors of IBS pathogenesis.

sex hormones like estrogen and progesterone affect motor and sensory function of GIT and triggfer IBS symptoms in women before or during mensturation.

Figure adapted from “THE LANCET gastroenterology and hepatology

SYMPTOMS OF IBS

The most common symptoms of IBS are abdominal pain, bloating, altered bowel movements diarrhea or constipation. Some people may experience both constipationa and diarrhea at different time. IBS is also associated with psychological disorders like anxiety and depression, gastroesophageal reflux and genitourinary infections. women with IBS may be at risk of developing endometriosis or having a hystercetomy.

TREATMENT

Only symptomatic treatment is available for IBS, the choice of drug treatment depends on the nature and severity of the symptoms. Many drug treatment options for IBS are available over-the-counter. According to NICE guidelines, Antispasmodic drugs (such as alverine citrate, mebeverine hydrochloride and peppermint oil) can be taken in addition to dietary and lifestyle changes. A laxative (excluding lactulose as it may cause bloating) can be used to treat constipation.

Antidepressants like amitriptyline and citalopram can be used as a second line of treatment  in patients who have not responded to antispasmodics, anti-motility drugs, or laxatives. A selective serotonin reuptake inhibitor may be considered in those who do not respond to a tricyclic antidepressant [unlicensed indication]

LIFESTYLE INTERVENTIONS

DIET

Diet plays an important role in IBS management as it controls symptoms, but it does not necessarily target the underlying cause. so if you eliminate the foods that trigger your symptoms it improves your IBS symptoms but, when trigger foods are reintroduced, often symptoms also return. In IBS management, the way you eat and what you eat both have an important impact on gut symptoms.

• Reduce caffiene intake;limit tea and coffee to not more than three cups a day.
• limit alcohol and fizzy drinks
• Reduce intake of resistant starch, fatty foods
• Drink plenty of water
• Try Probiotics;Yoghurt and some drinkss and supplemets such as tablets, capsules or sachets.

Fibre in IBS; Fibre is double edge sword in IBS as for some it is a blessing and for other IBS patients, it can worsen their symptoms. When considering fibre, it is important to look at both the quantity and the type of fibre (insoluble or soluble), as too little or too much fibre can trigger IBS symptoms.

Quality of fibre also matters. soluble fibre and insoluble fibre behave very differently when they reach the digestive system. If an increase in dietary fibre is required always to prefer soluble fibre as they dissolve in water and remove excess fluid and that how they are good in IBS with diarrhea.

 Intake of insoluble fibre (e.g. bran) and ‘resistant starch’ should be reduced or discouraged as they may exacerbate symptoms.

• Psyllium; It is a unique soluble fibre that has a dual function, it softens the hard stools and also helps in IBS with diarrhea by thickening up loose stool.it may also improve bloating and incomplete evacuation.

• Flaxseed; Flaxseed is good for IBS with constipation. aways start with low quantity like half tablespoon (6g) per day and then gradually increase up to 2 tablespoons. The seeds are either swallowed whole with water or soft food such as yogurt, or they are ground up and sprinkled on food

• Peppermint oil /tea; There is a growing body of evidence that supports the efficacy of peppermint oil in IBS. It is a natural solution for IBS with minimal side effects. Peppermint oil is antispasmodic and relax intense intestine and reduce abdominal pain.

FODMAP

There is a group of carbohydrates found in different foods which causes IBS symptoms as they are poorly absorbed in the small intestine. FODMAP is a term used for these foods. f=fermented,o=oligosaccharide,d= disaccharides, m=monosacchrides,p= polyols. these are present in the stonefruits, legumes, lactose-containing foods, and artificial sweeteners might exacerbate symptoms in a subgroup of patients due to their fermentation and osmotic
effects.

• BACTERIAL FERMENTATION; Gut bacteria in the large intestine ferment this indigestible fodmap and gives off-gas. This gas distends the stomach, causing bloating, wind, constipation and explosive stool.
• OSMOTIC OVERLOAD; FODMAP can draw water in from the body into the small bowel and increasing the pressure over the intestinal wall causing diarrhea or some experience hard stool followed by watery stools.

Low FODMAP diet ; Low fodmap diet is a sceond line approach for IBS patients. It improves IBS symptoms in around 70% of patients however, this diet is not for a lifetime and should be introduced under the supervision of qualified professionals. For more about low fodmap diet, which food are included, phases of this diet, visit this website. https://www.monashfodmap.com/

NON DIET APRROACH

Move YOUR BODY;

Physical activities boost mood and also good for the gut muscles. Low-intensity exercises like walking, swimming, cycling, light jogging can help reduce stress and control IBS symptoms.

STRESS MANAGEMENT

IBS is considered a disorder of gut and brain and any kind of stress, physical or psychological have a direct effect on the symptoms of IBS as evident by data. Relaxation and other stress-reduction techniques could bring a sense of wellbeing and have an impact on the severity of IBS symptoms.

COGNITIVE BEHAVIOURAL THERAPY (CBT); There is increasing evidence for the efficacy of CBT in alleviating the physical and psychological symptoms of IBS.

SLEEP HYGIENE;

Sleep disturbance is very common among IBS patients. studies show positive association between sleep deprivation and worse gut symptoms. Poor bad night sleep results in bad IBS day symptoms. Sleep quality and duration equally important, but one in three adult do not get quality sleep.

take home message;

IBS is a chronic disorder ofthe digestive system but for the majority of patient, it is frustrating and its effect on the quality of life make it a disease with high cost. Current medical tratment for IBS, only targets the symptoms of this disorder. IBS can be managed by identifying what triggers the symptoms, which food is good for IBS. Non diet approach like physical activity, relaxing tecniques all show promising results in alleviating IBS sypmtoms.IBS symptoms varies from person to person so personalized interventions are important.

The shoe that fits one person pinches another; there is no recepie for living that suits all

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