What is irritable bowel syndrome (IBS)?
IBS, also known as irritable colon or nervous colon, is a chronic disorder of the digestive system that affects the large intestine (colon).
IBS is considered a functional disorder. This means there are no visible signs of damage or disease in the intestine, but the function is altered. It is currently one of the biggest digestive health issues in the world due to its high prevalence, which ranges from 6 to 12% depending on the country and the method of diagnosis.
Although the exact cause of IBS is not completely known, it is thought to be attributable to a combination of factors, which can include:
Psychological factors and stress: Stress and emotional disorders, such as anxiety and depression, can play a role in the development and escalation of IBS symptoms. Although stress doesn’t cause IBS directly, it can worsen symptoms in people who already suffer from the condition.
IBS Symptoms
IBS is characterised by the presence of chronic and recurrent symptoms that can vary in intensity and duration from one person to the next. These include:
Abdominal pain: Abdominal pain or discomfort is one of the principal symptoms of IBS. In general, the problem is described as cramps or a feeling of abdominal distension. The pain can vary in location and intensity, and is often alleviated after defecation.
Altered intestinal pattern: People with IBS can experience changes in the frequency and consistency of intestinal evacuation. They can alternate between periods of constipation, when they have difficulty evacuating or have hard stools, and diarrhea, when their deposits are loose or liquid.
Changes in the appearance of stools: Stools may have an abnormal appearance in people with IBS. They may be very hard and dry during periods of constipation or aqueous (watery) during periods of diarrhea. Mucous may also be observed in the stools.
The feeling of incomplete evacuation: After going to the toilet, many people with IBS have a persistent feeling that they need to evacuate further. This feeling of incomplete evacuation can be frustrating and affect quality of life.
Due to its recurrence and chronicity, IBS significantly impacts the quality of life of those it affects. The discomfort can range from occasional inconvenience to periods of incapacitation which prevent sufferers from leading a full social, personal or working life.
How is IBS diagnosed?
Diagnosis currently follows the ROME III criteria, part of an international attempt to create scientific data around gastrointestinal disorders, co-ordinated by the U.S.-based non-profit Rome Foundation.
The patient has to meet the following three criteria, with recurring abdominal pain or discomfort at least three days a month over the last three months, associated with two or more of the following symptoms:
Improvement with defecation.
Onset associated with a change in the frequency of deposits.
Onset associated with a change in the consistency of deposits.
The symptoms should have started at least six months before diagnosis. The differential diagnosis should rule out pathologies that cause similar symptoms.
Particular importance is placed on the presence of typical symptoms such as abdominal pain and alterations to defecatory habits; a normal physical diagnosis made by the doctor; and the return of normal results from tests carried out according to the criteria of specialists, such as for example:
• Analysis of blood and stools.
• Radiographies.
• Colonoscopy and endoscopy exams (with or without a biopsy).
• Bowel flow tests with barium.
• Tests of intolerance to foods like gluten and lactose.
• Any and all tests that specialists consider opportune, based on the age and history of the patient.
IBS affects 11.2% of people in western countries on average, and its prevalence is greater in women (1.67%) in the global context.
How is IBS treated?
IBS treatment focuses on alleviating symptoms and improving the patient’s quality of life.
Treatment can include changes in nutrition, such as avoiding certain foods that trigger symptoms; increasing the consumption of fibre; following a diet low in FODMAPs (fermentable carbohydrates); using medications to alleviate specific symptoms (such as laxatives or antispasmodics); embarking on a course of cognitive-behavioural therapy for the reduction of stress and other key changes to manage lifestyle.
Irritable Bowel Syndrome is a chronic pathology, so the doctor will typically propose a number of measures to affected patients with the goal of relieving symptoms and restoring a regular quality of life.
What is the FODMAPs diet?
A diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) is a dietetic strategy used to manage the symptoms of Irritable Bowel Syndrome (IBS) and other gastrointestinal function disorders.
FODMAPs is a term that refers to certain types of fermentable carbohydrates that may be poorly absorbed by certain people. This can lead to symptoms such as swelling, abdominal distension, diarrhea and/or constipation.
A diet low in FODMAPs implies the restriction of foods that contain these fermentable carbohydrates.
Examples of foods rich in FODMAPs include:
Certain types of fructans (found in wheat, onion and garlic).
Lactose (a sugar present in lactose products).
Fructose (a sugar present in certain fruits).
Polyols (artificial sweeteners like sorbitol and xylitol, and certain foods like apples and pears).
The objective of a diet low in FODMAPs is to reduce the load of these fermentable carbohydrates in the intestine, which can help to relieve symptoms in people sensitive to them. However, it is important to note that a diet low in FODMAPs is not a permanent solution and is not designed for the long term. It is primarily used as a diagnostic tool and short-term treatment.
The implementation of a diet low in FODMAPs should be carried out under the supervision of a dietician or nutritionist who specialises in this area, as it is important to ensure that the patient receives the right nutrients during the period of restriction. In addition, the gradual reintroduction of restricted foods is essential to determine which specific FODMAPs may be triggering symptoms in each individual.
General guidelines for living with IBS
Consult a digestive specialist to obtain your diagnosis and treatment, a nutrition specialist to establish a diet and a mental health specialist if you’re suffering from anxiety, depression, agoraphobia or any form of psychological unrest.
Avoid foods that are fried, spicy, greasy, irritating or heavily seasoned foods, as well as cafe and drinks with gas and alcohol. Incorporate fruits and vegetables into your diet gradually, and observe their effect. Avoid foods that cause flatulence.
The differences between IBS and SIBO
IBS and Small Bacterial Intestinal Overgrowth (SIBO) are two conditions related to the digestive system, but they are different in terms of their cause and clinical presentation.
SIBO occurs when there is an abnormal increase of bacterias in the small intestine. Normally, the small intestine contains a limited quantity of bacterias compared with the large intestine. However, with SIBO, bacterias multiply excessively in the small intestine and may interfere with the digestion and adequate absorption of foods. This can provoke symptoms like abdominal distension, flatulence, diarrhea and malabsorption of nutrients.
It is important to note that SIBO may be associated with IBS and may be one of the underlying causes of symptoms in certain people. However, not all those people with IBS have SIBO and not all those with SIBO have IBS. It is necessary to carry out specific tests, like bacterial culture or the hydrogen breath test, to diagnose SIBO.
Treatment of IBS focuses on alleviating symptoms and improving quality of life through changes to diet, management of stress and the use of medications and complementary therapies. The treatment of SIBO involves the use of specific antibiotics to reduce the bacterial load in the small intestine, together with dietary changes to prevent recurrence.