Irritable Bowel Syndrome is a functional disorder of the digestive tract. A functional disorder or functional complaint means that there or no recognizable organic causes which can explain the symptoms. The affected people suffer from ever returning troubles such as stomach aches, irregular bowel movements (diarrhea and constipation) and flatulence. Very many people suffer from an irritable bowel. Some have constant complaints, but most have them only once in awhile and then they occur in special situations. The underlying causes are until now not clearly explainable. Things such as dietary habits, food intolerances and psychological burdens are considered triggers for the illness. The diagnosis normally takes place through a thorough questioning of the medical history and symptoms of the patient and a detailed body examination. In order to rule out any other diseases of the digestive tract, other tests can be necessary. The treatment of Irritable Bowel Syndrome is individually determined according to the complaints and treatment mainly focuses on alleviation of the troubles through a dietary change. Medical treatment and psychotherapeutic treatments also come into use. The prognosis for irritable bowel syndrome is good. There is not an increased risk for the affected patients to develop an inflammable or malignant illness of the digestive tract.
2. How does IBS show itself? What symptoms appear with Irritable Bowel Syndrome?
The individual symptoms of Irritable Bowel Syndrome are not very characteristic, however, when looked at collectively they build an almost typical disease picture. In the foreground is a constant alternation between stomach aches and stomach cramps, irregular bowel movements, flatulence, as well as the feeling as if the stomach is severely blown up and taut. Pain can occur in different locations of the stomach and are often hard to locate. Even the bowel movement itself is often painful. Many affected people have the feeling incomplete evacuation. Frequently the stomach pains do get better after a bowel movement. Constipation and diarrhea appear in alternation, and very often there is a mixture of slime in the stool.
To define Irritable Bowel Syndrome, different criteria are specified:
Stomach aches, often in connection with the bowel movement
Emptying of the bowels changes in at least two of the following aspects:
Frequency
Consistency (hard, mushy, watery)
The passing through is troublesome, increased urge for bowel movements, feeling that the emptying was not completed, an outflow of slime
Flatulence
Next to these bowel complaints, so-called extraintestinal (found outside of the bowel) symptoms like headaches, backaches, fatigue, sleeping disorders, anxiety disorders and depression, trouble with urinations or menstrual and heart complaints can occur – all without an explainable bodily cause. Most affected people are without complaints at night. These discomforts are not life-threatening, however, they do normally interfere greatly with the quality of life.
3. What causes IBS? How does Irritable Bowel Syndrome come to be?
The exact cause of Irritable Bowel Syndrome is until now unexplained. One talks of a functional illness, because there are no organic changes which can be determined, e.g. inflammation or tumors.
However, this does not mean that one is dealing with a psychological disorder. Stress and emotional conflict situations can, however, considerably influence the illness. Other factors can equally facilitate the development of Irritable Bowel Syndrome. These so-called„triggers“ are, for example, wrong dietary habits (e.g. low fiber and very fatty diets), overly sensitive pain reception in the digestive organs, wrong colonization of the intestinal flora, disorders of the immune system, medications, hormonal influences and much more.
By some of the affected people the development of Irritable Bowel Syndrome can be lead back to a bacterial intestinal inflammation or an intolerance of certain foods such as dairy products, coffee, alcohol, citrus fruits or fried foods.
During the last several years, many theories on the causes of Irritable Bowel Syndrome have been posed. A major importance belongs to the so-called enteric nervous system (ENS). This „intestine’s own“ nervous system controls the transportation function of the intestines. One assumes that a large portion of the complaints comes from a conditional movement disorder (gastroparesis) of the musculature of the bowel. The disturbed transmission of signals in the bowel is controlled and influenced by certain substances.
4. Are there different forms of IBS?
Patients that suffer from Irritable Bowel Syndrome, complain of irregular bowel movements, such as constipation and diarrhea. By some of the affected people, these symptoms alternate, and others suffer from only the one or the other symptom, so that one has to divide into three forms.
Irritable Bowel Syndrome of the constipation type (mainly constipation symptoms)
Irritable Bowel Syndrome of the diarrhea type (diarrhea is the main complaint)
Mixed type (alternation between constipation and diarrhea)
5. Is IBS frequent?
It is assumed, that in around 10 percent of all adults suffer from irritable bowel syndrome. The diagnostics are frequently put off because many patients first go to the doctor after having already suffered a long time. When the diagnosis „functional bowel complaints“ is made, it is for many (partly also for doctors) not clear, that they are dealing with Irritable Bowel Syndrome. Even though Irritable Bowel Syndrome is not life threatening, it can still impair a patient very much in regards to their quality of life. Women are around twice more affected then men. There is a frequency of appearing when between the age of 20-50 years.
6. Which organs are affected?
By irritable bowel syndrome the complete digestive tract can be affected.
