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What is irritable bowel syndrome?
Irritable bowel syndrome (IBS), also known as "spastic colitis", is a bowel movement disorder. It is characterised by chronic abdominal pain and disturbances in bowel habits, such as diarrhoea, constipation or both, in the absence of an organic condition. Symptoms vary in severity and duration from person to person. It is the most common disease of the gastrointestinal system, affecting 15-20% of the Greek population, especially young people and women.
Although it is not a threat to the patient's life, it has a negative impact on their quality of life. The symptoms and consequences of this disorder directly affect social activities, work, travel, sexual function and even sleep quality. It often causes the person to feel frustrated or even depressed because it is a chronic problem with flares and remissions.
What are the categories of irritable bowel syndrome?
Normal bowel habits vary considerably from person to person. They can range from a few times in the same day to a few times a week. However, these habits remain generally stable and the person does not show any of the characteristic symptoms of SAE. In contrast, in SAE there is no stability in bowel movements and the person suffers from chronic troublesome symptoms. Depending on the patterns of changes in bowel movements, IBS is divided into three types:
- IBS with Constipation (IBS-C)
It is characterised by delayed or infrequent bowel movements, with hard stools or lumps. It is accompanied by discomfort, abdominal pain, bloating and gas.
- IBS with Diarrhoea (IBS-D)
In this case, there is an urgent need for frequent stools with watery stools. It is also accompanied by abdominal pain and gas.
- IBS with alternating Diarrhoea - Constipation or "Mixed Type" (IBS-M)
It is a combination of the two above.
What are the symptoms of irritable bowel syndrome?
Irritable bowel syndrome may include some or all of the following symptoms, but this does not mean that someone who has them has irritable bowel syndrome. The symptoms have flares and lows. The most common are:
- Stomach pain, especially after eating
- Bloating
- Diarrhoea
- Constipation, often accompanied by a feeling of incomplete emptying
- Alternations of diarrhoea and constipation
- Inability to control stools (fecal incontinence)
- Gases
- Shipping
- Mucus in the stool
- Pain in the back
When constipation predominates, stools may be hard and stools may be painful or infrequent (less than 3-4 stools per week). It may also be accompanied by symptoms such as nausea, vomiting and a feeling of stomach fullness after eating a small amount of food. When diarrhoea predominates, the stools are usually soft or mushy in small quantities, with an urge to void and increased frequency.
Sometimes extra-intestinal symptoms occur, such as frequent urination, easy fatigue, dysmenorrhoea (pain during menstruation), dyspareunia (pain during sexual intercourse), generalised pain. Also, the chronic suffering of the patient may lead to psychological distress and depression.
Attention is needed when abdominal pain is associated with anorexia, weight loss or waking the sufferer during the night, because it may be related to serious causes.
What are the causes of this disorder?
Although the exact causes of irritable bowel syndrome remain unknown, it appears to be a multifactorial disorder. Below are the most prevalent scenarios for the development of IBS:
- Disorder of gastrointestinal motility
It involves fluctuations in the motility of the small and large intestine. It seems that insufficient coordination of signals between the brain and the gut affects intestinal motility. Weak contractions of the bowel muscles cause constipation, while frequent and strong contractions lead to diarrhoea.
- Intestinal microbiome
It appears that the microbiota of people with MS differs from that of healthy people.
- Severe infections of the gastrointestinal tract
SLE is likely to develop after a severe bacterial or viral gastroenteritis.
- Psychopathological disorders
Up to 80% of patients with MS have psychopathological disorders such as depression, somatization disorders, anxiety neurosis, panic disorders, phobias. Most data state that psychiatric disorders pre-exist or manifest simultaneously with abdominal discomfort.
What are the factors that intensify the symptoms?
- The stress
When the person experiences stressful situations, the symptoms become more intense.
- Nutrition
It has been observed that an unbalanced diet, combined with alcohol and smoking, inhibits the proper functioning of the gut, triggering disturbing reactions. Also, the consumption of certain foods and drinks increases the intensity of symptoms. These foods are usually rich in oligosaccharides, monosaccharides, disaccharides and polyols (FODMAP carbohydrates). Some indicative examples of such foods are wheat, dairy products, citrus fruits, beans, cabbage and carbonated drinks.
- Medicines
Formulations most commonly associated with symptoms of SAE are:
- The antibiotics
- Some antidepressants
- medicines containing sorbitol, such as some antidiarrheal syrups
How is the diagnosis made?
Unfortunately, no blood test has been found to prove the existence of the disease, so the diagnosis is made by exclusion. In addition to the history and clinical examination, stool cultures are performed to rule out an infection. A blood test is then performed for coeliac disease, a disease with similar symptoms. If symptoms persist, an abdominal ultrasound and even a colonoscopy is performed to rule out organic disease.
What is the treatment?
Irritable bowel syndrome is a chronic disease for which no definitive cure has yet been found. The main aim of medical interventions is to relieve the patient's symptoms. The cornerstone of the treatment is a relationship of trust between the doctor and the patient.
Treatment for MS is completely individualised for each patient. It includes a special diet, medication and psychological support. In more detail:
- Diet
The role of diet is particularly important. Most studies conclude that patients should avoid those foods that tempt them. The best way to do this is to eat a low FODMAP diet. This diet is carried out under the guidance of the gastroenterologist and the nutritionist.
What are FODMAPs?
FODMAPs are a group of carbohydrates that are poorly absorbed in the human small intestine and lead to bloating and changes in digestion speed. This group includes some oligosaccharides, disaccharides, monosaccharides and polyols.
What are the stages of a low FODMAP diet?
- Restriction
It lasts 2-6 weeks. It involves the strict avoidance of all high FODMAP foods and their replacement with low FODMAP foods of equivalent nutritional value.
- Retrieved from
It involves the gradual reintroduction of high FODMAP foods. It usually takes 6-10 weeks.
- Personalization
Once the person has identified which FODMAPs trigger their symptoms, they adjust the amount and type of FODMAPs in their diet based on their personal tolerance.
- Medication
The medical management of spastic colitis includes:
- Medicines with action on intestinal motility
- Treatment of anxiety with anxiolytics, sedatives or antidepressants
- Antibiotics that modify the gut flora
- Probiotic and prebiotic preparations, which help to balance the intestinal flora
- Psychotherapy
- Daily exercise
- Adequate sleep
A consistent sleep schedule of 7-9 hours, with a fixed wake-up time, plays a key role in improving symptoms.
- Stable voiding schedule
It is very important that bowel movements are done at the same time every day, ideally in the morning after waking up. A consistent sleep and eating schedule is very helpful in this regard. In this way, the bowel is gradually trained and its mobility improves.
Inference
SLE is a chronic disorder that negatively affects the patient's quality of life. However, it is neither fatal nor dangerous to health. Close communication between the patient, gastroenterologist and dietician is important to prevent relapses and mitigate symptoms.
References
https://proctoclinic.gr/spastiki-kolitida-therapeia/
https://diaitologos.com/katastaseis-ygeias/sindromo-everethistou-enterou-diatrofi/
https://peptiko.gr/eyerethisto-entero-spastiki-kolitida-pliris-odigos/
https://www.advanced-endoscopy.gr/σύνδρομο-ευερέθιστου-εντέρου/
https://www.endounit.gr/pathiseis/syndromo-eueresthitou-enterou/
https://www.peptocare.gr/ενημέρωση/item/98-σύνδρομο-ευερέθιστου-εντέρου
https://medcare.clinic/σύνδρομο-ευερέθιστου-εντέρου-σ-ε-ε-και/
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