What is now called irritable bowel syndrome (IBS) was initially called nervous colitis . However, the suffix “ite”, of colitis, refers to inflammation, a condition that does not occur in the symptomatic picture of IBS.
In addition, the reference to “nervous” comes from the constant relationship between symptoms and emotional or psychological factors, in which the reactions often manifested themselves after traumatic situations, stressful situations or emotional disturbances. Or, still, because the intestinal dysfunctions gave an irritated aspect to the organ.
Along with the inaccurate nomenclature, it was found that, instead of an inflammation, the cause of the symptoms was abnormal peristaltic movements – either excessive or reduced.
This set of symptoms began to be called irritable bowel syndrome. However, after a while, the researchers found that it was not just the colon (part of the large intestine) that was affected. Then the syndrome needed to be renamed again, until finally it reached the irritable bowel syndrome.
With reports that involved difficulties in going to the bathroom or increased frequency of bowel movement, recent change in the functioning of the intestine, pain, swelling and constant discomfort, more precise parameters were started to define what is now understood as bowel syndrome irritable.
Despite several studies and follow-ups on the subject, the syndrome still has vagueness and debates about its causes.
Contents
What is irritable bowel syndrome?
Irritable bowel syndrome is a condition identified around the globe, affecting up to 20% of the population.
Patients, in general, complain of abdominal pain, sensation of incomplete evacuation, cramps, abdominal distention, difficulty in going to the bathroom or loose intestine and other intestinal changes without an identifiable cause.
Symptoms, although varied, need to be present for at least 3 days a month, for the last 3 months.
Although there are no metabolic, structural or biochemical changes in the intestine (such as the presence of infections, obstructions or damage to intestinal cells), irritable bowel syndrome (IBS) constitutes an alteration of the digestive functioning capable of causing several impacts on well-being of the patient.
The syndrome does not represent, until then, severe complications to the patient’s health, but it proves to be a very limiting condition to daily life and routine, as it can negatively affect social life, professional and educational productivity, as well as other daily activities.
Patients with symptoms need medical attention to assess the condition and find the best alternatives to deal with the condition.
As IBS is considered multifactorial, that is, the causes can be diverse, treatment consists of general measures that aim to reduce discomfort, such as fiber supplementation, medications and, often, changes in eating habits.
The criteria are based on a research carried out in 1989, which aimed to define parameters for the diagnosis of gastro diseases. The study’s ratings are still constantly changing.
The last update of the criteria on IBS was in 2006, resulting in Roma III, which is a manual of procedures, diagnoses and classifications on functional gastrointestinal disorders (that is, when there are no structural or biochemical factors causing the symptoms). The main objective is to produce material that can be used by healthcare professionals around the world.
The main differences for the previous versions refer to the time of occurrence of the symptoms and the consistency of the bowel movements.
Therefore, irritable bowel syndrome can be defined as an alteration or disorder of chronic intestinal functioning, with the presence of constant symptoms that are not caused by identifiable diseases or conditions.
Intestine: the second brain
The intestine is formed by two parts: the small intestine (which is divided into duodenum, jejunum and ileum) and the large intestine. The organ is complex and very important, after all, it extracts energy and nutrients from food, in addition to eliminating from the body what should not be accumulating.
There are those who call the intestine a “second brain”, due to its functional importance. More than that, it has about half a billion neurons, 50% of all the body’s dopamine and about 90% of serotonin . But what does it mean?
You have probably experienced an episode in which emotional situations interfered with your bowel routine.
For example, that stress from work resulted in a few days of constipation or, on the contrary, an immediate need (more than once that day) arose to go to the bathroom. In addition to the problems at work, you can’t go too far from the bathroom.
Thus, most people already know, from personal experiences, that emotions can alter intestinal transit. But recent studies have suggested the other way around as well.
This means that the neurons present in the gut communicate with the brain and can interfere with behavior, emotions and even determine personality traits.
After observing that the composition of the intestinal flora could influence the way mice act, some scientists began to investigate this relationship in humans as well. The University of Oxford followed 45 volunteers who were assessed on their nutritional and behavioral constitutions.
Patients who received supplementation with a carbohydrate called galactooligosaccharide (GOS) had a greater proliferation of intestinal bacteria, specifically lactobacillus and bifidobacterium .
Along with the rise in bacteria, there was a reduction of up to 50% in the rates of cortisol, which is the stress hormone.
