Irritable Bowel Syndrome: What Is It, Symptoms And Treatment

Content

• Specifics of IBS
• What is the norm
• IBS classification
• Is there any violation of the chair - IBS
• Symptoms of IBS
• Diagnosis of IBS
• The reasons
• Treatment
• Is it treated

Irritable bowel - what is it? Problems with a chair and a lifelong diet? Or a psychological disorder, when malfunctions in the gastrointestinal tract are only part of the symptoms?

How to distinguish IBS due to constipation or diarrhea caused by malnutrition from other diseases? Which specialist should I go to and can a nutritionist help with IBS? Can IBS be cured or is it a lifelong diagnosis?

Specifics of IBS

First of all, IBS is a functional bowel disorder. A disorder is considered functional when there are symptoms of dysfunction of the organ, and there are no lesions of the organ itself yet. For now, because if functional disorders are not treated, then over time, organic lesions are likely to appear as a result of improper functioning of the organ.

According to statistics, almost 10% of the population (800 million people) have IBS - and only 25-30% of them go to the doctor. The real prevalence of IBS is difficult to determine, because most people with functional bowel disorders do not even realize that their condition is not normal.

IBS is a complex problem and can manifest itself in many different ways. Often the symptoms differ not only in several people, but also in one person at different periods. Because of this, it is difficult to identify the relationship, to understand that an unhealthy state is natural and has some kind of trigger, which means that it is not the norm and can be corrected.

Modern free medicine especially complicates the diagnosis and treatment, which, as a rule, does not work preventively, and complaints of constipation and a general deterioration in well-being are not always given due attention.

What is the norm

According to the clinical guidelines of the Russian Gastroenterological Association, irritable bowel syndrome is a functional disorder in which abdominal pain is associated with defecation, changes in the frequency and nature of the stool.

The chair is a very sensitive subject, and few are willing to discuss this problem, much less treat such a disorder. It is widely believed that constipation is a difficulty in defecation, and diarrhea is just loose stools. Many people consider it normal to have a bowel movement twice a week or a constant heaviness in the abdomen. People live this way most of their conscious lives, they are used to it and do not consider such a state to be a deviation from the norm.

TFR classification

Since IBS is associated with impaired bowel movements, let's figure out which stool is considered normal. Consider the normal consistency, color, smell and frequency of the stool.

The Bristol fecal shape scale, a medical classification of fecal shapes, which is used in the diagnosis of constipation and is the basis for the classification of IBS, will help with this.

According to the Bristol scale:

• type 3 and 4 - the ideal chair;
• type 1 and 2 - tendency to constipation;
• type 5, 6 and 7 - tendency to diarrhea.

That is, constipation is not only the inability to defecate, and diarrhea is not only loose stools several times a day. Even if the stool is regular, but close to type 1 and 2 or 5-7, this may already be a sign of a violation of the digestive tract and the presence of IBS.

What does the consistency of stool say?

• dense feces - a sign of colon spasm, slow movement of food through the intestines, dehydration, fiber deficiency in the diet, reduced acidity of gastric juice;
• "Sheep" feces - a sign of an inflamed large intestine as a result of a violation of its motility and a malfunction of the gallbladder;
• ointment-like feces, leaving traces on the walls of the toilet bowl, is a sign of a malfunction of the pancreas and gallbladder;
• liquid feces - a sign of disruption of the gallbladder, stomach, pancreas (including enzymatic deficiency), increased secretion of gastric juice and / or its acidity, hyperactivation of intestinal motility as a result of stress;
• mushy feces - a sign of increased secretion of gastric juice and / or its acidity, colitis, dyspepsia, increased intestinal motility, indigestion of fiber, fructose and carbohydrates;
• foamy feces may indicate fermentative colitis as a result of the activity of putrefactive flora.

Normal stool color is brown.

