Irritable Bowel Syndrome (IBS)
What is Irritable Bowel Syndrome (IBS)?
Irritable bowel syndrome is a common digestive problem characterised most often by bloating, abdominal pain, flatulence, constipation and/or diarrhoea. It is defined as a benign, chronic disease and is sometimes considered to be a functional type of bowel disorder that is caused by heavy, muscular spasms in the colon (large intestine). IBS can cause people to miss work and social events, and there is often some associated anxiety and/or depression. Sometimes people find that their symptoms subside for a few months and then return, while others report a constant worsening of symptoms over time. The majority of sufferers are women and most have their first symptoms between the ages of 15 and 40.
What causes IBS?
When the word 'syndrome' is used in medicine it indicates an umbrella term for a range of symptoms with no single, clear cause. This article sets out to review a range of current theories on the development of IBS.
People who suffer from IBS may have a colon (large intestine) that is particularly sensitive and reactive to certain foods and stress. The immune and nervous systems may play a central role in the development of this condition as there are many neurological (nerve) and hormonal connections between the brain and the gut. It is also often the case that psychological and emotional factors can trigger neural and hormonal changes that cause an inflammatory response in the digestive tract.
IBS may be linked to small intestinal bacterial overgrowth (SIBO), a condition where abnormally large numbers of bacteria are present in the small intestine. These types of bacteria can have a similarity to those more commonly found in the colon and are considered to establish an imbalance in the gut. It is also thought that many carbohydrates (sugars) cannot be successfully broken down and absorbed within the small intestine. As a result, these sugars are rapidly fermented by bacteria in the bowel which draws in fluid and produces gas, pain and bloating. Therefore, a lack of the appropriate pancreatic and intestinal enzymes could be an issue for IBS sufferers.
The transit time of fluids through the gut is determined by peristalsis (muscular movement), bowel wall integrity and other factors. Any condition that reduces muscular activity in the small intestine will slow transit time, allowing bacteria to remain longer and multiply. Reduced muscular activity may also allow bacteria to spread backwards from the colon and into the small intestine causing a bacterial imbalance.
Alternatively, malabsorption of sugars and carbohydrates in the small intestine caused by rapid transit time can also be problematic, allowing increased amounts of sugar and carbohydrate to reach the colon where greater amounts of gas are produced.
Some research states that IBS may be caused by bacterial, viral, fungal or parasitic infection in the gastrointestinal tract. Studies show that people who have had gastroenteritis sometimes develop IBS, otherwise called post-infectious IBS. Bacteria such as brucella, staphylococcus and campylobacter are commonly diagnosed with appropriate blood tests. Some people may carry miasms (inherited toxins) that have ben passed through several generations, common examples being luesinum (from syphilis) and bacilinum (from tuberculosis).
Researchers have also found very mild coeliac disease in some people with symptoms similar to IBS. People with coeliac disease cannot digest gluten, a substance found in wheat, rye, and barley. An immune response is triggered in response to the gluten causing significant pain.
Other research suggets that serotonin is linked with normal gastrointestinal (GI) functioning. Serotonin is a neurotransmitter, a chemical that delivers messages from one nerve cell to another, and 95% of the serotonin in your body is located in the GI tract while the other 5 percent is found in the brain. It affects the nervous system and functions to regulate appetite, sleep, memory, learning, temperature, mood, behaviour, and critically muscular movement. It may also have a role in depression as some depressed patients are seen to have lower concentrations of metabolites of serotonin in their brain tissue and cerebrospinal fluid. Cells that line the inside of the colon work as transporters and carry the serotonin out of the GI tract. People with IBS, however, have dysfunctional receptor activity that causes abnormal levels of serotonin to exist in the GI tract. As a result, people with IBS experience problems with bowel movement, intestinal fluid levels and pain.
Finally, some researchers have also found that women with IBS may have more symptoms during their menstrual periods, suggesting that reproductive hormones can worsen IBS problems.
We can see that IBS is a complex matter and the integrated approach is methodical in identifying the relevant issues for each individual.
We need to be careful with the prescription of drugs for chronic bowel symptoms. Anti-inflammatories, antidepressants, antispasmodics, antihistamines, steroids and broad-spectrum antibiotics can all be common prescriptions for bowel conditions where the cause is unclear. For example, steroids may suppress immune function where the immune system is already compromised. Various different approaches may be required but people can often overcome IBS with an appropriate individual treatment plan that might include any of the following: acupuncture, diet, herbal medicine, massage, shiatsu, stress management and carefully prescribed medications.