In addition, there are other studies that associate low concentration of lactobacillus and psychological disorders, such as depression and anorexia .
In general, it is noticed that emotionally unstable or shaken patients tend to have small inflammations in the intestine. These lactobacillus bacteria help maintain the intestinal mucus, which is responsible for protecting the organ walls.
When carrying out tests on animals, the researchers realized that, when supplementing the mice with the bacteria, the organism presented similar responses to the use of antidepressants.
Therefore, here we can already understand the important relationship that occurs between the mind and the intestinal process. It also means that bowel dysfunctions can have an impact on mental health and even behavior.
Remembering that it is in the intestine that is the second highest concentration of neurons, only losing to the brain.
The organ also has its own muscle activation system to perform digestion and forward the bolus, in addition to having the highest concentration of immune cells.
The relationship between the emotional side and the gut is still not entirely clear, but it is accepted that there is some kind of interaction.
What are the chances for interaction?
In a study carried out in 2016, in the scientific journal Cell, the researchers indicated that ingested food or microorganisms may be warning signs for neurons present in the intestine.
These neurons send messages by activating defense cells, that is, causing the immune system to activate. But each person has different bacteria in the intestinal flora and it can change over the course of life.
In addition to genetic conditions, metabolism, diet and bowel function are factors that can alter the composition of the intestinal bacteria.
The constitution of flora (which bacteria are present), together with the sensitivity to certain components (such as some foods) are factors that are associated and can alter communication with neurotransmitters.
This communication can then have an impact on various diseases and disorders. Studies carried out by the American Neurological Association point out that inflammation of the intestine can be an aggravating factor in cases of autism and parkinson’s.
It is not known exactly how or why the irritable bowel syndrome occurs, but knowing the complexity of the intestine can assist in conducting research, as well as understanding the different ways that the syndrome can affect each patient.
Types
Although there are no different types of the syndrome, according to Roma III, irritable bowel syndrome (IBS) can be subclassified according to the consistency or appearance of the patient’s stool.
But changes in bowel behavior are quite common. Therefore, if the patient starts the diagnosis with constipation (IBS-C), it may be possible that at some point the syndrome changes to the subtype with diarrhea (IBS-D), for example:
IBS with diarrhea (IBS-D)
Subtype D presents in 1 out of 3 cases of IBS, being more frequent in men. The patient has alternating bowel movements, with 25% or more of defecations, the stools are soft or like diarrhea.
The frequency of evacuations is also considered. This is because, many times, the patient does not consider the constant visit to the bathroom as an intestinal dysfunction if there are no visibly liquid stools.
IBS with constipation (IBS-C)
About 1 in 3 patients has IBS subtype C, with the condition prevalent in women. In general, 25% or more of the time the patient goes to the bathroom, the stools are hard.
In addition, the frequency of evacuation tends to be quite low, maintaining long periods without going to the bathroom.
IBS with mixed bowel habits or cyclic patterns (IBS-M)
Subtype M has no prevalence of stool consistency. In at least 25% of defecations, the patient presents with faeces with alteration in consistency, which may be soft or hard.
Cyclic or seasonal behavior can also be observed, for example, during the week, the patient has constipation and at weekends the intestine is loose.
No IBS subtype
Observation of bowel movements does not allow defining the IBS subtype.
Causes
The causes of irritable bowel syndrome are not yet fully understood and, in general, different causes are attributed to the dysfunction.
For most physicians, there is an association of intestinal malfunction with emotional, social and behavioral factors.
Recently, investigations between the syndrome and dysfunctions of the central nervous system (CNS) have related factors.
It is assumed that brain neural centers participate in regulating the functioning of the intestine, just as the intestine interferes with the regulation of the CNS. In this respect, the relationship between emotional and psychological changes with the functioning of the intestine is understood.
That is, the researchers believe that when stressful situations occur, for example, they are able to interfere in the secretion of substances, in the intestinal movement (peristalsis) and in the digestive sensations (stuffing, for example).
In addition, there are recent studies that investigate the behavior of IBS and immune reactions. The researchers analyze the cases in which IBS occurred after an inflammation of the intestinal mucosa, in which the inflammation altered neurological functioning and resulted in the syndrome.
The causes of the syndrome point to several factors that, generally, can be associated, among them:
food
It is observed that, often, certain foods or food groups can precede intestinal dysfunctions.
