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Irritable Bowel Syndrome: Symptoms, Diagnosis and Treatment.
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Irritable Bowel Syndrome (IBS) is classified as a functional gastrointestinal disorder. This is because upon diagnostic testing, the colon shows no evidence of disease such as ulcers or inflammation. Therefore, IBS is diagnosed only after all other possible digestive disorders and diseases have been ruled out.
IBS is often misdiagnosed or misnamed as colitis, mucous colitis, spastic colon, irritable bowel disease or spastic colon. These misnomers persist, even though IBS is now a recognized and treatable condition. Affecting between 25 and 55 million people in the United States, IBS results in 2.5 to 3.5 million yearly visits to physicians. 20 to 40 percent of all visits to gastroenterologists are due to symptoms of IBS.
Muscles in the bowel normally contract a few times a day, moving feces along and ultimately resulting in a bowel movement.
It is believed that in a person with IBS, these muscles are exceptionally sensitive to stimuli, or triggers. While they would not normally affect others, triggers such as food or stress can provoke a strong response in a person with IBS. A person who does not have IBS may have no trouble eating a salad, or drinking coffee, but a person with IBS may exhibit symptoms such as pain, bloating, and diarrhea.
The symptoms of IBS can include:
• Gas.
• Pain.
• Bloating.
• Nausea.
• Vomiting.
• Mucous in the stool.
• Constipation.
• Diarrhea.
Cramps are often relieved by a bowel movement, but some people with IBS may have cramps and be unable to pass anything. Severity of symptoms can vary widely and be described as anything from a mild annoyance to debilitating. Blood in the stool, fever, weight loss, vomiting bile, and persistent pain are not symptoms of IBS and may be the result of some other problem.
Many people with IBS describe that symptoms frequently occur shortly after, or even during, meals. Fatty foods, alcohol, caffeine and gas-producing foods (such as broccoli or beans) have regularly been named culprits in causing IBS attacks. It can be difficult to track down which particular foods can act as triggers for IBS.
Further complicating the issue, not every person with IBS responds with symptoms to the same foods. The range of triggers is unique to each individual, although there are many common elements among most people with IBS. Symptoms can also be intermittent. Something that was fine to eat last week may be causing symptoms today.
Treatment for IBS can include changes to diet, lifestyle, stress reduction, and medications or natural supplements. Often, a combination of two or more of the above will help to provide the most relief. There is still much that is understood about IBS, so it may take some time, and some experimentation with different therapies to achieve good results.
DIET
Keeping a food and symptom diary is a good way to trace foods that lead to IBS attacks. Starting with a bland diet of "safe foods" and gradually adding a new food each day can also help in the search for specific food triggers. The food diary can then be discussed with a doctor or dietician for help in treatment. A blood test can also be done which shows food allergies and sensitivities.
LIFESTYLE CHANGES
Smaller portions at mealtimes may help to prevent bloating and cramping. Instead of three large meals every day, five smaller meals may also help. Eating a healthy diet, of mostly whole foods and drinking plenty of water and daily exercise are also helpful in reducing IBS symptoms. These changes can also contribute to an overall healthy lifestyle.
STRESS REDUCTION
Relaxation training, in addition to medical therapy, can also help to reduce symptoms.
It is important to note that stress is not the cause of IBS, but as with any disease or disorder, stress can cause the symptoms of IBS to worsen. IBS is not believed to lead to ulcerative colitis, Crohn's disease or cancer.
MEDICATIONS
For constipation, fiber supplements may be prescribed. These supplements help with both constipation and diarrhea. They bulk up the stool in cases of diarrhea, and also make it easier to pass in the case of constipation. Laxatives can be habit-forming, and should not be used on a regular basis.
THE FUTURE
The good news about IBS is that it is increasingly being seen under a new light. People with this common disorder can discuss symptoms with health care professionals without being told "it's all in your head".
COMMON TRIGGER FOODS:
•Alcohol
•Artificial sweeteners
•Artificial fat (Olestra)
•Carbonated beverages
•Coconut milk
•Coffee (even decaffeinated)
•Dairy
•Egg yolks
•Fried Foods
•Oils
•Poultry skin and dark meat
•Red meat
•Shortening
•Solid Chocolate
CAUSES AND TREATMENTS OF IRRITABLE BOWEL SYNDROME:
Possible Causes:
Irritable Bowel syndrome is a gastrointestinal motility disorder for which there is no organic or structural cause. Since the symptoms of IBS can mimic other disorders such as hypothyroidism, IBS is diagnosed when all other local and systemic conditions have been ruled out.
