Irritable bowel syndrome is an interdisciplinary problem

Research shows that irritable bowel syndrome very often troubles people with emotional problems, such as anxiety, neurosis or depression. Treatment is based on symptom management, diet and psychological support.

What is irritable bowel syndrome (IBS)? What are the symptoms characteristic of it?

Symptoms are most often intestinal complaints of a different nature, it can be a form of diarrhea, i.e. diarrhea or loose stools, with a bowel movement from a few to a dozen a day. The constipation form is the opposite situation, i.e. the patient has a bowel movement less than every three days, the stools are hard, compact and the bowel movements are very uncomfortable. Disturbances in bowel movements are accompanied by abdominal pain, a feeling of distension, gas, flatulence. It is therefore a syndrome of ailments across the spectrum of symptoms. There are also undefined forms of IBS or a mixed form in which there is an alternating rhythm of bowel movements – either diarrhea or constipation of a variable nature.

In this ailment, the emotional component is emphasized in patients, which influences the appearance of symptoms. The intestine and our state of mind – stress, tension – are very closely related to each other. Any tension translates into a more or less disturbed bowel function.

Many cases of IBS go undiagnosed. Does this mean that the sick do not seek medical help because they think they can somehow live with it?

It’s not that they’re not looking for help. It is known that with incidental diarrhea, we do not go to the doctor right away. On the other hand, this is a group of patients who observe themselves quite closely and want to diagnose themselves if the ailments last a long time – weeks, months or even years. So they go to the doctor, but the symptoms are so nonspecific that it is very hard to tell that it is IBS on the first visit. The doctor diagnoses by exclusion, i.e. eliminates all other probable conditions that may have the same symptoms as IBS. Therefore, diagnostics are often quite complicated.

So how is Irritable Bowel Syndrome diagnosed?

Fortunately, there are markers and tests that allow us to determine whether we are dealing with functional disorders and irritable bowel syndrome, whether it is, for example, inflammatory bowel disease or microscopic colitis, which have a completely different course and, as a result, different health consequences. For example, the determination of calprotectin is a simple and accessible stool test that guides us on a certain path.

The problem requires a very comprehensive treatment, and because the symptoms are interdisciplinary, the patient visits many specialists. Due to the above-mentioned emotional component, he may have feelings of anxiety, fear, palpitations, with which he goes to a cardiologist or psychiatrist. The patient may suffer from musculo-articular complaints related to increased muscle tone or fibromyalgia, which accompanies irritable bowel syndrome, and then he will go to a rheumatologist.

Theoretically a simple disease entity, but it often involves many specialists to unambiguously establish the diagnosis. And the colonoscopy result alone is not a reason to rule out or confirm IBS, which is a functional disorder.

What are the possible treatments for Irritable Bowel Syndrome? Is there one effective treatment for both diarrhea and constipation?

Treatment is very difficult, and it is based on doctor-patient cooperation. The patient should understand the essence of their disease, its background and be aware that it is not a curable disease right away. He must know that this is a comprehensive treatment, and pharmacotherapy is one of its elements. It is followed by the elimination of food products, which can potentially aggravate symptoms, emotional calm, or treatment of metabolic disorders (insulin resistance) or disorders of the intestinal microbiota. As far as pharmacotherapy is concerned, in both forms of IBS, antispasmodics and drugs regulating the peristalsis of the large intestine, as well as auxiliary – diastolic drugs, which reduce the tension of the large intestine, work well. Treatment is symptomatic, i.e. aimed at alleviating the most troublesome ailments. Sometimes it is worth resorting to drugs that have a large absorbent surface, are able to absorb gases in the intestine, and this already reduces unpleasant sensations such as stinging or expanding in the abdominal cavity. Thanks to this, the patient calms down, because the ailments are less persistent and thus reacts better to the proposed therapy.

Does the right diet affect the course of IBS?

Adequate diet improves treatment results. Patients themselves report that there are products that make them feel bad. They associate the occurrence of ailments with what they eat and come to the gastroenterologist’s office not only for medications, but also for dietary advice. We set the diet individually, because it depends on the form of IBS.

It is worth limiting simple carbohydrates in the diet, leaving complex carbohydrates in limited amounts – groats, coarse bread – supplement it with an appropriate amount of fiber and protein with the addition of good fats. Of course, in the form of diarrhea, you should consume fiber-containing foods with caution. Conversely, it is in the form of constipation.

How important is the stabilization of the microbiome in the treatment of irritable bowel syndrome?

Recently, there is a lot of talk about the so-called the gut-brain axis and the fact that the gut has our second brain. And that’s the truth. The influence of the microbiota is enormous. Incorrect diet, medications, stress cause disturbances in the intestinal flora, the so-called dysbiosis. The gut flora has both a local and overall influence on what happens in the body. Therefore, we should take care of the intestinal microflora. The recently favored silage is perhaps one of the best nutritional fashions of recent years. Silage is a natural prebiotic, i.e. food for intestinal bacteria. In addition, they contain the right amount of fiber, which regulates intestinal peristalsis, soothes ailments such as flatulence and constipation.

Patient’s voice

At Mrs. Agnieszka from Wrocław, IBS was diagnosed over 20 years ago. I had to learn and accept my illness. You can’t fight it. IBS affects everyday functioning – going to the city, visiting friends, everyday duties. The disrupted rhythm of bowel movements forces sudden changes of plans and causes a general decline in well-being. Unpleasant, bothersome ailments are most related to what I eat, what I drink.

In this disease, diet is very important and it is the only way to regulate the functioning of the intestines. I am lucky that from the beginning of the treatment I have been under the care of Dr. Waśko-Czopnik, who is not only a gastroenterologist, but also a nutritionist. She made me realize the importance of diet in preventing symptoms of irritable bowel syndrome. In my case, pharmacology is needed only temporarily in the moments of exacerbations. Then I take diastolic drugs and they help me.

The gas that accumulates for me is the biggest nuisance and I never know what products they will appear after, because one day I will eat an egg and everything is fine, the next time I have ailments after the same meal. Even in the water, I have gases. Gas, bloating and diarrhea are the main conditions I have with Irritable Bowel Syndrome. It is very onerous because it disrupts my professional work and everyday functioning.

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