Even patients who do not have pathological conditions (such as allergies or intolerances) sometimes identify foods that cause changes in bowel movements without changes in the intestinal flora, inflammation, infections or intoxications.
Very stimulating, strong or fatty foods, such as coffee, chocolate, milk, gluten , white sugar and alcoholic beverages can trigger symptoms or accentuate the malaise during crises.
In addition, some researchers believe that these foods can trigger the syndrome in patients who are predisposed.
Decreased bowel movements
Intestinal motility (movement of the intestine to forward the fecal bolus) can be altered by several factors, both external and endogenous (internal).
For example, food is characterized as external, as food can change the intestinal rhythm, depending on the amount of nutrients, fats or even the size of the meal. The increased release of bile acid is an internal (endogenous) factor, which alters the intestinal rhythm due to the production of the organism itself.
Increased bowel motility can cause the patient to evacuate more often, also changing the consistency of their stool. In addition, there may be cramps or abdominal pain resulting from increased bowel movement.
For patients with constipation, reduced mobility may be due to less rectal sensitivity or reduced secretion of substances that stimulate peristalsis (bowel movement).
Traumatic factors
In general, psychological and emotional factors can interfere with intestinal flow even in healthy people.
For example, when a person is experiencing stress , he or she may experience constipation. Others may also have a more frequent bowel movement or gas build-up in situations of nervousness.
With regard to IBS, it is not known whether the psychological condition is a triggering factor of the syndrome, but there are studies that point to emotional factors as influencing episodes, being able to worsen or worsen symptoms.
In addition to emotions (such as happiness, nervousness, euphoria, fear) studies carried out in 2003 by the University of Manchester, indicate that there is a high prevalence between IBS and psychiatric disorders or disorders (which are more persistent psychological disorders than emotions).
A study published in the Revista de Psiquiatria Clínica, in 2011, indicates that between 30% and 70% of patients with bowel dysfunction have conditions such as depression, anorexia , generalized anxiety , panic syndrome, social phobia , somatization or post-traumatic stress disorder. .
Believing that emotional traumas have a strong relationship with IBS, studies that follow patients diagnosed with IBS, indicate that histories of physical, sexual or emotional abuse are more present in patients with more severe or severe IBS symptoms.
Deregulation of the central nervous system
The central nervous system (CNS) participates in several functions of the gastrointestinal system.
There are still no definitions as to the real action of the CNS in irritable bowel syndrome, but some studies carried out in 2008 with magnetic resonance, published in the Revista de Pesquisa Psicosomatica, suggest that there are incorrect activations of brain regions in patients with IBS.
That is, studies indicate that there is a bidirectional relationship between the central nervous system and the intestine. There may be brain problems that cause IBS and there may be intestinal predispositions that cause undue commands or responses in the brain.
The region in which the problem starts is not yet known – it may be in the CNS or in the intestine – or if it is the result of associated changes in both, but the issue has been debated and with recent interests, raising several studies.
Irritable bowel syndrome after infections
The condition can develop after an acute gastroenteritis . Likewise, the agents that cause IBS after an intestinal infection are still not fully understood.
However, research has shown that after temporary intestinal changes (such as intoxications or infections) there may be an increase in some cells, such as T-lymphocytes, macrographs and enteroendocrine cells, along with an increase in intestinal permeability.
These cellular elevations alter the mobility of the intestine and may predispose the syndrome.
Hormonal changes
Although there are no studies ensuring the relationship between the syndrome and hormonal changes, many patients, especially women, report intensification of symptoms when there are hormonal changes (for example, in the menstrual period).
The condition tends to show more constipation or more bowel movements, accentuated abdominal pain, more gas or more sensitivity to food, for example.
In general, periods leading up to menstruation are widely reported, however, changes in thyroid hormone rates may also be associated.
Changes in routine
Studies that seek to trace factors associated with IBS suggest that there may be a relationship between personal routine and intestinal functioning.
Some people already know that traveling or sleeping with friends can cause changes in the functioning of the intestine. This can occur with high intensity in patients with IBS.
It was observed that many patients tend to present seasonal symptoms or demarcated by activities, such as days of the week, trips or the end of school years.
Changes in intestinal flora
The intestinal flora has bacteria responsible for the correct functioning of the intestine. The excessive proliferation of these bacteria in the small intestine may be related to IBS.
Eating habits, medication use, alcohol consumption and inflammation of the intestine can harm or alter bacteria or their concentrations in the intestine.
