Allergy Capital

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Irritable Bowel Syndrome

Irritable bowel syndrome is an uncomfortable but not dangerous condition affecting the small and large intestine. It is a diagnosis of exclusion. Common aggravants include stress, the menstrual cycle and food intolerance.

What is irritable bowel?

Irritable Bowel Syndrome effects the small and large bowel. Common symptoms are loose bowel motions, constipation, cramps, wind and bloating. While uncomfortable, irritable bowel is not dangerous and does not decrease life span. Irritable bowel is diagnosed when no other cause can be found for these symptoms, such as an ulcer, celiac disease, lactose intolerance or inflammation in the bowel.

What Causes Irritable Bowel Syndrome?
The cause is unknown. Symptoms often (but not always) follow an acute gut infection. One theory is that symptoms are experienced because the bowel is more sensitive than usual, and because muscle contraction within the bowel is poorly coordinated. There is no good evidence that infection with Candida albicans (the "yeast connection") causes irritable bowel, nor that treatment with anti-yeast agents is helpful. While dietary factors can sometimes worsen gut symptoms, irritable bowel is not due to a food allergy and food allergy testing is seldom of use in diagnosis.

How common is it?
Symptoms of irritable bowel are quite common (perhaps up to 20% of the population), especially in those who are stressed and have anxiety or depression. Indeed, treatment of these conditions sometimes relieves symptoms of irritable bowel syndrome as well.

What makes it worse?
The severity of symptoms is frequently influenced by:

• Dietary factors (food intolerance)
• Stress, anxiety
• Menstrual cycle

What Type of Tests are Necessary?
A number of tests may be performed to exclude conditions that can cause similar symptoms. Test may include examination of stool ("poo") samples, some blood tests or looking directly into the stomach (endoscopy) or lower bowel (colonoscopy) using a fibreoptic telescope. When necessary, these tests are normally performed under sedation by a specialist gastroenterologist or surgeon.

Treatment Options

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  Identify potential triggers. A symptom diary is helpful in identifying factors that worsen symptoms such as dietary factors or stress so that steps can be taken to manage these.
• Set realistic goals. Dietary change and the use of medications can reduce (but not necessarily abolish) symptoms and improve quality of life.
• Relaxation therapy or self-hypnosis is useful when stress plays a role.
• Exercise is often helpful
• Avoid excessive caffeine. This bowel stimulant often worsens diarrhoea and mucus.
• Adopt a healthy approach to diet. Eat a variety of foods, including wholemeal bread, fruit, vegetables and have plenty of water to re-establish a regular bowel pattern.
• Avoid some foods. Occasionally, excessive wheat bran actually increases wind and bloating, particularly if introduced too rapidly. In these cases, fibre from fruit, vegetables, rice or barley bran may be better tolerated. Sometimes foods like baked beans, soy beans, cabbage or onion can worsen bloating and wind. This is because carbohydrates in these foods can be fermented into additional gas by bowel bacteria.
• Medications can be useful. Medications may sometimes help by acting as stool softeners, as artificial "fibre", reducing muscle spasm or by slowing the rate at which food passes through the gut. Older laxatives containing senna are best used infrequently because they can make the problem worse in the long term.
• Elimination diets sometimes help. Some patients find that milk or wheat worsen their symptoms. Sometimes naturally occurring food "chemicals" such as amines, salicylates and MSG can do so as well. Since irritable bowel is not caused by allergy, allergy testing is of little use in identifying dietary triggers. The only reliable way to sort out whether diet is playing a role is by placing patients on a temporarily "elimination diet" under the supervision of a skilled dietitian. If the diet helps, this is followed by challenges with dietary factors under controlled conditions. The aim is to identify potential dietary triggers so that they can be avoided.