What is it?
Irritable Bowel Syndrome ( IBS ),
not to be confused with the more serious IBD ( Inflammatory Bowel Disease ), is
considered a “functional disorder” of the colon, which is to say that the large
intestine is not functioning properly, although there is no evidence of any
organic structural abnormality. Over the years, IBS has been known by a variety
of different names: spastic colon, intestinal neurosis, irritable colon, mucous
colon, nervous colon, laxative colon, cathartic colon, nervous diarrhea,
spastic colitis, mucous colitis, functional colitis and colitis. Reference to
the disorder as any type of colitis is technically incorrect, for with it there
is no inflammation, no ulceration or other tissue changes. Use of the words
“neurosis” and “nervous” imply that IBS is a psychological disorder – another
inaccuracy. It is a very real physiological disorder, not a psychosomatic
ailment, as once believed,1 although not one that is entirely understood at
present. In truth, more is known about what IBS isn’t than what it is. Some
think that IBS is a disorder of the enteric nervous system; that is to say
that the nerve supply in the ‘brain in the gut’ alters normal pain perception,2 so that the bowel becomes oversensitive to normal stimuli.
What Causes it?
The cause of IBS is uncertain,
although the following factors may well play a causative role:
- Irregularities in intestinal
hormones and nerves responsible for bowel motility (muscle contraction)
- Bacterial, fungal or parasitic involvement
- Stress
- Dietary inadequacies
- Food intolerances (allergies and
sensitivities)
- Inadequate enzyme production
- Dysbiosis (imbalance in
intestinal flora – too many bad bacteria, not enough good ones)
- Reaction to medications (such as
destruction of intestinal flora by antibiotics)
- Undiagnosed lactose intolerance
IBS is at least partially a
disorder of colon motility. In it, the normal rhythmic muscular contractions of
the digestive tract become irregular and uncoordinated. This interferes with
the normal movement of food and waste material and leads to the accumulation of
mucus and toxins in the intestine. This accumulated material sets up a partial
obstruction of the digestive tract, trapping gas and stools, which in turn
causes bloating, distention and constipation.3
The colon of the IBS sufferer
seems to be more sensitive and reactive to stimulation than that of most
people. Intestinal spasms may result from ingestion of certain foods or
medicines and from abdominal distention caused by gas. While these factors
would not cause undue gastrointestinal stress for the average person, for the IBS sufferer, they can be triggers of painful abdominal
spasms.
It is normal for eating to cause
contractions in the colon. Normally, these contractions would result in the
urge to defecate within an hour after eating. For the person with IBS however,
the urge may come sooner, accompanied often with cramps and diarrhea. This is
especially true if the meal is large and/or contains a high percentage of fat.
Fatty foods such as meat, dairy products, oils and avocados provide a strong
stimulus for the colonic contractions after a meal for the person with IBS.
Stress has the same effect.
There is evidence that food
sensitivities and allergies may play a major causative role in IBS, for they
are found in ½ to 2/3 of those afflicted with the disorder.4 The most common
allergens are dairy products and grains (especially wheat and corn). Other
foods that often trigger episodes of IBS are coffee, tea, citrus and
chocolate.5 Caffeine in any form may serve as a gut irritant, as may nicotine.
Over-consumption of alcohol may also trigger intestinal spasms in the person
with IBS. Meals high in sugar can also contribute to IBS by decreasing
intestinal motility.6 A high percentage of people with IBS are intolerant not
only to sucrose (table sugar), but also to other forms of sugar like manitol,
sorbitol and fructose.7 Foods from the cabbage family (broccoli, brussel
sprouts, cauliflower) may be irritating to the IBS sufferer because of their
tendency to cause gas.
Other factors that appear to play
a role in IBS include hormonal changes (women tend to have flare-ups around the
time of their menstrual cycle), low-fiber diets and infection. Many patients
have reported onset of symptoms during or soon after recovery from
gastrointestinal infection (such as an episode of food poisoning), abdominal
surgery or treatment with antibiotics.
The true cause of IBS symptoms in
some cases may be undetected parasitic infection, especially giardiasis or
amebiasis. Because of the similarity in symptoms, it is not uncommon for
giardial infection to be mistaken for IBS.8 There also may be an underlying
problem with overgrowth of the yeast Candida Albicans.
Who Gets it?