See also the explanations „How does the digestive tract work?“
7. How is IBS determined?
The first thing to do after having found a doctor is the doctor-patient consultation, the so-called anamnesis. Here the doctor will find out exactly what your complaints are through questions. Following that, a complete body examination will be done where, among other things, the stomach will be more precisely examined, as well as the rectum being felt out with the finger. That is an important test, because the doctor can so pick up first signs of a constipation, inflammation or hemorrhoids. This test should not be declines, even though it can be conceived as being unpleasant.
After that the doctor will then have different blood tests done (signs of inflammation, liver values, kidney values, electrolytes, haemogram). Tests on urine and stool (for occult blood and pathogens) belong just as well to the examination.
According to age and medical history, other tests such as ultrasound, x-rays of the bowel or a colonoscopy/gastroscopy can make sense, in order to rule out other organic diseases.
8. What is a colonoscopy?
A colonoscopy is an examination of the colon and the rectum by means of a so-called endoscope. For this test one uses a special endoscope, the so-called colonoscope, which has a movable hose with glass fiber optics, which enables the doctor to see inside. Although older devices were set up with an optical device which let the doctor look directly into it, today the standard is video optics, with transmission onto a monitor. It is then possible for the patient to follow the examination. The endoscope is usually fitted with a working device which can take tissue samples. Before the test, the large intestine has to be emptied, so that the test will not be impaired by stool remains. To do this, the day before the test or right before the test a strong laxative is given, usually in a liquid form. A colonoscopy can be done by a doctor either in a practice or in a clinic. One can request a light sedative for this test which will be injected, in order to make the test more pleasant. By now, the test is frequently conducted under short anesthesia, so that the patient doesn’t notice anything of the complete procedure.
9. What is a gastroscopy?
A gastroscopy is also called an esophagogastroduodenoscopy (EGD) by physicians.
With this test it is possible to see inside of the esophagus, the stomach and the duodenum. In doing so it is also possible to take small tissue samples (biopsy) from the mucuous membrane in order to examine them under the microscope. For the test a special endoscope is used, the so-called gastroscope. Today a video endoscope is mostly used which has a video chip attached to the top point and which then transmits a picture to a monitor. This test can also be carried out ambulatory in a practice or in a hospital. Just like with a colonoscopy, the patient can ask for a light sedative, so that the test is more bearable.
10. What are breathing tests?
It is possible to diagnose the causes of disorders in the gastrointestinal tract area through breathing tests.
Breathing tests are based on the fact, that bacteria found in the gastrointestinal tract can divide substances. The products that result of this then get in the blood stream and from there into the lungs, where they can be messured in the exhaled air. There are two groups of tests:
By the 13C breathing test the concentration of carbon dioxide is measured, which among others, can produce the bacteria Helicobacter pylori when certain degradation products are divided. Proof of Helicobacter pylori can be seen as the reason for gastrointestinal complaints and should be treated with a weeklong combination therapy of antibiotics and an acid beta-blocker.
By the H2 breathing test the concentration of hydrogen (H2) is measured, a product of the division of carbohydrates in the intestines. Hereby the malabsorption syndrome can be diagnosed. Depending on which function is supposed to be examined, a test substance is administered together with a certain sugar. Given, among others, are lactose, saccharose, glucose and fructose.
The most frequent malabsorption syndromes have to do with lactose and fructose malabsorption, which often appear along with Irritable Bowel Syndrome.
11. What are malabsorption tests?
See under breathing tests, in particular the H2 breathing test.
12. What is pH-metry?
By pH-monitoring a nasal probe is inserted in order to measure the pH-values in the lower parts of the esophagus. Hereby it can be proven whether or not there is a reflux of gastric acid which comes back into the esophagus. This is the cause of heartburn and upper stomach pain and should be treated with an antacid.
13. Which diagnostics make sense?
A blood test and examinations of urine and stool are useful examinations. Colonoscopy and gastroscopy can help to exclude illnesses such as inflammatory bowel diseases, stomach cancer, intestinal cancer and diverticulosis. These tests are not necessary in order to diagnose Irritable Bowel Syndrome, however, they do help to rule out any serious illnesses.
Discuss with your doctor which tests he recommends for you.
Other examinations, such as ultrasound and functional tests (breathing tests, pH-metry) should be reserved for certain questions.
14. What is the treatment for Irritable Bowel Syndrome?
Every patient with Irritable Bowel Syndrome has complaints that are individual and pronounced in different strengths that can also change during the course of a lifetime. For that reason it may be advisable to view the treatment on a long-term basis and to put trust in a doctor that is knowledgeable of this disease pattern. Only this way can the doctor correctly judge the course of the illness and begin the necessary therapy for you.
A trusting relationship between doctor and patient is an important requirement for the successful treatment of Irritable Bowel Syndrome. The doctor clarifies the diagnosis and the possible causes of the complaints and explains the results of the examinations in order to eliminate any fears of a life threatening illness, especially that of cancer.
Nutrition plays an important role when it comes to an irritable colon. Changing ones alimentation can often be a promising help. A special diet is not recommended, and it is better to have a healthy and balanced diet with a high amount of fibers, as well as plenty of liquids. Foods that cannot be tolerated should be avoided. It is important to take one’s time by eating and not to eat meals when one is under time pressure.
