This week still on the GI-series, I will be writing on Irritable bowel syndrome (IBS), which is one of the most commonly diagnosed GI
disorder. IBS affects at least one out of 10 persons. It is more common in females than males. There are 2 main variants of IBS depending on
the predominant symptoms: IBS associated with constipation (IBS-C) and IBS associated with diarrhea (IBS-D). Some other time IBS could show
up as alternating bouts of constipation and diarrhea. The exact cause of IBS is not fully understood, but it could be mostly related to
diet and food intolerance. Therefore understanding and avoiding the potential triggers can be helpful in management of symptoms. certain
lifestyle modification and stress management can also play a role in improving quality of life.
Signs and symptoms:
abdominal cramps, bloating, excessive gas usually relieved by bowel movement, constipation and or diarrhea, mucous in the stool. Prolonged
constipation can lead to hemorrhoids, and prolong diarrhea can cause dehydration. IBS is characterized by periods of flares (when it gets
worse) and remission (when it gets better).
How to relieve IBS symptoms
stress management: IBS has been associated with increased stress level, therefore the more tensed and stressed you are, the more likely you
are to have a flare. Use mindfulness and relaxation techniques to keep your stress level at bay.
Food journaling: keep a food journal to learn what specific food makes it worse or makes it better. Try to avoid suspected food for about 4
weeks to see if symptoms improve. There is a theory that foods high in fructose, lactose, fructans, galactans or polyols can be culprit.
This group of foods, called FODMAP ( Fermentable Oligo-, Di-, and Mono-saccharides And Polyols), are incompletely absorbed in the small
intestine and fermented in the colon, therefore causing bloating and excessive gas.
The fact that IBS is more common in women than in men also indicates an hormonal component. For example cyclical changes in hormones in women
make symptoms worse around the monthly menstrual period. So it would be great for women with IBS to pay attention to their diet around this
time every month.
Over the counter options for IBS
Fibre: it is important to start slowly when introducing fibre to the diet, start with one table spoonful of soluble fibre with one meal per
day and gradually increase to 2 or 3 times per day until desired effect is achieved. Don't forget to drink lots of water along with fibre
intake. Include food with soluble fibre such as oats, barley, oranges, dried beans and lentils in your diet. Insoluble fibres such as wheat
bran, whole grains can cause bloating and abdominal discomfort or worsen symptoms.
Antispasmodics: these may reduce GIT muscle contractions, abdominal cramps and spasms. If you have IBS-C antispasmodics may not be so
helpful. Peppermint oil is considered a safe and low-cost option to improve abdominal cramps. This can be taken in form of capsules
Probiotics: greatest benefit of probiotics is in IBS-D. Best evidence for efficacy of probiotics is with the use of one that has a specific
strain: Bifidobacterium infantis 35624 (e.g. Align), improving abdominal pain, stool consistency and IBS quality of life. Here is a link to
my article on probiotics if you haven't seen it.
Loperamide (Imodium): there is limited evidence to suggest use of loperamide may improve stool consistency and frequency in patients with IBS-D.
Continuous use of loperamide is not recommended only for short period of time. I have found there is an increasing demand for loperamide in
the pharmacy and some studies have shown potential for abuse and overuse of this product. Thus care must be taken when using loperamide. It
should ideally be used as an adjunctive therapy along with other interventions to control IBS symptoms.
PEG (poly ethylene glycol) Restoralax: this a laxative that may be used in IBS-C, however there is no evidence that PEG improves overall symptoms. I will
not recommend this other than for acute episodes of constipation at the lowest possible dose and for the shorted period of time.
There are other prescription-only medications that can help relive the symptoms of IBS. If you have any “alarm” symptoms such as fever,
blood in your stool, weight loss, or belly pain that doesn’t go away, be sure to contact your health care provider for further investigation.
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