All About Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a chronic, disabling and recurrent condition characterised by abdominal pain and/or discomfort often relieved on passing stools and is associated with change in either frequency or form of stools or both. It affects 10 to 20 percent of population. In some literature, the prevalence was found to be as high as 30 percent. Women are three times more affected than men. Interestingly, it remains one of the most common and stressful abdominal conditions globally.

Though the exact cause of IBS is not known, it is hypothesised that IBS is multifactorial in occurrence. The most plausible causes are –

• Genetic predisposition (Runs in Families)
• Emotional stress and psychological problems
• Abdominal infections
• Intestinal hypersensitivity
• Food allergies
• Poor gut flora
• Faulty intestinal motility
• Faulty gut immunity

IBS patients suffer from altered bowel habits which fluctuate from constipation to diarrhoea to normal bowel function in between. It may also manifest as incomplete evacuation of bowels or a sense of fullness which leads to psychological distress along with abdominal discomfort. Other problems faced could be bloating, cramps, nausea, chest pain, intense hunger pangs, poor appetite, belching, retching, acidity and flatulence. Most adults with the condition, experience episodes of symptom exacerbation, followed by periods of remission.

IBS is of the following four types –

1. IBS-D (diarrhoea predominant)
2. IBS-C (constipation predominant)
3. IBS-M (mixed diarrhoea and constipation)
4. IBS-U (unclassified; the symptoms cannot be categorized into any one of the above three types)

Choice of treatment is based on the nature and severity of the patient’s predominant symptoms. Imperative to note is that sometimes, the side effects of tummy medicines can exacerbate the existing mental issues or vice- versa. These facets must be kept in mind before chalking out a holistic treatment plan. In short, a thorough assessment of all the problems is the key to an effective control strategy.

The ideal management would be dietary modifications, drug therapy and talk therapy to ease out the emotional stress.

Some Do’s and Don’ts for the IBS sufferers-

1. Get a personalised diet plan from an expert depending upon the type of IBS you have.
2. Have small and frequent meals.
3. Consume homecooked meals as much as possible.
4. Take plenty of fluids, particularly water and other non-alcoholic, non-aerated, non-caffeinated drinks.
5. Restrict tea or coffee to 2-3 cups a day.
6. Avoid alcoholic and aerated beverages.
7. Introduce a source of probiotic in your diet
8. Take high roughage diet. However, if it hasn’t led to improvement, limit the intake of high fibre foods.
9. Limit the intake of fresh fruit to 3 servings per day (One serving is 100 gms)
10. Avoid milk and milk products if they increase the symptoms
11. Try to figure out your food allergies
12. Change your lifestyle to reduce emotional stress
13. Exercise regularly
14. Have a disciplined sleep schedule, that is a fixed sleep time and wake up time
15. Take 6 to 8 hours of night-time sleep
16. Avoid day-time naps
17. Seek help from an expert
18. Follow the management plan dedicatedly

Interestingly, a diet low in fermentable carbs known as FODMAPS significantly improves the symptoms and is highly recommended for people with IBS. FODMAPS stands for Fermentable Oligo-, Di-, Mono-saccharides and Polyols. Don’t forget to ask your doctor about low FODMAPS foods.

Most of the patients with IBS live healthy life provided they make lifestyle modifications and adhere to precautions. Besides, it is not a life-threatening disease. There are periods of exacerbations, which can be shortened, as well as those of remissions, which can be lengthened with the right therapy.

Wishing you the best of mental health today and always!

Dr Apala

Special credits for proof-reading the article –
Dr Ujjwal Sonika
MD (Medicine), DM (Gastroenterology, AIIMS)
Assistant Professor, GIPMER
Maulana Azad Medical College, New Delhi