What  is IBS ? 

Living with Irritable Bowel Syndrome (IBS) often feels like navigating a labyrinth; the path is unpredictable, and each turn presents its own set of challenges. However, armed with knowledge, strategies, and a support network, managing IBS becomes more feasible. Irritable bowel syndrome is a condition of your gut in which you feel an uncomfortable sensation comprising of abdominal cramps, bloating, and constipation or diarrhea. According to Rome IV criteria, IBS is defined as recurrent abdominal pain on average, at least one day per week in the last three months, associated with two or more of the following criteria:

• Related to defecation
• Associated with a change in stool frequency
• Associated with a change in stool form (appearance)2

Symptoms of IBS 

The symptoms of IBS can vary widely among individuals and may include:

• Abdominal pain or discomfort
• Bloating
• Changes in bowel habits (diarrhea, constipation, or both)
• Gas
• Urgency to have a bowel movement
• Mucus in the stool

Video on how IBS affects you

Types of IBS

IBS is classified into three categories based on bowel movements which are as follows:-

• IBS with constipation (IBS-C)– Poop is hard and lumpy
• IBS with diarrhea (IBS-D)- Poop is watery and loose.
• IBS with mixed bowel habits (IBS-M)- Comprises of both of the above subtypes.

Classification is necessary as treatment options depend on it.

What are triggers for IBS ?

1. Dietary Factors:
   • FODMAPs: Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols are types of carbohydrates that may be poorly absorbed in the small intestine, leading to increased gas production and bloating. Foods high in FODMAPs include certain fruits (e.g., apples, cherries), vegetables (e.g., onions, garlic), dairy products, and grains (e.g., wheat, rye).
   • Spicy Foods: Hot and spicy foods can irritate the digestive tract, leading to abdominal discomfort and diarrhea in some individuals.
   • High-Fat Foods: Foods high in fat, such as fried foods, fatty meats, and rich sauces, can slow down digestion and trigger symptoms like bloating and constipation.
   • Caffeine and Alcohol: Stimulants like caffeine and alcohol can stimulate the intestines, leading to diarrhea and abdominal cramping in sensitive individuals.
2. Stress and Emotional Factors:
   • Anxiety and Stress: Emotional stress and anxiety can trigger or exacerbate IBS symptoms in many individuals. Stress-reduction techniques such as mindfulness, meditation, and deep breathing exercises may help alleviate symptoms.
   • Depression: Depression and IBS often coexist, and managing both conditions may require a holistic approach that addresses mental and physical well-being.
3. Hormonal Factors:
   • Menstrual Cycle: Fluctuations in hormone levels during the menstrual cycle can affect bowel function and trigger IBS symptoms in some women.
   • Hormonal Birth Control: Some individuals may experience changes in bowel habits when using hormonal contraceptives.
4. Medications:
   • Certain medications, such as antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and some antidepressants, may worsen IBS symptoms in some individuals. It’s essential to discuss any potential side effects with a healthcare provider.
5. Other Triggers:
   • Infections: Gastrointestinal infections, such as gastroenteritis, can trigger IBS symptoms in some individuals. This is known as post-infectious IBS (PI-IBS).
   • Sleep Disruptions: Poor sleep quality or disruptions in sleep patterns may exacerbate IBS symptoms in some individuals.

Causes of IBS

The exact cause of IBS is unknown but certain factors that can lead to symptoms of IBS are as follows:-

• Gastrointestinal motility– Abnormal motility of your gut muscles. Contractions that are frequent and strong can lead to abdominal cramps and diarrhea whereas slow motility can lead to constipation.
• Visceral hypersensitivity– Increases sensitivity of nerves of your gut. Poorly coordinated signals between the brain and the intestines can cause your body to overreact to changes that typically occur in the digestive process. This can result in pain, diarrhea, or constipation. The recognition of these interactions has led to the concept that IBS is a disorder of the brain-gut axis, and this term is now used instead of the previous designation of a “functional bowel disorder.”.
• Infection- The development of IBS following infectious enteritis has been suspected clinically based on a history of an acute diarrheal illness preceding the onset of irritable bowel symptoms in some patients. The increased risk of post-infectious IBS is associated with bacterial, protozoan, helminth infections, and viral infections. Causes can be due to malabsorption, an increase in lymphocytes, and antibiotic use post-infection.
• Emotional stress
• Changes in gut microbiome
• Childhood stress

Diagnosis of IBS 

• The first step is a detailed medical history and your provider may ask you a series of questions which is the most crucial aspect for making the diagnosis.
• Lab tests- Blood test, stool tests, hydrogen breath test.
• Imaging studies to rule out other diagnosis.
• Refer to following article for further details on diagnosis :https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs#diagnosis-and-tests

 Management of IBS

Despite the absence of a cure, there are numerous strategies to help manage IBS symptoms:

• Dietary Modifications: Keeping a detailed food diary can unveil patterns between dietary choices and symptom flare-ups. While trigger foods vary among individuals, common culprits include dairy products, fatty foods, caffeine, alcohol, and certain artificial sweeteners. Experimenting with a low-FODMAP diet under the guidance of a healthcare professional and gradually reintroducing foods can also provide valuable insights.
• Stress Management: The gut-brain connection is a significant factor in IBS. Stress and anxiety can exacerbate symptoms, leading to a vicious cycle of discomfort. Engaging in stress-reduction techniques such as mindfulness meditation, yoga, progressive muscle relaxation, or regular exercise can help soothe the gut and alleviate symptoms.
• Medication: Depending on the predominant symptoms, healthcare providers may recommend medications to manage IBS symptoms. These may include antispasmodics to relieve abdominal cramping, laxatives to alleviate constipation, or anti-diarrheal drugs to regulate bowel movements. It’s essential to work closely with your healthcare team to find the most suitable treatment approach for you.
• Lifestyle Adjustments: Small lifestyle changes can make a big difference in managing IBS. Establishing a consistent sleep schedule, staying hydrated, and avoiding smoking can contribute to overall gut health and well-being.
• Seeking Support: Living with a chronic condition like IBS can feel isolating at times. Connecting with others who understand your struggles can provide invaluable support and encouragement. Online communities, support groups, or counseling can offer a safe space to share experiences, exchange tips, and find solace in knowing you’re not alone.
• Follow the link for evidence based management of IBS https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/treatment

The Importance of Medical Guidance

While self-management strategies can be empowering, it’s crucial to seek guidance from a healthcare professional. They can help confirm an IBS diagnosis, rule out other potential causes of symptoms, and tailor a treatment plan to address your specific needs. Regular check-ins with your healthcare team ensure that your management plan remains effective and adaptable as your needs evolve.

For further details please refer https://gastro.org/news/new-aga-guideline-a-targeted-approach-to-ibs-c-and-ibs-d-treatment/