The Irritable Bowel Syndrome therapy is based on three pillars:
General measures: Identifying non-tolerable foods and individual diet consultation, identifying and reducing general stress factors (work-related and private).
Symptom oriented medical treatment therapy
Psychosomatic therapy
Medical treatment therapy:
Whether and which medications are to be given for Irritable Bowel Syndrome is based individually on the complaints.
By constipation, that cannot otherwise be controlled (e.g. with lots of movement, high fiber diet, drinking a lot etc.), one can take a laxative (like e.g. lactulose) – this, however, cannot be taken for a longer time period and only after consultation with the doctor.
By diarrhea is e.g. the giving of Loperamid possible. This active ingredient inhibits actions of the bowel.
By stomach aches and cramps there are numerous medications that come into consideration:
Spasmolytics, also antispasmodic analgesics, e.g. Butylscopolamin
Medications that relax the bowel musculature, e.g. Mebeverin and Pinaveriumbromid.
Phytotherapeutics (herbal substances), e.g. peppermint, caraway, chamomile, fennel or anise.
Psychotropic drugs (incl. plant based psychotropic drugs such as e.g. St. John’s wort/hypericum) should, if possible, only be taken after consultation with a psychiatrist or psychotherapist and the doctor.
Prebiotics: It is worth trying to build up the intestinal flora with medications that contain active cultures of lactic acid bacteria, especially Lactobacillus acidophillus, Lactobacillus rhamnosus and Bifibacterium.
New therapy tendencies: Presently, a certain messenger that is involved in releasing stimulants of the bowel musculature is being intensively researched. Statements about the possible effectiveness for a treatment of Irritable Bowel Syndrome however, are as of now not yet possible.
Psychological support
If the complaints due to Irritable Bowel Syndrome occur intensified because of emotional circumstances such as stress or conflicts, then further measures make sense.
Every person affected can first try themselves to reduce their everyday stress. One should ensure a regular daily routine, make sure to have enough body exercise (e.g. walking, bicycle riding, aerobic, swimming) and well balanced leisure time activities on a daily basis.
Besides that, relaxation exercises (e. g. autogenous training or meditation) can help, and also aimed psychotherapeutic support (e.g. psychoanalytical conversational therapy, behavioral therapy, hypnosis, among others) can be helpful. A psycho¬therapy is mostly recommended when additional psychological disorders appear, the complaints have been around for a long time or when an affected person stands under a strong level of suffering
15. Does my nutrition influence my Irritable Bowel Syndrome?
Undisputable is that a balanced diet has a positive effect on the course and the symptoms of an illness. However, with Irritable Bowel Syndrome the most different foods and drinks can cause problems. In order to find out which foods and drinks you can tolerate and which not, you should take some time to find out which diet is most suitable for you personally.
16. Is there a connection between Irritable Bowel Syndrome and other illnesses?
Patients that suffer from Irritable Bowel Syndrome can be afflicted with number of other symptoms/complaints. Complaints that originate in the digestive tract (=intestinal symptoms) are included, such as
excessive fullness after eating; early fullness
non-acidic repeating
nausea/vomiting
upper stomach pain
heartburn
Symptoms outside the digestive system (extraintestinal) can also persist, such as
An irritable bowel syndrome is not a dangerous illness and does not lead to intestinal cancer. There is also no increased risk of becoming sick with intestinal cancer.
18. What is the prognosis?
Irritable Bowel Syndrome impairs the people affected and reduces their quality of life. The symptoms can persist lifelong. The complaints can from time to time increase or ease up. With the right treatment about half of all patients suceed in leading a complaint free life. For that reason it is important for the patient to find an experienced doctor they can trust.
19. What connection does stress have with IBS?
Stress can have a negative influence on the illness. If you suffer from Irritable Bowel Syndrome, an important factor is overcoming stress. There are different methods to do this, e.g. progressive muscle relaxation according to Jacobsen and other relaxation exercises. Make sure you get enough rest and relaxation in your everyday life.
20. Does psychotherapy help by IBS?
A psychotherapeutic therapy by patients with IBS is recommended and is justified through the present standard of knowledge that psychological factors such as e.g. stress and depressing situations in life, can influence the illness and that Irritable Bowel Syndrome can be a consequence of fears and burdens due to the illness.
21. Are there self-help groups?
Links to self-help groups can be found on our homepage.
22. Where can I get more help/ information? You can get links and information on your Solvay-IBS page.
23. What can I do?
It can be helpful to maintain a dietary diary in order to find out by which foods the symptoms appear and then to avoid these or to discuss alternatives with your doctor.
Maintaining a complaint diary can also be helpful in order to find out what caused the complaints (stress, dietary habits, daily rhythm, medications).
Avoid stress; learn avoidance strategies such as e.g. relaxation exercises.
A balanced diet along with enough movement helps to strengthen the bowel performance.