Studies carried out in 2006 suggest that between 65% and 84% of patients with the syndrome have altered intestinal flora.
Risk factors
It is difficult to determine risk factors, as the conditions of irritable bowel syndrome are not yet fully understood. However, it is suggested that some conditions can more easily trigger IBS:
Family history
People with a family history may be at risk. Although studies on genetic relationships are not entirely clear, there is a prevalence among members of the same family.
The surveys and observations suggest two hypotheses for the family history: the genetic factors themselves or the sharing of the same environment and habits.
That is, if the cause is hereditary or genetic, the syndrome can occur in members of the same family for reasons related to DNA.
However, the second hypothesis raises the possibility that families tend to share the same social environment, that is, they have similar eating habits, routines and similar stress levels. So the syndrome is more related to behavior than genetic inheritance.
Women
The syndrome is described by many researchers as possible to occur equally between men and women.
However, diagnoses point to a higher prevalence in women, in a proportion of 2 for each diagnosed man.
Some researchers point out that female prevalence occurs because, in general, women go to the doctor more and pay more attention to non-emergency issues.
Age
Adults between 20 and 45 years of age have a higher prevalence of IBS. Symptoms usually appear during adulthood and may remain with aging.
Psychiatric disorders and traumas
It is suggested that people undergoing treatment for a psychiatric disorder, such as anxiety or depression, are more likely to have the syndrome. Likewise, there is evidence that serious emotional trauma may precede bowel dysfunction.
Therefore, people who have severe emotional instability, who need psychiatric care or have emotional conflicts may be more susceptible to IBS.
Associated behaviors
It was mainly in 2005 that research related to patients’ behaviors and habits gained visibility in irritable bowel syndrome. The hypothesis is that there are behaviors not common to the patient’s routine capable of affecting the proper functioning of the intestine.
These activities are quite diverse and may include altering the amount of water ingested, drug use, occasional dietary changes (inserting a new food in meals) and consumption of non-edible substances (such as plastics or paper).
In addition, situations that are not always associated with the intestine can be risk factors. For example, doing physical activities without much frequency (cycling on holidays only) and fighting or fighting that could result in impacts on the abdomen.
Symptoms
The symptoms must be noticed by the patient in the last 6 months.
According to the criteria established by Roma III, signs of IBS involve recurrent abdominal pain or discomfort, changes in the frequency of bowel movements (for example, one week with diarrhea and the following week with a trapped bowel), in addition to the change in the appearance of the stools (more consistent, more liquid and irregular).
But other symptoms are reported by patients and are present in most cases:
- Gases;
- Intense pain;
- Swelling and stuffing;
- Difficulty evacuating;
- Need to go to the bathroom right after meals;
- Urgency to evacuate when cramps start;
- Feeling that defecation was not adequate / sufficient;
- Nausea and reflux;
- Vomiting;
- Loss of appetite;
- Abnormal relief after going to the bathroom;
- Change in the frequency of evacuations;
- Elimination of mucus through the rectum.
It is important to remember that, in most cases, symptoms are cyclical, with identifiable periods or not. That is, it is possible to trace the appearance of symptoms (during the week, in periods of stress, when eating certain foods), or not (when the body changes its digestive functioning without an apparent cause).
What can make the symptoms worse?
Some factors can worsen the symptoms or be the cause of them:
Specific foods
There are hypotheses that the intestines of patients with IBS are more sensitive to food groups, mainly lipids and carbohydrates .
Therefore, some nutritional components can trigger exaggerated responses, such as gas, stuffing and noise during digestion.
It is important to remember that the patient’s sensitivity can be altered by many factors. That is, it may be that in a period the body is very tolerant to lactose, but in times of stress it does not react adequately to the intake.
Stress factors
Altered emotional conditions (such as news of illness, death in the family or other conditions that have a high emotional impact), constant levels of stress (due to work, for example) or psychological disorders (such as depression or anxiety) may be associated.
In addition to being triggering or aggravating factors for the syndrome, emotional disorders can worsen due to IBS.
That is, it is not known for certain whether the emotional changes the intestine or IBS affects the mind. But the relationship is believed to be bidirectional and joint.
Thus, when the intestinal flow is altered, some patients perceive worsening of mood stability, feel more aggressive, irritated, depressed and sleepy. So the psychological worsening further affects the functioning of the intestine.
