Irritable Bowel Syndrome is a distressing digestive disorder involving symptoms of persistent abdominal pain with frequent, urgent bouts of diarrhea or episodes of constipation and bowel straining. Other symptoms include abdominal bloating, the perception of excessive gas, and, at times, a feeling of incomplete evacuation after a bowel movement. IBS is quite common, though you wouldn't know it. Although IBS affects 10 to 20% of the population, there is continued social stigma and discomfort relating to the discussion of any issues related to the bowel. Therefore, many people suffer in silence, as they struggle with feelings of shame and try to cope with the stress that goes along with the disruptive nature of IBS symptoms.
Diagnostic testing of an IBS patient does not reveal overt physical causes such as inflammation, tissue damage or tumor. Thus, IBS is characterized as a functional disorder. Symptoms appear to be related to two factors: the intestinal system becomes overly sensitive to material passing through, resulting in abdominal pain — particularly after eating, and the speed of intestinal contractions becomes disrupted. When the system is moving too quickly, diarrhea results — contractions that are too few or too slow result in constipation.
Why does this happen? - It is not known why this disorder manifests in some individuals and not in others. A severe case of gastroenteritis, or the "stomach flu", can sometimes precipitate the onset of IBS. There is also evidence to suggest that IBS develops after a major life stressor. A high incidence of IBS is seen in people who were physically or sexually abused as children. It may be that exposure to severe or chronic stress causes the system to burn itself out, resulting in ongoing malfunction. Researchers have been focusing on the connections between the brain and the enteric nervous system (responsible for governing the process of digestion) to better understand and treat IBS.
Could it be something more serious? - If a person suspects they have IBS, they should be evaluated by a physician. With a symptom picture of abdominal pain and a change in bowel habits, a diagnosis of IBS can be made with confidence and with a minimum of diagnostic testing. Further testing would be indicated if the symptoms include anemia, fever, bleeding from the rectum or the stool, significant weight loss, or sudden onset of symptoms in a person over the age of forty. These symptoms are not characteristic of IBS and, therefore, would necessitate additional investigation.
Does stress play a role? - The relationship between stress and IBS plays out in two ways. Exposure to stress may set off or exacerbate symptoms. In addition, coping with IBS itself can be very stressful due to the intrusive and disruptive nature of the symptoms. Efforts to keep the disorder hidden from others can result in strong feelings of shame and embarrassment, further stressing the individual and contributing to symptom outbreaks. Abdominal sensations in and of themselves can become triggers. A person who has been traumatized by IBS may become hypervigilant to any intestinal rumblings and respond with anxiety, setting off the very process that the person was worried about in the first place. It is this process that often leads IBS sufferers to conclude, wrongly, that they are safer if they remain at home, leading to social isolation and impairment in their quality of life.
Are there other triggers? - Hormonal changes, certain types of food and simply eating a heavy meal are all possible triggers for IBS symptoms. With the exception of lactose intolerance, true food intolerances are very rare. The trick is to discover the relationship between particular foods and each individual's system, while at the same time ruling out the contribution from other triggers. Often a particular food is blamed, when it is merely the size of the meal that has triggered painful symptoms. Sometimes, certain foods need to be avoided during times of stress, but can be enjoyed during calmer times.
Can medicine help? - A physician will tailor treatment to the acute symptoms. If pain is severe, an antispasmodic or antidepressant may be prescribed. For diarrhea, an over-the-counter antidiarrheal agent may be recommended. For constipation, increased fiber, whether through dietary additions or fiber supplements, appears to be the treatment of choice. In either case, supervision by a physician is imperative. In addition to these traditional strategies, new medications are just recently becoming available which specifically target IBS symptoms by acting on neurotransmitters in the enteric nervous system.
Are there other treatment options? - There is evidence that IBS symptoms respond favorably to a variety of non-drug treatments such as cognitive therapy, relaxation training, biofeedback and hypnosis. As IBS is a chronic condition, with an ongoing fluctuating course, these treatments help the individual to develop skills for managing the condition over the long haul. Many people with IBS also have a co-existing anxiety or depressive disorder, the symptoms of which also benefit from these types of treatments.
What about self-management? - It is not necessary to be a passive victim of IBS. Once triggers have been identified, they can be managed in creative ways to reduce the frequency and severity of symptom outbreaks. Improved eating habits, working toward regularity in bowel habits and improved stress management skills can all help the individual to regain a feeling of control over their body while reducing the impact of IBS on their overall quality of life.
Researchers have been studying how the brain reacts to bowel pain, comparing people with IBS and those lucky individuals who do not suffer from the disorder. Balloons are used to distend the bowel and cause pain, while brain scans are conducted to see which part of the brain responds. In people without IBS, the part of the brain that is activated in response to the pain is that which serves to modulate or suppress pain through the use of the brain's own opiates. Scans of people with IBS indicate that this part of the brain is not activated in response to bowel pain. Instead, the part that is associated with anxiety, arousal and hypervigilance responds. Therefore, instead of the brain accessing its own pain-reducing capabilities, a pain-enhancing process is initiated. What does this mean for the IBS sufferer? One way to regain control over the disorder would be to take active steps to turn off the brain's anxiety response. Relaxation techniques can help to calm the body by regulating breathing and reducing muscle tension. The use of distraction, meditation or calming visual imagery can help to reduce hypervigilance. Keeping the body and mind as calm as possible in response to abdominal sensations will help to quiet down the processes that contribute to the severity of IBS symptoms.