Characteristic symptoms of IBS include recurrent abdominal pain, abdominal pain relieved by defecation, disordered bowel habit, including constipation, diarrhea, or an alternation between the two, and abdominal distension and bloating.
IBS is also associated with non-gastrointestinal conditions such as headache, low back pain, arthritis, non-cardiac chest pain, difficult urination and fibromyalgia.
FOOD INTOLERANCE - True food allergy is mediated by the immune system and is associated with hives, asthma, eczema, nasal discharge, and positive skin prick, RAST scores, or other allergy tests8. However, food intolerance, rather than true food allergy, is believed to be more significant in IBS. Between 33-66% of IBS patients report having one or more food intolerances. The most common culprits are dairy (40-44%) and grains (40-60%). The resulting gastrointestinal bloating, flatulence, and pain caused by this reaction appears to be mediated by inflammatory prostaglandin synthesis.
NEUROCHEMICAL IMBALANCE - Interaction between the brain and the gut occurs via nerves that send neurotransmitter signals. An imbalance between two of these neurotransmitters, serotonin and norepinephrine, are implicated in IBS. Constipation may result when levels of norepinephrine increase, causing a reduction in serotonin levels and inhibition of another neurotransmitter called acetylcholine. Conversely, diarrhea can occur when increased serotonin inhibits norepinephrine and causes levels of acetylcholine to increase. For IBS patients, such an imbalance in the nervous system can lead to the fluctuating bowel symptoms of constipation and diarrhea.
HISTORY OF ANALGESIC USE - Use of acetaminophen, a common pain-relieving medication, is associated with diarrhea-predominant IBS. Its action may be due to an imbalance in the neurotransmitter serotonin. Since acetaminophen can cause elevated levels of the serotonin by-product 5-HIAA in the urine, it is possible that acetaminophen somehow interferes with serotonin metabolism. Plasma serotonin levels have indeed been shown to be elevated after eating in patients with diarrhea-predominant IBS. Clinically, a drug that blocks the 5-HT3 serotonin receptor (5-HT3 receptor antagonist)may be effective for women with diarrhea predominant IBS. It is interesting to note that asthma, another condition associated with disordered smooth muscle function, was recently found to be associated with acetaminophen use.
REPRODUCTIVE HORMONES - IBS occurs more than twice as frequently in women than in men and tends to follow a cyclic pattern, with aggravation during the postovulatory (progesterone-dominant) and premenstrual phases of the menstrual cycle. Progesterone is known to delay gastric emptying and cause constipation; constipation with straining and the frequent passage of hard stools is a more prevalent IBS manifestation in women, especially during the postovulatory phase. At the end of the postovulatory phase, the sudden withdrawal of progesterone that occurs with the start of the premenstrual phase may trigger increased bowel activity.
Women frequently report loose stools and diarrhea before or with the onset of menstruation. In contrast to progesterone, estrogen has not been associated with exacerbations of IBS symptoms.
In one study, high levels of luteinizing hormone (LH) were found in women with IBS; drugs that decreased LH levels and consequently suppressed ovarian production of estrogen and progesterone resulted in significantly improved IBS symptoms. LH is a reproductive hormone responsible for the production of testosterone in males and estrogen and progesterone in women.
In men, the opposite result was found: low LH and low testosterone tended to be associated with IBS symptoms. High LH therefore appears to cause exacerbations in women by stimulating progesterone and estrogen, yet have a protective effect in men.
Along with progesterone levels in women, prostaglandins E2 and F2 alpha also increase in the premenstrual phase. Since they are powerful stimulants of bowel contractions, it is possible that women with IBS may have an exaggerated response to these prostaglandins.
MOOD - Anxiety, hostile feelings, sadness, depression, and sleep disturbance are associated with IBS. Adverse life events such as family death, marital stress, financial difficulties, and especially physical and sexual abuse, have also been reported more frequently in IBS patients than in the general population8. However, it is possible that IBS patients with this social or psychological background may be more likely to seek medical treatment or participate in research studies.