Tiredness and fatigue
A study conducted by Columbia University in the United States shows that between 35% and 59% of patients with chronic fatigue syndrome (CFS) also have IBS.
The results point to the relationship between syndromes and changes in certain intestinal bacteria.
The study helps to reaffirm the results of previous research: the bacteria present in the intestine directly impact the rest of the body and may be related to neurological diseases and symptoms as well, such as reduced memory, concentration and learning.
Associated diseases and conditions
Some diagnoses are associated with IBS, including:
- Fibromyalgia: occurs between 20% and 50% of patients with IBS;
- Chronic fatigue syndrome: occurs between 35% and 59% of patients;
- Temporomandibular joint disorder: up to 64%;
- Chronic pelvic pain: in up to 50% of those diagnosed.
How is the diagnosis made?
The diagnosis is made by exclusion, as there are no biological, chemical or structural conditions to cause changes in the intestinal flow.
The professionals most suitable for diagnosis and treatment are the general practitioner and the gastroenterologist , who will assess the symptoms, collect the patient’s reports and, mainly based on Roma III, and analyze the possible causes.
The doctor will investigate if:
- Symptoms persist for more than 6 months;
- Stress worsens the picture;
- The patient makes frequent consultations for different symptoms (not related to the intestine);
- Symptoms worsen after meals;
- There are current anxiety or depression conditions or if the patient has already undergone psychological treatment.
Several tests may be ordered to rule out other illnesses or dysfunctions. That is, for IBS to be diagnosed, it is necessary that there is no change in the results of the requested tests.
The professionals most apt to carry out the diagnosis and follow-up are the gastroenterologist, the nutritionist, the nutrologist and the general practitioner.
Roma III hair diagnosis
According to the Roma III criteria, the diagnosis occurs with the detection or confirmation of:
- Symptom onset at least 6 months before diagnosis;
- Recurrent abdominal pain or discomfort for more than 3 days a month for the past 3 months;
- The presence of at least two of the following characteristics:
- Improvement with defecation; changes in the frequency of bowel movements;
- Variations in the shape of the stool.
Differential diagnosis
As there is no specific test for the syndrome, tests and investigations are needed to exclude other diseases. Initially, the first signs observed are:
- Rectal bleeding (presence of blood in the stool);
- Abdominal pain that evolves during the night;
- Marked weight loss;
- Continuous abdominal pain (which does not subside after bowel movement).
These symptoms, in general, are not caused by IBS and can be indicative of more serious diseases, such as colon cancer , requiring further investigation.
When there are no symptoms listed above and the patient does not report a family history of gastrointestinal diseases, treatment with IBS medications can be started, with follow-up.
In this case, the improvement should be rapid, at most 1 month. If there are no positive responses to treatment for the syndrome, the patient should be referred for colonoscopy for further investigation.
In addition, tests may be ordered to rule out:
- Lactose intolerance;
- Laxative abuse;
- Diseases caused by parasites (such as giardiasis and enteritis);
- Celiac disease;
- Crohn’s disease;
- Early inflammatory bowel disease;
- Ischemic colitis;
- Hypothyroidism;
- Tropical Espru;
- Whipple’s disease.
According to the guidelines of the World Gastroenterology Organization for irritable bowel syndrome, it is still necessary to be aware of confusion with diseases:
- Colorectal carcinoma;
- Microcytic colitis (lymphocytic and collagenous);
- Acute or chronic diarrhea due to protozoa or bacteria;
- Small intestine bacterial super growth (SIBO);
- Endometriosis;
- Pelvic inflammatory disease;
- Ovarian cancer (in women over 40).
Exams
Irritable bowel syndrome does not have tests that can confirm the diagnosis or indicate specific changes caused by IBS. However, several tests can be ordered in order to rule out other diseases or dysfunctions in the body.
Tests that the doctor may order include:
Stool examination
Stool evaluation allows the identification of the presence of a parasite. The examination is simple, with the patient being asked to deliver a stool sample to the laboratory.
Blood count
The test is performed with a traditional blood collection, which is usually done on the arm. The sample makes it possible to assess the quantity and quality of red blood cells, leukocytes and platelets.
Briefly, red blood cells act in the transport of oxygen and nutrients, leukocytes protect the organism (act in the immune system) and platelets work in blood clotting.
As many patients with IBS may experience weakness, headaches and tiredness , the blood count helps to rule out cases of leukemia , anemia, infections and allergies, which can present these symptoms as well.