An estimated one out of five
Americans suffers from Irritable Bowel Syndrome ( IBS ).9 The average age of
onset is between 25 and 45, with prevalence of the disease declining with age.
It is not uncommon for IBS symptoms to surface during teen years, though the
disease may be present from infancy.10 At least twice as many women as men are
diagnosed with it.11 More men may suffer from the desease than reported,
however, for many with IBS (an estimated 90%) never consult a physician – at
least in Western cultures. Interestingly, the incidence of IBS is reversed in
India (twice as many men affected as women) where men are more apt than women
to seek medical care.12 Although once thought to be a disease of the white
middle class, recent studies have established that the prevalence of IBS seems
to be independent of race, with Japanese, Chinese, African Americans and
Hispanics having the same incidence of the disease as Caucasians.13
IBS is the most common
gastrointestinal disorder seen by physicians and makes up 40% of all visits to
gastroenterologists (GI disorder specialists).14 Three and a half million
office visits are made to doctors every year for IBS in the United States,
making it the 7th leading diagnosis overall.15
What are the Signs & Symptoms?
International conferences have
actually been held to establish agreed-upon criteria by which function bowel
disease can be recognized. These conferences have produced the “Manning
criteria” (named after Adrian Manning who proposed one set of criteria) and the
“Rome critieria” (named for the
location of one of the conferences). The Manning criteria are:16
- Stools that are more frequent and
looser at the start of episodes of abdominal pain
- Relief of pain after defecating
- A sense of incomplete rectal
evacuation
- Passage of mucus with the stool
- A sense of abdominal bloating
The Rome
criteria added to the above:
- Constant presence of abdominal
pain and altered bowel habits
- Presence of remaining symptoms
25% of the time
Although the above criteria are
the “official” ones, in reality, patients presenting with variations of these
symptoms may be diagnosed with IBS;17 these variations may include:
- Constipation with or without pain
- Pain associated with bowel
movements
- Painless diarrhea only
- Alternating constipation and
diarrhea
IBS sufferers may also experience
other symptoms, including:
- Flatulence
- Nausea
- Vomiting
- Headaches
- Loss of appetite
- Anxiety
- Depression
- Poor nutrient absorption (if
diarrhea is severe)
The abdominal pain associated
with IBS is often triggered by eating and accompanied by abdominal spasms. The person
with IBS may feel an urgent need to move the bowels but be unable to do so.
Rectal bleeding is not a typical
sign of IBS. If it is present in an IBS sufferer (who is correctly diagnosed),
it will be due to a minor disorder such as hemorrhoids or a fissure (a crack in
the lining where the rectum joins the skin around the anus).
IBS Facts:
- According to the National
Institute of Diabetes and Digestive and Kidney Diseases, irritable bowel
syndrome ( IBS ) is one of the most frequently occurring gastrointestinal
disorders and accounts for 41% of all visits to gastroenterology practices.
- It is estimated today that one in
five Americans has IBS symptoms, making it second only to the common cold as
the most frequent cause of absenteeism from work and school.
- Most people with IBS have such
mild symptoms that they do not seek medical care for it, and those that do are
seldom hospitalized.
Optional Nutritional Approaches
Depending upon their level of
awareness, doctors may also advise their IBS patients to eat smaller meals,
chew thoroughly, reduce fat intake, increase water consumption, eliminate
gas-forming foods, refined foods and sugar. Some may recommend the use of
digestive enzymes with meals, probiotics (to increase friendly bacteria),
glutamine (to help heal the bowel wall) and peppermint oil (enteric-coated
capsules have been used to help soothe and relax intestinal muscles21).
Complementary Mind/Body Therapies
Since stress can be a key trigger
for IBS, the following can be very important in the management of this
condition:
- Meditation/Prayer
- Massage therapy would be
excellent in the management of IBS
- Acupuncture has stress-reducing
effects; ask your practitioner specifically about this
- Yoga – good not only for exercise
but also for stress reduction
- Biofeedback can be helpful in
teaching relaxation skills
- Colon
hydrotherapy / Colonics – If your IBS condition results from an imbalance in
the GI tract, (due to such conditions as Candida or parasites), or you have the
constipation IBS, colon hydrotherapy could be beneficial.
- Chiropractic
- Music therapy
For more info, read pages 137-146 in Gut Solutions by Brenda Watson, N.D. and Leonard Smith,
M.D.
