Irritable bowel syndrome affects 20% of North Americans

Irritable bowel syndrome is the most common cause of chronic diarrhea and lower abdominal discomfort in North America.

It is a benign disorder of the colon, or large intestine, and is typically characterized by periods of diarrhea often alternating with bouts of constipation.

This syndrome is estimated to affect up to 20% of the North American population. It accounts for 50% to 75% of all people with digestive complaints and represents 30% to 50% of referrals to gastroenterologists or specialists in treating digestive disorders.

It commonly begins in individuals between the age of 20 and 40 years but can also occur in young children and the elderly. It is one of the most frequent causes of diarrhea in young children. Although IBS occurs in the elderly, it is an uncommon cause of diarrhea in that age group.

Symptoms of irritable bowel syndrome include alternating periods of diarrhea and constipation, abdominal pain, bloating, cramping, flatulence, belching, nausea, vomiting, heartburn, variable appetite, poor digestion and difficulty swallowing. Fever, gastro-intestinal bleeding and weight loss are not part of the syndrome and may suggest a more serious underlying disorder.

The exact cause of irritable bowel syndrome is not fully known. It is generally agreed IBS is a disorder of movement of digestive material or muscle contraction of the colon and intestines. Factors that affect large and small intestine motility include psychological and emotional stressors, diet, especially lack of fibre and increased consumption of refined carbohydrates.

Diagnosis of irritable bowel syndrome is usually made after other more serious gastro-intestinal disorders have been ruled out. It is based on history, presenting symptoms and lab tests to rule out other disorders. Other conditions may mimic IBS and include excessive consumption of coffee, tea, cola and refined sugars, intestinal infection, ulcerative colitis, Crohn’s disease, lactose intolerance, laxative abuse, drug induced intestinal inflammation, diverticulitis, liver and gall bladder disease pancreatic insufficiency, malabsorption symptoms, diabetes, hypothyroidism, scar tissue and cancer.

Conventional medical treatment of irritable bowel syndrome focuses on drug therapy to provide relief of the symptoms associated with this disorder. Anti-cholinergic, anti-diarrheal, anti-ulcer and psychotropic drugs may be prescribed for symptom relief. Prescribed medication includes the anti-cholinergic drugs Imodium (loperamide), Lomotil (diphenoxylate) or other narcotic medicines, beta-blockers, prostaglandin inhibitors and a variety of psychotropic drugs and muscle relaxants.

Stress is strongly associated with the development of irritable bowel syndrome. Stressors should be identified and reduced when possible. Meditation, yoga and biofeedback are effective techniques that can help the digestive system relax and prevent spasms. Exercise is also a great way to reduce stress and should be a part of daily routine. The combination of behavioural modification and medical treatment is a very effective combination in altering the course of IBS.

Diet and food choices can play an important role in the development and progression of IBS. Refined and ultra-processed carbohydrates can aggravate intestinal muscle spasms. Added white sugar and other refined sweeteners should be minimized. Coffee, tea, colas and other caffeine laden beverages and drinks should be reduced or eliminated. Caffeine and other stimulants induce intestinal muscle contractions and can make diarrhea worse.

A low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) can help dramatically reduce symptoms of IBS in some individuals. Saccharides are basically simple sugars found in different foods. Bacteria in the large and small intestine can break down and ferment these simple sugars thereby creating gas, bloating, diarrhea and other symptoms of intestinal discomfort.

Food sensitivities and allergies are often implicated as triggering agents for IBS. An elimination challenge protocol, allergy or sensitivity test can help to identify possibly offending foods. Commonly identified offending foods include wheat, milk and other dairy products, beef, pork, soy, corn, coffee, citrus fruits, nightshade vegetables including tomatoes and an array of different fruits. Increase consumption of naturally occurring high fibre foods from whole grains and cereals, vegetables and high-quality protein foods.

The standard North American diet lacks adequate amounts of dietary fibre. Indigestible fibre can help increase stool bulk, both increase and decrease stool transit time and help both constipation and diarrhea. Whole grain and cereals sources like wheat bran, oat bran, psyllium and flaxseed can be good sources of fibre.

Digestive enzymes can help improve digestion of foods and improve symptoms associated with IBS. Hydrochloric acid supplementation is warranted when low levels occur in the stomach.

Probiotics or good bacteria found in fermented foods can help some individuals with IBS. These bacteria and yeast include species Bifidobacterium, Lactobacillus and Saccharomyces.

Carminative herbs contain low doses of oils that help to relieve symptoms of gas and bloating associated with IBS. They include caraway, chamomile, fennel, ginger, lemon balm, peppermint and rosemary. Special enteric-coated peppermint capsules relax large and small intestines cramps and gas pains.

The information provided in this article does not, and is not intended to constitute medical advice. All information and content are for general information purposes only.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.