Internal bowel examinations
Internal (invasive) exams help to rule out countless possibilities for diseases and changes, such as cancer, intestinal obstruction, damage to the intestinal wall, presence of polyps or improper tissue formations, for example.
Among the requested exams, can be:
- Anorretal manometry;
- Colonoscopy;
- Video Retosigmoidoscopy;
- Upper gastrointestinal endoscopy and small bowel radiography
Imaging exams
Imaging tests also help to rule out other dysfunctions in the body. Generally, you are asked to:
- X-ray of the small intestine;
- Ultrasound of the abdomen;
- Computed tomography.
Is there a cure?
No. But the syndrome has control. Most patients are able to find resources that alleviate symptoms and discomfort.
In addition, the topic is still recent and several researchers have shown interest in further studies on the causes and treatments. This suggests that more effective therapeutic measures are close.
What is the treatment?
There is no specific treatment for the syndrome. Several measures can be adopted to alleviate the symptoms, sometimes combining medications that help to regulate intestinal transit, reduce gas, pain and discomfort.
The doctor will assess the patient’s condition and check the need to prescribe medication treatments, such as laxatives.
In general, the measures recommended for all IBS patients are changes in diet, fiber supplementation (in the types with constipation), stress reduction and medications that can affect the intestine.
In addition, it is necessary to maintain a good quality of sleep and observe emotional changes, such as anxiety, depression or irritability. If necessary, the doctor can refer the patient for psychological counseling and psychiatric treatment.
General care includes:
Feeding at the SII
The patient should make a self-observation and identify if there are foods that worsen the symptoms.
If there are specific food groups or foods capable of intensifying symptoms, they should be avoided as much as possible. In many cases, patients are sensitive to gluten, lactose, carbohydrates (especially simple ones, like sugar) and fats.
In addition, consuming excessive meals (more than people usually eat daily), alcohol or large amounts of caffeine tend to trigger symptoms more intensely.
In this case, it is recommended that the patient eat small meals throughout the day, opting for lighter and more natural foods, such as salads, fruits and vegetables.
Avoiding industrialized foods , rich in sodium, preservatives and stabilizers can reduce discomfort and the formation of gases, in addition to being a good measure for the health of the whole body.
According to the World Gastroenterology Organization practice guidelines for IBS, food treatment of the syndrome may involve:
Fibers
The diet consists of enriching the diet with fibers or components that facilitate the formation of fecal volume, such as psyllium flour.
There are 2 types of fibers: soluble and insoluble. The first dilutes in water and forms a kind of gel in the stomach. Upon reaching the intestine, it promotes fermentation and therefore improves bowel movement.
Insoluble fibers, on the other hand, do not dissolve in water and remain intact during digestion. In the intestine, they help to give more consistency to the fecal bolus, making it easier for the peristaltic movements to direct the content through the intestine.
In addition to adequate fiber consumption, there must be a good intake of water daily.
FOMAPs diet
The acronym means (F = Fermentable, O = Oligosaccharides, D = Disaccharides, M = Monosaccharides, A = and, P = Polyols) refers to the removal of fermentable carbohydrates from the diet.
The FOMAPs diet is recommended to promote a reduction in abdominal pain and bloating. But observations about the diet are recent and it is not yet clear what the long-term triggers are.
Probiotics and prebiotics
The use of probiotics may aim to alleviate or reduce general or specific symptoms. Probiotics and prebiotics are microorganisms that help to compose or reconstruct the intestinal flora, usually ingested through food.
For example, some may act solely to minimize gas and bloating. The global protocol for IBS does not recommend the widespread use (for all those diagnosed) of probiotics for long periods, mainly because supplementation tends to have a limited effect.
Despite being good health foods, pro and prebiotics are not a specific treatment for IBS, except in cases indicated by the doctor or nutritionist.
Medicines
Supplementation with:
Soluble and antispasmodic fibers , such as Buscopan , which are drugs capable of reducing movements within the intestine. These are considered first-line treatments, that is, they are usually the first drugs prescribed to patients after diagnosis.
Among the most recommended types are: otilonium , hyoscine , cimetrope, pinavério , dicyclomine and mebeverine .
In addition to antigases , the use of peppermint oil, according to global guidelines for IBS, has shown improvement in patients’ symptoms, with the advantage of having little or no adverse effects.