• Black feces can be a sign of bleeding in the upper gastrointestinal tract, taking iron supplements.
• Reddish is the result of taking red foods (beets, grapes, etc.), as well as a sign of hemorrhoids or bleeding in the lower gastrointestinal tract.
• Yellow-green color - a signal of problems with the pancreas or a consequence of increased consumption of plant foods.
• Gray, light yellow, and discolored stools can be a sign of insufficient bile flow.
• White feces may indicate a complete blockage of the common bile duct.
• White discharge with feces is a sign of a lack of enzymes, candidiasis of the esophagus or intestines, helminthic invasion (that is, the presence of a focus of inflammation).

Normally, feces have a mild odor.

• A putrid smell is a sign of colitis, protein digestion disorders, dyspepsia, gastritis.
• A fetid odor may indicate an increase in putrefactive processes in the intestine due to disruption of the stomach and the activity of pathogenic flora.
• A sour smell indicates increased fermentation of food, deterioration in the enzymatic breakdown of carbohydrates or their absorption, and infectious processes.
• The smell of rancid oil can be a sign of accelerated excretion of feces from the intestines.
• Lack of smell can be a symptom of insufficient digestion of food, accelerated evacuation from the small intestine, often with constipation.

How often do you need to go to the toilet? All people are unique, and it is difficult to come up with a universal formula for the frequency of bowel movements. Nevertheless, it is considered normal to empty the bowels 1-2 times a day, provided that the stool is formed with a normal color and smell. If the chair takes place 1 time in 2 days or less, it is considered constipation. If more than 2 times a day - diarrhea.

The regular act of defecation is the basis of detoxification processes, namely the 3rd phase (removal of metabolic products). How to track down the reason for the violation of detox processes, and is it possible to adjust the stool frequency on your own using nutritional tools? Let's talk about the free 3-day intensive "Biochemistry of Detoxification".

A fecal assessment is a simple, free, and very revealing method for diagnosing gastrointestinal problems.

If your feces are not type 3 and/or 4 on the Bristol stool shape scale and have a color other than brown and some specific smell, this is not the norm, you should definitely look for the cause. The reason can be both household (banal lack of fluid, errors in diet, lack of movement), and specific, requiring correction and treatment (organic and functional disorders of the gastrointestinal tract, including IBS).

IBS classification

One of the important diagnostic criteria for IBS is the duration of complaints. It is believed that the diagnosis of IBS can be made if complaints (including the nature of the stool) continue for at least 3 months.

Depending on the nature of the stool, IBS is divided into several groups:

• IBS predominantly with constipation (when about a quarter of bowel movements within 3 months meet the criteria for constipation);
• IBS predominantly with diarrhea (when about a quarter of bowel movements within 3 months correspond to types of diarrhea);
• mixed type of IBS, when diarrhea is replaced by constipation and vice versa;
• unclassified IBS - when complaints meet the diagnostic criteria for IBS, but they are not enough to make a specific diagnosis.

Is there any violation of the chair - IBS

You scored the stool on the Bristol scale and realized that you often have constipation and/or diarrhea. Does this mean you have IBS? Not! The cause of a violation of the stool can be a violation of nutrition and lifestyle, which is easy to correct on your own, and the first thing to do is to remove possible "provocateurs" of constipation or diarrhea.

For adequate functioning of the gastrointestinal tract, lifestyle and prevention of disorders in the functioning of the digestive organs are important.

With constipation, attention should be paid to sufficient intake of water and fiber, an adequate level of physical activity, good bile flow and stress correction.

Top 10 simple steps to correct and prevent constipation:

