Irritable bowel syndrome can be quite unsettling. But, it can be managed with food and medication
Saranga is worried. She has noticed in the past month that every time she eats, she has to literally run to the bathroom to pass motion. Quite often the stools are loose. Occasionally she has days when she gets constipated and has severe abdominal cramping. She also feels bloated quite often and feels very uncomfortable. She seems to be constantly focusing on how her stomach feels.
Saranga has irritable bowel syndrome (IBS). IBS is a disorder that interferes with the normal functions of the colon. It affects women more often than men, and usually starts in the 30s. It can be set off by certain food or stress.
It is usually diagnosed by the presence of cramping, abdominal pain, bloating, constipation, and diarrhoea. Though irritable bowel syndrome can be very distressing, it does not permanently harm the intestines and does not lead to a more serious condition such as cancer.
What causes IBS?
There is no specific cause for IBS. People with IBS have a colon (large intestine) that is particularly sensitive and reactive to certain foods and stress. In a country such as India, where gastro-enteritis (bowel infection) is common because of lack of food hygiene and safe drinking water, repeated bowel infections may trigger off IBS. Usually, a malfunctioning colon results in IBS.
The colon, which is about five feet long, connects the small intestine to the rectum and anus. Partially digested liquid matter enters the colon from the small intestine each day. The colon absorbs water, nutrients, and salts from the partially digested food that enters from the small intestine. What is left over is stool. The colon contracts regularly and moves the contents inside the colon toward the rectum. Usually at a regular time, contractions push the stool down the colon, resulting in a bowel movement.
In IBS, this smooth mechanism goes awry and there is no coordination in the colon contractions; the contents inside the colon do not move correctly and this results in abdominal pain, cramps, constipation, a sense of incomplete stool movement, or diarrhoea. When the contents move too quickly through the colon, the water is not absorbed and this results in diarrhoea. On the other hand, when the contents move too slowly, too much fluid is absorbed and the stools become hard, resulting in constipation.
How do you know you have IBS?
You know you have IBS if you have a few or all of the following
· Abdominal pain or discomfort for at least three months a year; the abdominal pain is usually relieved by a bowel movement
· A change in frequency of bowel movements
· A change in appearance of bowel movements
· The uncontrollable urgency once you know you are going to have a bowel movement
· Frequent cramping
· Feeling flatulent (‘gassy') all the time
· Feeling bloated
However, it is important to remember that bleeding, fever, weight loss, and persistent severe pain are not symptoms of IBS, and may indicate other problems such as inflammation, or rarely, cancer.
Usually your doctor will diagnose IBS by taking a detailed history. If there is any cause for concern, a colonoscopy may be done. This involves inserting a small, flexible tube with a camera on the end of it and looking inside the colon.
How is IBS managed?
Managing IBS basically involves careful eating. A food diary maintained for a few weeks may help you pinpoint food that trigger IBS.
Increasing dietary fibre may lessen IBS symptoms, particularly constipation. Whole grain breads and cereals, fruits, and vegetables are good sources of fibre. However, pain and diarrhoea may not decrease. High-fibre diets may initially cause gas and bloating, though these symptoms may go away within a few weeks.
Make sure that you drink plenty of water (at least six to eight glasses of a day). Avoid carbonated beverages that may increase gas and worsen the discomfort. Chew your food slowly and do not gulp it down, as eating too quickly can lead to swallowing air, which also leads to gas.
Large meals can cause cramping and diarrhoea, so eat frequent small meals. Reducing the fat content of food has been shown to help. Curd (yogurt) is rich in lactobacilli that help in digestion, and may be tolerated even by people who are lactose intolerant.
Medications for IBS
Medication may be prescribed to relieve symptoms. You may be prescribed fibre supplements such or laxatives as loperamide for constipation or medicines to decrease diarrhoea. An antispasmodic may be prescribed, which will help reduce abdominal pain.
The author is an obstetrician and gynaecologist practising in Chennai and has written the book “Passport to a Healthy Pregnancy”.