Irritable Bowel Syndrome
Irritable Bowel Syndrome (IBS) is a chronic health condition affecting the large intestine, or colon. IBS commonly causes symptoms such as abdominal bloating, pain, and cramping as well as changes in bowel motility resulting in diarrhea and/or constipation. Though IBS may share some common symptoms with inflammatory bowel conditions such as Crohn’s disease or ulcerative colitis, is does not cause permanent damage to the intestine or increase risk of other diseases such as colorectal cancer. IBS is more likely to occur in women, people under 40 years of age, people with a family history of IBS, and in those with concurrent mental health diagnoses such as depression or anxiety.
IBS symptoms may fluctuate, sometimes disappearing for periods of time. Mild symptoms may be managed with lifestyle modification, stress management, and dietary changes. Moderate to severe symptoms which cause chronic diarrhea, rectal bleeding, persistent pain, and/or weight loss, may require the addition of medications and further diagnostic work up by a gastroenterologist. These symptoms could result in dehydration or malabsorption of minerals/vitamins, or could possibly be indicative of another disease process.
Causes of IBS may include an alteration in the motility of the smooth muscle of the gastrointestinal tract and/or alterations in nerve function between the gut and brain. If the muscle contraction is too strong or lasts for a longer than normal period of time, pain, diarrhea and gas/bloating may occur. Conversely, if the contractions are weaker than normal, the intestinal contents move too slowly resulting in constipation. Additionally, the discomfort associated with IBS may be related to alterations in the nerves of the gastrointestinal tract. Nerve impulses between the GI tract to the brain may be abnormal, resulting in increased sensitivity to stimuli (such as the normal squeezing of the smooth muscle as it digests food). This increased nerve activity can translate to pain and discomfort. There is some research available to indicate that central nervous system sensitivity may contribute to IBS.
If you have symptoms of IBS, your doctor may first attempt to rule out any other disease processes (such as Crohn’s disease, ulcerative colitis, intestinal parasites, or colorectal cancer) by completing diagnostic testing including blood work, scans of the gastrointestinal tract, and/or scopes such as a colonoscopy. Testing for food allergy or intolerance may also be completed, as this can contribute to IBS-type symptoms. If no other disease process is thought to be causing symptoms, your doctor may diagnose you with IBS based upon your symptom presentation.
If You’ve Been Diagnosed with Irritable Bowel Syndrome
If you’ve been diagnosed with IBS, your doctor may advise you to make lifestyle changes to control stress, to get appropriate amounts of exercise, and adequate sleep. Since IBS can be triggered or intensified by diet, certain dietary changes may be recommended as well. If lifestyle and diet change is not enough to control your symptoms, certain medications may be used. These medications may be aimed at altering the motility of the GI tract, the amount of gas within the intestine, controlling the water content of the bowel, or may manipulate the neurotransmitters that affect the nerve impulses in the GI tract and the brain. Some medications have only been approved for use in women.
A Whole Health Perspective:
Looking at Irritable Bowel Syndrome through a Whole Health model, we explore the individual’s unique presentation from the 5 Aspects of Whole Health™ perspective.
1. Physical: Symptoms of IBS can often be managed through lifestyle modification and avoidance of triggers such as stress, caffeine, alcohol, dairy, high fat and high sugar foods (these triggers are different for everyone). Risk factors for IBS and/or increased symptom presentation include inadequate or disordered sleep, under or over exercising, and increased acute and chronic stress. Chronic stress contributes to IBS through hormonal release and the activation of the Hypothalamic-Pituitary-Adrenal pathway (the “stress response pathway”), which has the potential to alter gastrointestinal function. Other infectious processes, such as Small Intestinal Bacterial Overgrowth, or SIBO, can contribute to IBS. The body’s immune system in general, and the GI-related immune system in particular, are affected by chronic stress. High levels of stress can negatively alter immunity and thus affect symptoms. Women with IBS may notice an increase in symptoms before and during menstruation, thus controlling triggers during this time may relieve some symptoms. Integrative approaches, such as acupuncture, moxibustion, Traditional Chinese medicinal herbs, relaxation methods, or mental health counseling, can also be helpful in symptom control.
2. Environmental: Environmental pollutants may contribute to IBS, as may stressful environments. Situations or relationships that contribute to conflict and distress may increase symptoms. Direct or passive exposure to cigarette smoke is known to negatively affect the gastrointestinal tract and its function. Repeat exposure to microbial or viral agents which cause intestinal upset could possibly increase the frequency and severity of IBS flares. Exposure to nature, even visual or auditory, can decrease stress and have a positive effect on health. Appropriate exercise can have a beneficial effect on IBS symptoms and quality of life.
3. Nutritional: Dietary recommendations to reduce IBS symptoms include the exclusion or reduction of FODMAP (Fermentable Oligo-Di-Monosaccharides and Polyols) foods. These are certain carbohydrate foods that are poorly absorbed in the intestine and may be fermented by intestinal bacteria, leading to IBS-type symptoms. Some vitamin deficiencies, such as vitamin D, may be implicated in the pathogenesis of IBS, thus should be tested and treated if found to be low. Use of probiotics shows some positive results in diminishing IBS symptoms. IBS patients may find some symptom relief with dietary interventions including small but frequent meals, eating slowly and mindfully, avoiding highly stimulatory foods such as caffeine and sugar, and avoidance of food allergens/sensitivities such as dairy (lactose). Keeping a food diary to track intake, stressors, and symptoms may help to identify triggers.
4. Emotional: The gastrointestinal tract and the brain communicate closely. The function of the GI tract may be altered by emotions such as anger, fear, and frustration. Because of this gut-brain connection it may be beneficial for IBS patients to engage in activities which assist in the regulation of emotion and stress. Activities such as meditation and/or mindfulness may be helpful in symptom reduction by reducing overall stress and by rebalancing the nervous system response to stress. Cognitive behavioral therapy is also implicated in symptom reduction. Treating co-existing anxiety and depression may also assist in amelioration of symptoms.
5. Beliefs, Values and Worldview – also identified as Spirituality: Cultural or religious traditions regarding food and dietary choices may be involved in gastrointestinal function. Spiritual expression and development, whether through prayer, meditation, yoga, etc., has been shown to be an important factor in health. Possible feelings of isolation, living in discordance with one’s values, or inability to connect with support and the natural surroundings due to illness or other factors could increase stress and exacerbate symptoms.