• drink a glass of warm water on an empty stomach;
• drink warm water during the day between meals (total volume of water - 30-35 ml per 1 kg of body weight per day);
• do gymnastics for the gastrointestinal tract in the morning before breakfast - the practice of manual pressure, vacuum;
• maintain a sufficient level of physical activity during the day - at least 8,000-10,000 steps;
• take warm magnesium water 50-200 ml 30 minutes before each meal, after releasing gas from the bottle. Course - 4 weeks (maximum 4 courses per year, contraindicated in cholelithiasis, exacerbation of any diseases of the gastrointestinal tract, chronic renal failure);
• diversify the diet with products that accelerate intestinal motility (cherry plum, prunes, cauliflower);
• introduce products that enhance the secretion of gastric juice, stimulating intestinal motility (boiled beets or beetroot juice, zucchini, cauliflower, baked apples, dried apricots, apricots, asparagus, daikon, pineapple);
• add fermented foods to normalize the intestinal microflora (coconut yogurt, kimchi, sauerkraut, kombucha);
• add choleretic foods to each meal - fats and bitter foods (unrefined vegetable oils, egg yolks, coconut products, butter or ghee and bitter herbs in the form of watercress, radish, chard, green onions, arugula, artichoke. You can brew the root dandelion, chamomile, Icelandic moss);
• if necessary, take additional fiber, such as psyllium (1-2 full tablespoons with 1/2 glass of water, especially ensure that you drink enough water while taking), apple pectin (taken with a glass of water, half an hour before meals). You can use natural laxatives as an ambulance - Triphala powder (1/2-1 tsp 20-30 minutes before meals 2 times a day and at night).

With diarrhea, you need to avoid foods that accelerate intestinal motility and increase the secretion of gastric juice, add natural sorbents to the diet, take pharmacy sorbents if necessary and work on stress correction.

Simple steps to correct and prevent diarrhea:

• for a short period, rice porridge on water can be introduced into the diet - a natural sorbent that absorbs excess fluid and leads to a slowdown in peristalsis;
• psyllium is effective (1-2 full tablespoons with 1/2 glass of water, it is especially important to monitor sufficient water intake while taking);
• if necessary, take sorbents "Zosterin", "Aminosorb", "Pektovit" (according to instructions);
• enrich the diet or take supplements - L-lysine, ginger, ginseng, gingko biloba. They reduce the level of serotonin and histamine, the increased secretion of which can cause diarrhea.

Nervous system support measures to help relax and alleviate both types of stool problems include:

• neuromuscular relaxation according to Jacobson - consistent tension and relaxation of different muscle groups;
• baths with Epsom salt (500 g of salt per bath) 1-2 times a week;
• essential oils (lavender, verbena) directly affect the part of the nervous system responsible for relaxation. You can practice mini-inhalations - when stressed, apply oil on the palms, grind and inhale.

All of these measures are first aid, helping to relieve symptoms and alleviate the condition, and also, possibly, identify eating and lifestyle disorders that may be a sign of stool disorders.

A nutritionist can help you create a diet that is right for you, which will help eliminate existing violations.

If there is no improvement against the background of these measures, it is necessary to consult a gastroenterologist, since such a condition can be a symptom of functional or organic disorders of varying severity, including IBS.

Symptoms of IBS

The symptoms of IBS are rather non-specific and may be a manifestation of other conditions.

According to clinical guidelines, IBS is diagnosed when the following symptoms are present:

• recurring abdominal pain that occurs at least once a week, which is characterized by at least two of the three signs: associated with defecation, combined with a change in the frequency of bowel movements, combined with a change in the consistency of feces;
• symptoms occur within the last 3 months with a total follow-up of at least 6 months;
• there are no organic diseases of the gastrointestinal tract that can cause these symptoms.

In addition, the change in the frequency of defecation in IBS has its own characteristics:

• a feeling of bloating, which is often absent in the morning, but increases during the day and intensifies after eating;
• diarrhea usually occurs in the morning, after breakfast, and is absent at night;
• with constipation, feces in the form of a “pencil” are possible, as well as cork-like feces (discharge of dense, formed feces at the beginning of defecation, and then mushy or even watery feces). The feces do not contain impurities of blood and pus, but mucus is often present;
• often there is a sudden urge to go to the toilet or a feeling of incomplete emptying of the bowels.

The most important symptom that distinguishes IBS from other functional disorders is pain! If there is no pain, there is most likely no IBS.

Abdominal pain in IBS - features:

• may be described as vague, burning, dull, aching, constant dagger, twisting;
• it is felt mainly in the iliac regions, more often on the left;
• increases after eating, and after defecation, passing gases, taking antispasmodic drugs weakens;
• in women, it increases during menstruation;
• missing at night.

With IBS, a person may have a good general condition, but there are many different non-specific symptoms. It is believed that in the presence of a large number of non-gastroenterological complaints in addition to the main symptoms of IBS, the diagnosis of irritable bowel symptom is more likely.

