What is Irritable Bowel Syndrome? Is this just simple constipation? But I got this for such a long time. As you can say, I’m living with this gut. Alright, you might not really worry about your constipation, because you are living with this condition in a long term period 6-7 years.
But do you know that constipation might be linked to one of the symptoms of Irritable Bowel Syndrome (IBS)? Yes, it’s linked. For mine, I am also a post IBS’s patient, and not knowing this diagnosis for about almost 7 years. So, In this month this IBS awareness month, so I loved to share this information for all of you so you can be more aware and go get your medical check up if you possibly get the symptoms of IBS.
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What is Irritable Bowel Syndrome (IBS) ?
Irritable bowel syndrome is a common medical condition characterized by chronic, recurrent, abdominal pain and discomfort, and altered bowel habits that occur in the absence of other organic gastrointestinal (GI) disease.1 IBS is the most common reason to visit a gastroenterologist and the second most common reason, after common flu, to be absent from work.1 Usually, women are more commonly affected than men, in ratio of 2:1, and the peak of the disease often starts in early adulthood.2 In general, patients are evenly distributed among 3 subtypes diarrhea-predominant [IBS-D], constipation-predominant [IBS-C], or mixed [IBS-M].
The underlying cause is still being defined but is thought to be multifactorial.1
Signs and Symptoms
Common sign and symptoms of IBS are abdominal pain, bloating, straining during defecation, sensation of incomplete evacuation3, mucus with stools, urgency, postprandial symptoms, depression, and anxiety.5
Things Cause IBS
- Food Intolerance
One of the most common factors causing symptoms in IBS patients is food intolerance.6 They believed that specific types of food trigger their symptoms. Foods that contain fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) are known triggers that worsen IBS symptoms because of their osmotic and fermentation effects.7
2. Enteric Infection
Enteric infection known as post-infectious IBS6 and usually occurs after an acute bacterial, viral or protozoal gastroenteritis, when around 20% of patients will develop symptoms of IBS.9 The groups of pathogens that lead to IBS symptoms are still unknown, but colonic spirochetosis was linked previously with colonic eosinophilia , lymphoid follicles, and IBS-D(IBS Diarrhea).10,11
Up to 75% of patients with IBS symptoms usually have coexisting or depression.10 One study that compared anxiety and depression levels in IBS patients and healthy individuals found that the activity of the dorsolateral prefrontal cortex in IBS patients was dysregulated in behavioral selection duties.12 Norepinephrine production by stressful stimuli appears to enhance the growth of many intestinal pathogens, including Campylobacter jejuni13, Escherichia coli (E.coli) and E. Coli 0157:H7, with activation of the HPA axis.14 It appears that this stress stimulation also affects the non-pathogenic bacteria, such as Lactobacilli and Bifidobacteria, promoting even more invasion from other potential pathogens.15
IBS patient assumed have altered microbiota in their intestines.16 Observation from a study in 110 IBS patients show that patients with IBS have different intestinal microbiota.17
Lactobacillus and Bacteroides species, known beneficial bacteria, are also depleted, while the number of pathogenic bacteria, such as Streptococcus spp., are increased.18 In a study of IBS patients with abdominal pain, the investigators observed that patients with pain had 5 times smaller amounts of Bifidobacteria in their intestines.19
Inflammatory Bowel Syndrome is a disease that is manageable. The cause IBS is multifactorial and not completely elucidated. The initiation of treatment of IBS starts with identifying the severity and predominant symptoms of the disorder. If symptoms do not significantly affect quality of life, management with lifestyle modification and education is a reasonable choice. Treatment is based on a trial of lifestyle changes and symptom management. The low FODMAP diet and exercise should be recommended for lifestyle changes. Pain and bowel cramping can be treated with antispasmodics and peppermint oil, tricyclic antidepressants , counseling, probiotics, or a trial of rifaximin.1
This month awareness of IBS just wants people to be more concerned about their gut changes activity. If you find something uncomfortable, painful, or even bloody stool please be more concerned and go to see your doctor!
Stay safe and Healthy!
- Defrees DN, Bailey J. Irritable bowel syndrome: epidemiology, pathophysiology, diagnosis, and treatment. Prim Care 2017;44:655-671.
- Mayer EA. Clinical practice. Irritable bowel syndrome. N Engl J Med 2008;358:1692-1699.
- Enck P, Aziz Q, Barbara G, et al. Irritable bowel syndrome. Nat Rev Dis Primers 2016;2:16014.
- Böhn L, Störsrud S, Törnblom H, Bengtsson U, Simrén M. Selfreported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013;108:634-641.
- Jerndal P, Ringström G, Agerforz P, et al. Gastrointestinal-specific anxiety: an important factor for severity of GI symptoms and quality of life in IBS. Neurogastroenterol Motil 2010;22:646-e179.
- Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA 2015;313:949-958.
- Shepherd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 2008;6:765-771.
- Vakil, Namish. Dietary Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAPs) and Gastrointestinal Disease. Nutrition in Clinical Practice. Vol 00 Number 0. 2018;1-8. American Society for Parenteral and Enteral Nutrition. DOI: 10.1002/ncp.10108
- Keely S, Walker MM, Marks E, Talley NJ. Immune dysregulation in the functional gastrointestinal disorders. Eur J Clin Invest 2015;45:1350-1359.
- Holtmann GJ, Ford AC, Talley NJ. Pathophysiology of irritable bowel syndrome. Lancet Gastroenterol Hepatol 2016;1:133-146.
- Walker MM, Talley NJ, Inganäs L, et al. Colonic spirochetosis is associated with colonic eosinophilia and irritable bowel syndrome in a general population in Sweden. Hum Pathol 2015;46:277-283.
- Aizawa E, Sato Y, Kochiyama T, et al. Altered cognitive function of prefrontal cortex during error feedback in patients with irritable bowel syndrome, based on FMRI and dynamic causal modeling. Gastroenterology 2012;143:1188-1198
- Xu F, Wu C, Guo F, et al. Transcriptomic analysis of Campylobacter jejuni NCTC 11168 in response to epinephrine and norepinephrine. Front Microbiol 2015;6:452.
- Raskov H, Burcharth J, Pommergaard HC, Rosenberg J. Irritable bowel syndrome, the microbiota and the gut-brain axis. Gut Microbes 2016;7:365-383
- Pigrau M, Rodiño-Janeiro BK, Casado-Bedmar M, et al. The joint power of sex and stress to modulate brain-gut-microbiota axis and intestinal barrier homeostasis: implications for irritable bowel syndrome. Neurogastroenterol Motil 2016;28:463-486.
- Bhattarai Y, Muniz P DA, Kashyap PC. Irritable bowel syndrome: a gut microbiota-related disorder? Am J Physiol Gastrointest Liver Physiol 2017;312:G52-G62
- Tap J, Derrien M, Törnblom H, et al. Identification of an intestinal microbiota signature associated with severity of irritable bowel syndrome. Gastroenterology 2017;152:111-123.
- Parkes GC, Rayment NB, Hudspith BN, et al. Distinct microbial populations exist in the mucosa-associated microbiota of subgroups of irritable bowel syndrome. Neurogastroenterol Motil 2012;24:31-39.
- Jalanka-Tuovinen J, Salonen A, Nikkilä J, et al. Intestinal microbiota in healthy adults: temporal analysis reveals individual and common core and relation to intestinal symptoms. PLoS One 2011;6:e23035.