The syndrome irritable bowel (IBS) is also called irritable bowel syndrome . In France, the term ” functional colopathy ” is also used. It is a digestive disorder that is characterized by discomfort or painful sensations in the stomach.
These discomforts are associated with the change in the rate of passage of food in the colon, also called the large intestine (see diagram). Passing speeds that are too fast or, on the other hand, too slow will cause different symptoms. Thus, when the phases of contraction and relaxation of intestinal muscles are faster or stronger than normal, the colon does not have time to absorb the water contained in food. This causes diarrhea .
When contractions are slower and weaker than normal, the colon absorbs too many fluids, resulting in constipation . The stools are then hard and dry.
Generally, there are 3 subcategories of the syndrome according to the type of main symptoms.
- Syndrome with pain and diarrhea.
- Syndrome with pain and constipation.
- Syndrome with pain, diarrhea and constipation.
Who is affected?
The irritable bowel syndrome is a common disorder: it is the cause of 30% to 50% of visits to a gastroenterologist .
This syndrome affects 10% to 20% of the population of Western countries; it is mostly women . However, it should be noted that this is an estimate because it is difficult to obtain reliable statistics. On the one hand, it seems that only 15% of affected people consult their doctor about it. On the other hand, there are 2 different diagnostic grids (Manning and Rome III), which influence the number of people considered to be suffering from irritable bowel syndrome.
This disorder appears gradually in adolescents and young adults . In most cases, irritable bowel syndrome is chronic . However, those affected may experience longer or shorter periods of remission . Their discomfort can appear every day for 1 week or 1 month, then disappear, or even last a lifetime. Only a minority of patients have very uncomfortable symptoms.
Unlike more serious intestinal diseases, such as ulcerative colitis and Crohn’s disease, irritable bowel syndrome does not cause inflammation , does not alter the structure of the intestinal mucosa and does not increase risk of colorectal cancer. This is why irritable bowel syndrome is considered a functional disorder rather than a disease.
On the other hand, the pain , diarrhea and constipation it causes can become very bothersome.
The syndrome irritable bowel can also seriously hinder the professional and social activities of those who suffer, impoverish their quality of life and lead to anxiety and depression.
Finally, other disorders have been found to be associated with this syndrome, such as painful menstruation, chronic fatigue syndrome and fibromyalgia. For now, we do not know the reason.
When to consult?
If the discomfort is new, very bothersome or disturbing, it may be helpful to consult a doctor. Indeed, other health problems can give similar symptoms.
A medical consultation is necessary in case of blood in the stool, fever, significant weight loss or uncontrollable diarrhea, especially if it also occurs at night.
Causes of Irritable bowel syndrome
The causes of this disorder are still unknown and are the subject of much research. Two basic hypotheses are proposed: either sufferers suffer from abnormal and painful contractions of the intestine, or they are more sensitive than normal to movements of the colon and rectum, usually imperceptible.
As women are more affected than men and their discomfort worsens during menstruation, some researchers believe that hormonal changes play a role.
According to some data, up to 25% of cases of irritable bowel syndrome occur after a gastrointestinal infection. The hypothesis of an imbalance of the intestinal flora is also explored.
In addition, some researchers believe that an abnormal level of serotonin in the digestive tract could be the cause of the syndrome. This could explain why many affected patients suffer from anxiety and depression. It should be noted that serotonin has a significant effect on mood and bowel movements.
It is also possible that there is a link between irritable bowel syndrome and sexual or physical abuse experienced during childhood.
It has been thought that stress is a cause of this disorder, but it is not. On the other hand, it generally increases the symptoms (especially the pain).
Symptoms of Irritable Bowel Syndrome
The severity , type and number of symptoms vary greatly from person to person. Some individuals may experience many of the following symptoms.
- Of pain and stomach cramps , often disappearing with the evacuation of gas or stool.
- Of constipation or diarrhea , sometimes alternating.
- Of bloating and flatulence.
- A noisy “intestinal activity” (borborygmes).
- A need sometimes urgent to go to the saddle.
- A feeling of incomplete evacuation of the stool.
- Mucus in the stool.
These symptoms usually occur after meals.
Other symptoms, which are not directly related to the intestines, are sometimes present. For example, headache, nausea, heartburn, chronic pelvic pain, backache (lower back) and sleep disorders.
People at risk for Irritable bowel syndrome
The women would be 2 to 3 times more likely to suffer from irritable bowel syndrome than men. We do not know if it is because they are really at higher risk or because men are less interested in this.
As the causes of irritable bowel syndrome are poorly understood, the risk factors are unclear at this time.