When symptoms are severe, antidiarrheal medications may be prescribed or, if there is constipation, laxatives .
As laxatives tend to be more aggressive with the intestinal flora, it is necessary to evaluate the benefits of their use, always resorting first to dietary and behavioral changes.
When the patient does not show significant improvements with the initial treatments, second-line drugs can be prescribed. They act directly on the intestine, and may involve:
- Rifaximina;
- Alosetron;
- Lubiprostone;
- Linaclotide;
- Loperamide ;
- Ramosetron.
Medicines that help with the emotional situation can be indicated, provided they are accompanied by a psychiatrist. Generally, fluoxetine , sertraline , citalopram and diazepam can be prescribed to reduce anxiety and depression.
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Dieta and SII
There are no specific diets for IBS, however, in addition to the procedures recommended by the guidelines of the World Gastroenterology Organization, studies and patients report significant changes in the symptomatic picture with the exclusion or reduction of the following components of food:
Fats
In general, foods rich in fats (lipids) cause an increase in bowel movements. For those with diarrhea or a high frequency of bowel movements, foods such as fatty meats, yellow cheeses and fried foods should be reduced.
Fructose
Foods rich in fructose, which is the natural sugar in fruits, can favor the formation of gases and intensify bowel movements.
Some of the products that have high amounts of fructose are: dried fruit, grape , strawberry, apple, jam, gelatin, pudding and cookies.
Sorbitol
Sorbitol is a substance present mainly in sweeteners and diet products (indicated for people with diabetes ).
In addition, foods such as plums, cherries, apples, chocolates and some sweets contain quantities capable of interfering with the digestive functioning of sensitive people.
Like fructose, sorbitol can favor the formation of gases, increasing intestinal discomfort.
Gluten
Human tolerance to gluten is hotly debated. While some researchers argue that only patients with celiac disease or allergy to gluten should eliminate it from the diet, others indicate that the protein should not be part of the diet.
Studies carried out separately by Harvard University and the University of Columbia indicate that there are no scientific benefits to removing gluten from food, except for sensitive and intolerant people.
This does not mean that people cannot feel better about not eating a certain food, as each organism responds very individually to food.
However, there is a prevalence between the intensification of IBS-related symptoms and protein consumption. In general, it is necessary for the patient to identify if it is all gluten foods that cause discomfort or if only a few.
For example, it may be that the discomfort is caused by the consumption of white wheat flour, which tends to form more gases and not by the gluten itself.
Dairy products
Some patients with irritable bowel syndrome are also lactose intolerant. However, even those who are not diagnosed with intolerance, may be hypersensitive to milk derivatives.
In this case, it is necessary to reduce the consumption of cheese, milk, yogurt, margarine and butters.
There are patients who report hypersensitivity even to lactfree products, which have the enzyme lactase . That is, it is necessary that the food is completely free of products with milk.
Seasonings
Seasonings and condiments are used to flavor food, but there are many cases of people unable to digest these components well.
Foods that are very spicy or with strong spices can trigger gastrointestinal reactions even in people with no apparent problems with the digestive system.
Living together
Each person will need to adapt the routine according to their symptomatic condition.
There are patients who will need severe changes in routine and diet. However, others manage to live with the SII without major impacts on daily activities.
Some measures can facilitate the control of symptoms that, not always, can be avoided. That is, even if the patient follows an adequate diet, emotional and even environmental conditions can trigger crises of pain and discomfort.
To live with the syndrome, in addition to the treatment indicated by the doctor, you can add other activities, such as:
Alternative measures
Acupuncture, yoga, music therapy, stretching, meditation and relaxing activities can favor the control of the emotional condition, providing improvements in the quality of life.
It is recommended that the patient find activities or exercises that combine well-being and emotional improvements, in order to reduce the levels of stress and anxiety.
Meditation controls breathing, reduces stress and improves emotional balance. Patients who adopt relaxing activities report that there is a decrease in symptoms, probably due to the reduction of stress levels.
For patients who have severe pain or malaise, staying calm and controlling their breathing during peak pain can help with the crisis. Deep breathing helps to relax the body and often decreases the perception of pain.
Even though relaxing activities are not directly capable of reducing gas or bowel movements, controlling the mind prevents anxiety from being elevated and, as a result, further worsens pain.
Behavioral training shows to be highly beneficial in IBS. Learning how to deal with everyday situations, progressive muscle relaxation, stress management, self-instruction and self-perception can be effective.
