Medicine for Africa - Medical Information Service

RRITABLE   OWEL  YNDROME

Definition:

Irritable Bowel Syndrome – IBS – is sometimes also called ‘irritable colon’, ‘nervous indigestion’, ‘spastic colon’, ‘intestinal neurosis’, or ‘mucous colitius’.

Irritable bowel syndrome is the most frequent cause of complaints in the gastrointestinal (GI) tract.  Almost half of all patients with digestive problems are affected by IBS, which can be caused by a large number of circumstances. 

While there is no organic basis for this chronic disorder of the colon, the physician calls it a ‘functional’ problem.  This means that the normal function of the colon is disturbed without any physical damage to the intestinal organ itself.

Psychological stress, such as fear or general stress, play an important role in the development of this syndrome.  Thus, people who constantly transfer, consciously or subconsciously, their stress and tension onto their digestive system, will be particularly easily affected by IBS.  Also, people who had been sexually molested as a child, show an above average chance of suffering from IBS at a later stage in life.

However, psychological factors play only one part in the possible causes of IBS.  Recent studies have shown that the intestinal musculature of patients with IBS reacts more intensely, as compared to healthy people.  Pain can be caused by a hard stool, air in the colon, and certain foods, such as chocolates, milk products and certain nutritional food substances (e.g. fructose and sorbitol are well known factors), as well as alcohol and drugs.

Furthermore, an increase in symptoms in women during their menstruation is suggestive of an additional hormonal influence.

IBS can become so serious and incapacitating that patients will not be able to work anymore, and often retreat from socializing.  In addition, their sex life can suffer due to constant bloating and irregular stool behavior.  Serious complications do not occur, and there is no known increased risk for developing colon cancer.

Symptoms:

While the scope of symptoms is not diagnostic of the syndromes, the classic symptoms of IBS include constipation, alternating with diarrhea, pain and pressure feeling in the abdominal area and just below the rib cage, as well as bloating and a sense of fullness. 

Some patients experience pains in a sense of fullness and pain just below the breastbone (‘heartburn’) – these complaints can often improve following a bowel movement.  The collection of air in the lower (distal) parts of the colon, causes the sense of fullness, bloating and loud bowel sounds, often experienced by IBS patients.  The stool often resembles the shape of sheep’s feces, and can be interspersed with mucous.  However, neither blood in the stool, nor weight loss are associated with IBS!

General symptoms may include headaches, back and joint pains, the feeling of being overly tired, nervous or stressed, and poor sleep patterns.

Women suffer about twice as often from IBS as men.

 
Diagnosis:

The diagnosis of irritable bowel syndrome is based on the patient’s personal medical history and a thorough physical examination.

Since the symptoms of IBS are non-specific, other diseases, such as colon cancer and inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease, must be excluded before a diagnosis of IBS can be established.  Thus, IBS is a ‘diagnosis of exclusions’ of other diseases.

To exclude other diseases, screening tests should include:

• Fecal occult blood test – this test can detect minimal amounts of blood in the stool, pointing to a possible source of bleeding in the colon, thus pointing to another cause than IBS, such as inflammatory diseases or cancer;
• Barium enema – may be considered to rule out polyps and tumors in their early developmental phase; 
• Colonoscopy or sonography of the abdomen can also help to rule out other disease processes.

The suspicion of IBS will be confirmed, if blood tests reveal neither the presence of an infection, nor show any changes in the red and white blood cell count.

 
Treatment:

Since IBS is not a ‘functional’ disease, but rather a ‘psychological disorder’, any attempt to treat the syndrome effectively requires the active participation of the patient.  Thus, the patient needs to adjust his/her lifestyle, by changing eating habits, such as, for example, hasty eating and insufficient chewing of the food.  It is important to identify, which kinds of food products cause the symptoms, and to subsequently abstain from eating them.
                          
Herbal substances may be helpful, such as myrrh, curcumin, mint oil and artichokes, psyllium seeds or caraway-fennel-anise tea.

Another important aspect of treatment consists of psychological advice and therapy.  The understanding that the disease is not life threatening may often already cause an improvement of symptoms.  Alternative stress therapy, such as breathing techniques, autogenic training and/or Yoga, can help to restore the balance between body and mind.

Specific drugs for IBS usually only reduce the syndrome’s symptoms for a short period of time, if at all, and should only be taken upon a physician’s recommendation.  While a disease specific drug treatment of an irritable colon has yet to show desirable results, the drug’s side effects can be considerable.  Thus, two drugs that, at first showed some positive effects for IBS patients, were withdrawn from the market after just a few years due to the considerable side effects they caused – the drugs’ names were Lotronex® (alosetron hydrochloride) for diarrhea-predominant IBS, and Zelnorm® (tegaserod maleate) for constipation-predominant IBS.  Lotronex was withdrawn after several cases of ischemic colitis, a potentially fatal disorder, were reported; Zelnorm’s withdrawal in some countries occurred, following reports of various heart problems due to the drug.

Prevention:

Every person should carefully listen to the signals that his/her body and digestive tract convey to them.  One should be able to identify foods that cannot be well tolerated, and refrain from eating them.

It is recommended that patients with IBS should follow a variable diet that is rich in fiber and sufficient amounts of liquid, in order to allow for regular bowel movements.

Furthermore, daily relaxation exercises can counteract stress, and daily physical exercise, such as walking or jogging, can also relieve tension and loosen mind and colon.

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DISCLAIMER: The above article is only intended to provide general information regarding this topic. It is not intended and does NOT replace the need to consult a medical or other professional person, if you have or believe to have this disease/disorder. While the article was researched, written and reviewed by medical professionals, and Medicine for Africa, its staff and publisher made every effort to assure accuracy and correctness, it does not claim to be complete, correct or to reflect the very latest stand of medical/scientific knowledge in the disease’s/syndrome’s pathology, diagnostic and/or therapeutic development. Medicine for Africa, its founder, management, staff, writers, reviewers or publishers may NOT be made responsible or legally bound to any information provided above, and cannot be held liable to any conclusions or decisions the reader may draw after reading this article. The reader is explicitly advised to consult a licensed physician and to present his/her specific situation before making any health related decisions.