Gastroenterologist highlights important facts about Irritable Bowel Syndrome

APRIL is Irritable Bowel Syndrome Awareness Month. Irritable bowel syndrome (IBS) is considered a functional gut disorder. It involves problems with motility (movement of digested food through the intestines) and sensitivity (how the brain interprets signals from the intestinal nerves). This leads to abdominal pain and changes in bowel patterns and symptoms, such as bloating and gas.

IBS is so common that it’s likely you know at least one person with this functional disorder.

To learn more about IBS and what can be done to treat the disorder, Caxton Local Media reached out to Dr Kugan Govender, a gastroenterologist based at Life Entabeni Hospital with 16 years of experience practising in the field of gastroenterology.

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What is IBS?

Govender said IBS is an umbrella term that refers to a variety of bowel symptoms of which abdominal pain or discomfort is a core symptom and is associated with a change in the frequency and form of stool (diarrhoea or constipation).

“IBS is a functional disorder which means that the bowel is structurally normal but there is a problem with the way it functions. It may work frequently, resulting in diarrhoea, or work too slowly, resulting in constipation,” said Govender.

According to Govender, the diagnosis is made by doctors using the Rome IV criteria.

“The Rome IV criteria require that patients have had recurrent abdominal pain at least one day per week during the previous three months, which is associated with two or more of the following: the pain is related to defecation (may improve / may be increased / may be unchanged); it is associated with a change in stool frequency (frequent stools / reduction in frequency), or it may be associated with a change in form or appearance of stool (eg, watery/hard),” he said.

The gastroenterologist said that four bowel patterns can be seen with IBS: IBS-D (diarrhoea predominant); IBS-C (constipation predominant); IBS-M (mixed diarrhoea and constipation), and IBS-U (unclassified – cannot be categorised into the other subtypes).

What causes IBS?

Govender said the causes of IBS remain poorly defined. “Causes may be related to changes in bowel motility; changes in intestinal permeability; changes in intestinal bacteria (alteration in normal bowel flora); dietary intolerances, or stress, anxiety and depression. There is a link between brain and gut function (brain-gut axis) which means that the same neurotransmitters that are active in the brain also have effects on the gut. This explains why IBS tends to overlap with psychiatric conditions such as anxiety and depression.”

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What are the symptoms of IBS?

According to Govender, the common symptoms are abdominal pain, diarrhoea, constipation, bloating and an urgency to pass stool.

“Symptoms may fall into the subtypes mentioned above. It is important to look for ‘alarm symptoms’ or ‘red flags’ which are not part of IBS and warrant urgent investigation. These include: weight loss, anaemia and the passage of blood in the stool,” said Govender.

What can be done to treat IBS?

Govender said IBS should be treated in a holistic way. “This involves psychological support, dietary modification and medication (pharmacological).”

Govender described the three treatments that are necessary to combat this disorder:

• Psychological: This involves counselling and reassurance, and supportive therapy. Patients with underlying anxiety and depression will need assessment and management by a psychologist.

• Dietary modification: Numerous IBS diets have been suggested. The most evidence exists for the low FODMAP diet (which stands for fermentable oligosaccharides, disaccharides and monosaccharides, and polyols). High-fibre diets are recommended for patients with constipation – soluble fibre is preferable to insoluble fibre – with judicious water intake (predominantly in patients with constipation). Avoidance of stimulants such as caffeine is recommended (especially in patients with diarrhoea and anxiety).

• Pharmacological: Probiotics are useful and help restore the balance in gut flora. Not all probiotics are effective. Some probiotics have evidence for use in IBS. Other medications available include anti-diarrhoeals, eg, Smecta and loperamide; laxatives, eg, Movicol and bulk-forming laxatives, and anti-spasmodics, eg, Mebeverine. Anti-depressant and anxiolytic medication can be used in IBS which overlaps with either anxiety or depression. Treatment of the underlying psychiatric illness tends to assist in treating IBS.

What can be done to avoid IBS?

Govender said eating a balanced diet with an adequate intake of water is an important way to avoid IBS. “Avoid excessive caffeine, alcohol and high sugar-containing foods. Avoid processed foods and foods with preservatives. I would advise patients to eat food that is still in its natural form – not processed, no additives, etc.”

“Healthy eating habits also include eating smaller meals, taking time to chew food properly and avoiding eating late at night. Should IBS symptoms develop, I would advise doing a ‘food diary’ to try to work out which types of foods cause the symptoms so these can be avoided,” said Govender.

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Lesser known facts about IBS  

• It has been recognised since as far back as 1892.
• It was previously described as a spastic colon, irritable colon or nervous colon.
• It has an estimated worldwide incidence of about 5–10% (which is a large number of people).
• There is an entity called post-infectious IBS which means IBS that occurs after infective diarrhoea. The infection gets better, but the symptoms persist due to the effects of the bacteria or virus on the gut – they may increase the permeability of the gut or affect the gut nerves.

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