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The Scoop on Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders currently seen in health care. While a chronic GI disorder that affects the large intestine may seem simple, it is actually a very complex disorder. IBS is multifactorial in nature and goes beyond the large intestine. Many health care providers, including myself, may have initially underestimated it’s effects.

Causes

The main culprits of Irritable Bowel Syndrome include the large intestine, the gut microbes and the autonomic nervous system. These three distinct parts communicate with each other via the gut-brain axis (GBA). The GBA is a two-way communication route between the large intestine, gut microbes and the autonomic nervous system. The occupants of the route are neurotransmitters and hormones. Negative physiological changes in any one of these areas can lead to issues and cause IBS (Raskov et al., 2016).

What is IBS? The symptoms of IBS include:

  • Recurrent abdominal pain
  • Bloating
  • Change in stool consistency: diarrhea (IBS-D), constipation (IBS-C), interchanging of diarrhea and constipation is considered “mixed” (IBS-M). IBS-M is the most common variant
  • Bowel mucus secretion
  • Nausea
  • Indigestion
  • Along with these GI symptoms it is not uncommon to see fatigue, depression, anxiety, headaches and poor sleep patterns (Raskov et al., 2016)

According to Raskov et al. (2016), the cause of these symptoms is the imbalance between the gut microbes and the GBA. This imbalance causes changes to intestinal motility and secretions leading to alterations of the endocrine and immune cells within the gut. This imbalance has also been linked to many potential causes. These include cesarean delivery, formula fed versus human breast milk fed infants, antibiotic use, GI infections, diet, genetics, and an individual’s response to stressors both physical and mental. Likewise, it is important when taking an individual’s history, all of these factors are inquired about and taken into consideration.

Scenario

Jessica, an 18 yr old caucasian female, chief complaint of off and on “stomach aches, nausea, diarrhea and constipation” that have been an issue for the last couple of years but seem to be worsening over the last two to three months. Jessica was diagnosed with IBS-M last year by a gastroenterologist who started on dicyclomine last year. She reports that it did help for a little while but then seemed to stop helping so she stopped taking it. She denies any certain foods making her symptoms worse that she can tell.

During the subjective portion of the exam, you learn that before school exams her symptoms always worsen but tend to calm down a day or so after the exam. You also learn that Jessica was a born via cesarean delivery and was formula fed as an infant. She reports to you that she feels “very nervous” about graduating high school, leaving home soon and going off to college.

Thoughts thus far about Jessica’s situation:
-mental stressors are making her symptoms worse
-she was a c-section delivery and formula fed baby…so her gut microbes never got the true nourishment that they needed

There is nothing we can do about how she was delivered and what she was fed as an infant BUT we can help with the way she handles mental stressors. A great starting place for Jessica would be referring her to counseling so she can learn the tools and skills needed to handle these stressors. If we don’t do this and she never learns how to handle mental stressors we are potentially setting her up for a continued life of miserable GI symptoms.

IBS Impact on the individual and Society

Raskov et al. (2016), discussed that clinical studies have estimated the work productivity of individuals with IBS is 30% lower than healthy individuals. Another way to look at that is, for a 40 hour work week, patients with IBS lost 13.8 hours of productivity, yikes! It is estimated in the United States that the direct and indirect expenses IBS is responsible for is over $20 billion annually.

Not only is IBS costly from a monetary value it can also be costly in terms of an individual’s quality of life.

Potential Treatment Options

  • Medications are symptom dependent
  • Following a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet, referral to a dietitian or nutritionist would be ideal as a low FODMAP diet can be challenging for individuals to start and follow on their own. Research has shown foods that tend to trigger IBS symptoms are high FODMAP foods (Raskov et al., 2016). High FODMAP foods are carbohydrates that the small intestine is unable to break down and absorb, those foods then travel on to the large intestine where they still have trouble getting absorbed so they sit in the large intestine, fermenting, and can wreak havoc on an individual’s GI system.
  • Stress management education
  • Consider probiotics containing Bifidobacterium lactis and Lactobacillus (Raskov et al., 2016)

In my opinion IBS has bright future ahead of it in terms of treatment. Much research is continuing to be done on the gut microbiome and its role in the human body. I believe this research will not only benefit patients with IBS but other illnesses, as well.

References
Raskov, H., Burcharth, J., Pommergaard, H. C., & Rosenberg, J. (2016). Irritable bowel
syndrome, the microbiota and the gut-brain axis. Gut microbes, 7(5), 365–383.
https://doi.org/10.1080/19490976.2016.1218585

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