A US study of 399 nurses revealed that the risk of suffering from this syndrome is higher among those with rotating shifts (day and night) than those working only day or night . There did not appear to be a link between abdominal pain and sleep quality of the participants. The researchers assume that disruption of sleep-wake cycles may be a risk factor. For now, this is a hypothesis.
Prevention of Irritable Bowel Syndrome
|Can we prevent?|
|As the causes of irritable bowel syndrome are poorly understood, there is no way to prevent it.|
|Measures to prevent recurrence|
|Dietary changes and better stress management can reduce discomfort (see Medical Treatments section).|
Medical Treatments of Irritable bowel syndrome
Despite research, medicine still offers nothing convincing to treat irritable bowel syndrome . Nowadays, it is treated both psychologically as the physiologically because it is a disorder affecting the interactions between the brain and the digestive system.
Altering your diet and lowering your stress level may reduce symptoms in mild to moderate cases.
When the discomfort is very uncomfortable, the doctor may prescribe medications that reduce the pain by acting on the movements and contractions of the intestine.
Before starting a treatment, it is recommended to note for a few weeks what you eat in order to discover the foods that systematically trigger discomfort. Then, it is advisable to eliminate problem foods from its menu, or to limit the consumption. The advice of a nutritionist can be of great help. They will help find a new, well-adapted and balanced diet.
Some tips to reduce discomfort
- Increase the consumption of soluble fiber , because they are soft for the intestine: oat cereals, oatmeal, barley and barley cream, for example.
- Reduce the consumption of insoluble fiber because it stimulates the contractions of the intestine: whole wheat, wheat bran and berries, for example.
- Reduce fat because they stimulate a lot of gut contractions.
- Limit the consumption of foods that can cause bloating and gas . Reactions vary from one individual to another. The foods that are most prone to ferment are milk and milk products (lactose intolerance), sweeteners (eg sorbitol in sugar-free chewing gums) or mannitol ( a sugar-alcohol) and those that contain fructose (such as apples with their skin, figs and dates).
Legumes and crucifers (Brussels sprouts, broccoli, cauliflower, etc.) can also worsen symptoms. It should be noted that it is possible to buy medicines in the pharmacy that absorb excess intestinal gas. See our page Functional digestive disorders .
Note . It is recommended that people with lactose intolerance eliminate foods containing lactose or take lactase tablets (for example, Lactaid), the enzyme that degrades lactose, so as not to deprive the body of important source of calcium. There are tests to find out if you are lactose intolerant or not. Ask a nutritionist or your doctor.
- Avoid alcohol, chocolate, coffee and caffeinated beverages as they stimulate gut contractions.
- Replace spices (pepper, chili, cayenne, etc.) with herbs.
- Consume salad and raw vegetables at the end of meals.
- Drink water regularly during the day.
- Eat at regular times , chew well and do not skip meals.
For more information, see our Special Diet Sheet Irritable Bowel Syndrome.
People whose stress is an aggravating factor should learn to react less to the unexpected and other destabilizing events of daily life, it often helps to regulate the activity of the intestines.
The relaxation techniques are useful for stop “ruminate,” but to really fight stress, you have to understand the origin, experts say. This learning can be done independently or in psychotherapy. Indeed, studies have shown that cognitive behavioral therapy helps reduce the symptoms of irritable bowel syndrome .
Meeting other people with the same troubles can help. Group discussions and the advice of specialists in behavioral medicine can help the person understand his syndrome better and gradually control his symptoms. See the list of Support Groups at the end of this sheet.
At the Mayo Clinic, the following approaches are also suggested to help relax:
– massage therapy
In addition, regular exercise (30 minutes or more per day) is a good way to relieve stress and combat constipation.
To learn more, check out our stress file.
Some people may need extra help to get their symptoms alleviated. The doctor may suggest that they use medications that help with relief.
- In case of constipation: fiber supplements, also called ballast or mass laxatives (eg Metamucil and Prodiem), or emollients (which soften stools) based on sodium docusate (Colace) or Soflax) can help. If they have no effect, osmotic laxatives (Milk of Magnesia, Lactulose, Colyte, Fleet) can be used. Stimulant laxatives (ex-lax, for example) should only be used as a last resort, because in the long run they can affect bowel motility.
- In case of diarrhea: the fiber supplements often improve stool consistency. They can be tried before using an antidiarrheal medicine. If they do not relieve diarrhea, antidiarrheals such as loperamide (Imodium, for example) may be used.
- In case of pain: Some antispasmodics (substances that fight spasms) have a direct effect on muscle relaxation, such as pinaverium bromide (eg Dicetel) or trimebutine (Modulon, for example). Others act, such as dicyclomine and hyoscyamine. When these treatments are not relieve the patient, low doses of antidepressant drugs may be used, especially for those whose symptoms are diarrhea.