Possible additional symptoms in IBS include:

• disruption of the stomach, nausea, heartburn;
• pain in the lower back, muscles and joints;
• urological symptoms (nocturia - the need to visit the toilet more than 1 time per night, frequent and sudden urge to urinate, a feeling of incomplete emptying of the bladder);
• painful sexual intercourse in women;
• night sleep disturbances.

Even if you notice all the main and almost all additional symptoms of IBS, this still does not mean that the cause of your condition is irritable bowel syndrome. To make a diagnosis, additional examinations should be carried out to exclude other diseases.

Diagnosis of IBS

In other countries, IBS is a diagnosis of economic feasibility. Because of the costly diagnosis, it is often placed immediately and symptoms begin to resolve. In Russia, IBS is a diagnosis of exclusion, that is, if this disease is suspected, symptoms begin to be eliminated and, in parallel, diagnostics are carried out to exclude other diseases.

If your lifestyle efforts have failed and you have good reason to be diagnosed with IBS, your doctor should first check for anxiety symptoms. These are factors that can be a sign of organic pathology. Some of them:

• unexplained weight loss;
• heat;
• age 50 years or more;
• nighttime symptoms - you wake up because you want to go to the toilet;
• lack of appetite;
• colon cancer, celiac disease, ulcerative colitis and Crohn's disease in relatives;
• persistent abdominal pain as the only symptom;
• decrease in the level of hemoglobin in the blood;
• an increase in the number of leukocytes;
• increase in ESR;
• the presence of occult blood in the stool.

If these symptoms are present, an additional examination is performed to exclude other diagnoses that may be hidden behind the symptoms of IBS.

If there are no symptoms of anxiety, a classic diagnosis is performed. It is important to understand that there are no tests to confirm IBS. All diagnostics are aimed at its exclusion.

The main types of diagnostics:

• serological testing for celiac disease (with a tendency to diarrhea);
• C-reactive protein (with a tendency to constipation);
• fecal calprotectin instead of colonoscopy - for the presence of an inflammatory focus;
• fecal elastase (to exclude pancreatic diseases);
• coprogram (bile acids in the stool to exclude hologenous diarrhea and a general assessment of the function of the gastrointestinal tract).

It is important that if no other diseases are detected, then for the final diagnosis of IBS in Russia, a colonoscopy procedure will have to be performed - regardless of age and the presence of anxiety symptoms.

The reasons

When a person receives a diagnosis, he often asks himself and the doctor why this happened. In the case of IBS, there is no exact answer. The problem is complex, and there can be many reasons.

The most common combination is anxiety, microbiome disruption, and inflammation. But it is impossible to understand what exactly became the root cause, since one state can be both a cause and a consequence of another.

For example:

• erratic eating that leads to an imbalance in the gut microbiome;
• stress, especially chronic stress, increases cortisol levels, against which excessive amounts of serotonin and histamine are released, which can cause increased intestinal permeability, nausea, and activation of reverse motility;
• visceral hypersensitivity, when even minor pain signals are perceived as severe pain, may be due to increased intestinal permeability and/or disruption of the gut-brain axis. Provoking factors - stress, excessive consumption of gluten, sugar, fructose and dairy products, the use of food intolerances;

• female (women, due to their higher sensitivity, increased anxiety, and peculiarities of hormonal changes during the cycle, suffer from IBS almost 2 times more often than men).

Regardless of the mechanism by which the disease develops, to correct it, you need to work on both nutrition and the psyche, because all this is interconnected.

Treatment

How to treat IBS? Each patient with IBS requires individual complex treatment, which should include diet, correction of the psycho-emotional sphere, gastroenterological correction and relief of pain.

Depending on which symptoms predominate, a specialist is determined who should be the primary care physician. If there are more gastroenterological symptoms, it is necessary to be treated by an integrative gastroenterologist with the support of a nutritionist and, if necessary, additionally work with a psychotherapist. If psychological symptoms prevail, it is necessary to be treated by a psychotherapist with the support of an integrative gastroenterologist and a nutritionist.