The impact of stress on bowel motility and pain were explored in one study by administering corticotrophin-releasing factor (CRF), a hormone released in the body during stress8. CRF increases motility of the descending colon and can induce abdominal pain. The researchers found that IBS patients had greater colonic motility and more abdominal pain after receiving CRF than controls.
Antidepressants have been shown to be very effective for treating bowel motility and visceral nerve responses, in addition to addressing the emotional component of IBS.
INTESTINAL OVERGROWTH - Excess bacteria or yeast (especially Candida Albicans) in the small and large intestines is being recognized as important in the development of IBS. When these micro-organisms are present , excessive gas, bloating, abdominal distension and pain, and altered gut motility can result.
Causes of overgrowth include overuse of antibiotics, poor diet, over consumption of sugar, decreased gastric acid secretion (possibly due to natural aging, stomach ulcer, and colonization by helicobacter pylori bacteria), decreased bile flow, or decreased pancreatic enzymes with poor absorption of carbohydrates, fats, and proteins. The resulting undigested and unabsorbed carbohydrates in the small intestine and colon cause excess fermentation and encourage growth of unwanted bacterial species. An abundance of gas is produced, as well as short-chain organic acids such as lactic acid, which can damage the mucus lining of the intestines and further aggravate carbohydrate malabsorption.
In addition, putrefaction of proteins in the small intestine produces substances called vasoactive amines that can affect intestinal muscles.
For more information on Candida overgrowth:
Click HereAlternative Treatments for Irritable Bowel Syndrome:
An experienced doctor can perform specific tests to assess the above factors and design a treatment protocol most suitable for the individual. Below are some examples of treatment possibilities.
Peppermint oil (Mentha piperita) - Abdominal pain, the most frequent and disabling symptom of IBS, improves when the intestinal smooth muscles are relaxed. Peppermint oil can reduce abdominal pain and distension of IBS, possibly by blocking the influx of calcium into muscle cells and inhibiting excess contraction of intestinal smooth muscles. It is a carminative, which means it helps eliminate intestinal gas.
Peppermint oil should only be used in enteric-coated capsules to ensure that it reaches the intestines intact, otherwise, the oil can relax the lower esophageal sphincter and cause heartburn.
Magnesium is a mineral that has been used widely for treating abdominal cramps and constipation. It is obtained naturally from the diet, and is required for many metabolic activities in the body. Absorption of magnesium is reduced by high intake of calcium, alcohol, surgery, diuretics, liver or kidney disease, and oral contraceptive use.
Fatigue, fibromyalgia, migraine, premenstrual syndrome, and dysmenorrhea are conditions associated with magnesium deficiency. Women with premenstrual syndrome who were found to have low magnesium were more likely to have excess sensitivity to pain with generalized aches and pains.
Identify and remove food intolerances - A trained practitioner can supervise an elimination diet. Many foods are removed from the diet for a brief period of time, then re-introduced sequentially to isolate the body's reaction to the offending foods. Since grains are a common culprit, it is important to remember that carbohydrate digestion begins in the mouth and that chewing grains thoroughly allows amylase, the digestive enzyme present in saliva, to digest the grains. A blood test can also be done which shows food allergies and sensitivities.
Improve gut motility - Soluble fiber increases bowel transit and stools and relieves constipation. Wheat bran has been used in some research studies, however, it is not recommended for people who may have intolerances to wheat. Psyllium is a good source of soluble fiber and is readily available. Sufficient water should be taken or fiber can have the opposite effect and result in greater constipation.
Remediate any unwanted overgrowth and Restore a healthy balance of bacteria in the gut – Candida and other harmful micro-organism overgrowths can be alleviated with a natural treatment protocol. Lactobacillus acidophillus and bifidobacterium bifidum can help to restore healthy balance of bacteria in the gut. They can decrease the amount of bacteria with gas-producing abilities and relieve IBS symptoms such as abdominal distension and flatulence. Bifidobacterium acts as a barrier against colonization of the gastrointestinal tract by pathogenic bacteria, and lactobacillus inhibits the attachment of pathogens onto the intestinal mucus lining.
Low fiber intake is associated with an overgrowth of toxin-producing bacteria and a lower percentage of lactobacillus acidophillus. A diet high in dietary fiber increases the formation of short-chain fatty acids, such as butyrate, which is the preferred energy source of the cells that line the colon.
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