Imagine driving on a motorway and you get a very specific gnawing pain in the pit of your stomach. You start getting cold sweats as you know that there is only a small amount of time to get to the nearest toilet. There is panic as you are frantically trying to identify the next stop – luckily there is one at the next junction, you turn off, slam into the car park, and rush into the nearest toilet stall. You hope that no one is anywhere near the vicinity, as there is cramping pain and streams of diarrhea.
That is what it is like living with irritable bowel syndrome (IBS). Constantly on edge, the need to know the nearest toilet's location, and the stigma that can be caused by this syndrome. This isn’t helped by media that portrays the condition as a comedic outlet. But it isn’t that simple, and this portrayal can cause more harm than good.
IBS is a chronic condition that can cause irregular bowel movements, stomach pain, and bloating. It affects an enormous population of people – in the United States alone it ranges from 25 to 45 million people, 2 in 3 cases in females. It is thought that this high-female ratio is to do with many biological factors, one being that the prostaglandins released during menstruation can trigger contractions in the uterus and can also trigger contractions in the intestine (that is also the cause of period poops).
But, what causes IBS?
IBS affects the gut – more specifically, the large colon/bowel. The gut is a fascinatingly complex organ with a lot of surface area, 40 times the area of our skin. When food is broken down and absorbed into the body for energy, the walls of the bowels are squeezed together. This contraction helps to push the food through the system.
Unfortunately, for people with IBS, the gut wall is very sensitive and excitable. When the contractions happen too quickly, diarrhea can occur. When they occur too slowly then this causes constipation.
Work is still being conducted on the causes of IBS. One study suggests that the cause may be more psychological, and cognitive behavior therapy (CBT) has helped people with this. Another study suggests that the unexplained abdominal pain may be caused by receptors that normally cause an itchy feeling on the skin and also on the gut, and therefore the patients can experience "gut itch". This may explain a more recent study that suggests that it may be a locally-driven immune response from certain foods that causes the release of histamine.
Doctors can diagnose people with IBS based on symptoms when other bowel diseases have been ruled out by clinical tests.
What can help IBS?
As you can imagine with some of the causes listed above, it is no surprise that some of the triggers of IBS include stress, certain infections, medications, and food.
For stress, it is suggested that patients try and relax, promote stress-free habits, and try other psychological therapies. But in this day and age, this is often very difficult to do, so sometimes doctors may suggest medication like antidepressants. Even on these medications, acute attacks may happen during high stressful events; the classic interviews, exams, or public events come to mind. In these cases, some (often over-the-counter) medications can help. These medications can relieve constipation or diarrhea symptoms, while others can reduce bowel symptoms.
Some people with the condition say that vitamin D supplements can help. However, this is slightly controversial. Some studies suggest it helps alleviate symptoms, while some studies suggest that the supplement would not improve painful IBS symptoms.
For food-related IBS, it is often recommended that people try to avoid any food triggers.
What food triggers IBS?
Delicious foods like wheat, rye, garlic, dairy products, honey, and some fruit can make IBS worse. This is because they are a group of carbohydrates (called Fermentable Oligo- Di- Monosacharides And Polyols, or FODMAP for short) that passes very slowly through the small intestine and can attract water and ferment in the large intestine.
For people with IBS, this can lead to changes in bowel habits, bloating, excessive gas production, and distention. People with IBS have a very sensitive bowel, so any stretching of the intestinal wall and can cause pain and discomfort.
The FODMAP diet limits these carbohydrates and was created to help manage IBS. It is pretty successful too – it can reduce IBS symptoms in three out of four patients.
However, every person is different and there is no set rule for what triggers may affect a certain person. The caffeine in a cup of coffee may cause stomach pains for one person but not another person. So, it is often recommended to keep a symptom diary to determine which are your triggers.
While there is currently no cure for this chronic disease, there is hope that future research can help minimize the toilet dashes.