For the treatment of patients with IBS, the FODMAP diet (abbreviation from English, denotes a group of short-chain carbohydrates - oligosaccharides, disaccharides and monosaccharides, polyols), developed for people with gastrointestinal disorders, including irritable bowel syndrome, is shown.

The essence of the diet: with FODMAP, a number of products are excluded from the diet for 2-6 weeks, which contain substances that are poorly absorbed in the intestines or not absorbed at all and contribute to the growth of fungal and bacterial flora, bloating, gas formation and pain.

The FODMAP diet excludes fermentable (fermentable in the gut) carbohydrates:

• oligosaccharides - fructans and galactooligosaccharides found in wheat, rye, onions, garlic and legumes;
• disaccharides - lactose found in milk, soft cheeses and yogurts;
• monosaccharides - fructose found in honey, apples, high fructose corn syrups, etc.;
• polyols - sorbitol, mannitol, isomalt, xylitol, found in some fruits and vegetables and used as artificial sweeteners.

Following a diet for 2-6 weeks allows you to:

• reduce pain and discomfort;
• reduce bloating and distension;
• improve bowel function (minimize symptoms of diarrhea or constipation);
• improve the quality of life;
• reduce psycho-emotional disorders.

Despite the tangible positive effect, the diet relieves the symptoms, but does not help get rid of the causes of IBS. Therefore, the definition of a nutritional protocol is only one of the steps in a comprehensive approach to the treatment of IBS.

After 2-6 weeks of the diet, you need to gradually return the excluded foods to the diet, starting with a small amount and gradually increasing the volume. It is important to keep track of reactions to such foods by keeping a food diary and identifying your food intolerances.

The diet is not suitable as a permanent meal plan. FODMAP substances provide a qualitative composition of the microbiota, and without them, nutrition will not be complete.

According to the results of the diet in the diet, it will be necessary to limit only those foods for which intolerance has been identified.

Since stress is one of the IBS factors, one of the components of treatment is the correction of the psycho-emotional state. Important at this stage:

• sleep hygiene - sleep in complete darkness and silence from 22:00. Before going to bed, you need to ventilate the room, 30 minutes before bedtime you can read a book, meditate or make entries in your personal diary;
• vagus nerve stimulation (square breathing, anti-stress practices);
• magnesium salt baths;
• relaxing teas with valerian, lemon balm, mint, taking novopassitis.

With minor disorders of the psycho-emotional sphere, you can work on your own or with a healthy lifestyle coach, but if you have anxiety, hypochondria and depressive states, work with a psychotherapist is mandatory.

Depending on the symptoms, the doctor may prescribe various drugs: prokinetics, antispasmodics, enzymes, bile acids, antibiotics, carminatives.

Additionally, it is recommended to restore the health of the intestinal wall by enriching the diet with special products (nutritionists can work). Will help:

• enveloping agents, such as linseed jelly;
• healing agents, such as bone broth;
• anti-inflammatory foods, such as curcumin.

If necessary, the specialist prescribes drugs to relieve pain, including antidepressants. Gastroenterologists prescribe antidepressants in minimal dosages to reduce visceral sensitivity. If the symptoms are more psychological than gastroenterological, the appointment of antidepressants is considered by a psychotherapist.

Is it treated

IBS is a chronic disease that requires complex treatment and affects all spheres of human life. It is believed that with the right approach, you can completely stop the manifestations of IBS and improve the quality of life. But full recovery is often not achieved.

For successful treatment, it is important not only to work with the symptoms, but also to change the attitude to life, to situations that provoke the development of the disease. So, you can remove visceral hypersensitivity or anxiety levels with drugs, but if you do not learn how to respond to stress differently, when the drugs are discontinued, the symptoms will return.

Before prescribing antidepressants, it is recommended to work with a psychotherapist on the way of thinking, to work through existing injuries. Perhaps this will be enough to start the healing process.

Complete disappearance of symptoms is observed in about 25% of patients, although improvement occurs in many cases, and this depends directly on the complexity of the approach and work with the real causes of the disease, and not just the symptoms.