Consult a nutritionist
Food is a very present factor in the lives of patients with irritable bowel syndrome.
As the IBS has a very different behavior according to each patient, it is necessary that, initially, there is a self-assessment, identifying everything that may be a trigger for the malaise.
But, in addition to the standard dietary procedure, it is recommended to follow up with nutritionists.
Often, the need to reduce or eliminate some food from the routine can be quite unpleasant, although necessary. Therefore, accompanying with a professional will help to balance meals in a healthy way.
Sometimes, these foods can be gradually reinserted into the routine, but there are patients who opt for complete exclusion.
Despite bringing improvements to the symptomatic picture, diets can result in nutritional deficiencies, even if the results are only perceived in the long term. Therefore, multidisciplinary monitoring is important to stabilize the syndrome and maintain the good health of the body.
Natural products
There are several foods and products that can assist in intestinal transit. Especially those who have episodes of constipation, supplementation with fiber of passion fruit, eggplant , psyllium flour or flaxseed flour can assist in the correct digestive functioning.
Natural teas can be great options to facilitate digestion and decrease the formation of gases, such as chamomile, fennel, fennel and mint.
Mint oil has been shown to be effective in relaxing the muscles of the intestinal tube, improving organ movements.
Prognosis
Most patients have persistent symptoms of the syndrome, which can last for years. However, there is usually no worsening of symptoms or impairment of health.
Some patients present with stabilization of the condition, even without resorting to intense treatments (such as diets of complete food exclusion).
Others may experience significant improvements and isolated episodes of symptoms (for example, when experiencing stressful situations).
However, most patients are only able to alleviate symptoms, using complementary therapies (food, emotional control and medication), but they still live with frequent pain or discomfort.
Complications
The complications most associated with irritable bowel syndrome refer to daily limitation. In other words, the syndrome itself does not present evolution or severe impairment to the organism. However, the symptoms, for some patients, can make it difficult to carry out daily activities.
The pain and malaise can be intense, preventing common activities from being carried out, such as working or studying.
In addition, the condition can worsen emotional symptoms and psychiatric disorders, when present. If there is no due psychological monitoring, the patient may notice emotional changes, such as low self-esteem, insecurity and shyness.
These changes impact other daily spheres, for example, making it difficult for the patient to maintain links to social activities. Again, the person is part of a cycle that the IBS causes changes in the routine and they aggravate the symptoms more.
Therefore, irritable bowel syndrome can be a complicating factor for psychological disorders and problems.
In addition, patients who have high food sensitivity or who choose to adopt more rigid diets may have a marked reduction in weight.
In addition to diarrhea and, in some cases, vomiting, the organism’s involvement can be high. It is necessary to pay attention to the nutritional balance, hydration and the deregulations that can occur.
How to prevent irritable bowel syndrome?
The syndrome does not have proven preventive methods and its causes are believed to be multifactorial, which makes it more complex to prevent dysfunction. The recommendations, therefore, include care for the organism as a whole.
It is important to take care of the food, preferring natural products, with less preservatives and less industrialized. In addition, reducing stress rates, engaging in regular physical activity, and maintaining quality sleep have general health benefits.
As emotional factors are closely linked to the syndrome, care with emotional aspects has been shown to be quite relevant in preventive aspects.
Seeking less stressful routines, relaxing activities and less personal demands can be effective measures to reduce the incidence of numerous health problems.
Several problems, disorders and diseases are still relatively unknown to the medical community. But studies have sought the causes, treatments and prevention of conditions that can hinder patients’ quality of life.
Among these problems is irritable bowel syndrome, which is still a recent picture in the medical literature.
The syndrome, although it does not result in severe physiological compromises to the body, has a high impact on the patient’s routine and well-being.
It is not known yet to state the causes or the best procedure to be adopted in the diagnosis, but it is suspected that food and stress are quite associated with the triggering and worsening of IBS.
Care with nutritional balance, mental health and daily behaviors can alleviate the episodes. Although these measures are proven not to prevent or prevent intestinal disorders, they are extremely beneficial to health as a whole.
The stressful routine, carelessness with meals and sedentary routines are associated with a worse quality of life and worsening health in the long run.
Therefore, seeking measures that bring more comfort and well-being, prioritizing care with the body (including physical and mental health) are essential for those who want to keep their life in balance.
Find more information and tips on our blog!
