Irritable Bowel Syndrome (IBS

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a digestive system disorder primarily affecting the large intestine. Previously, it was also called spastic colon or sensitive bowel syndrome. It is a common problem affecting approximately 15-20% of the population.

Typical symptoms include abdominal pain, a feeling of restlessness or discomfort in the abdomen, bloating, gas, and irregular bowel movements (diarrhea, constipation, or alternating stool consistency). It is a chronic condition without a definitive cure, characterized by periods when symptoms worsen and other times when they improve or disappear. In most patients, symptoms are generally mild, but in some, they can be severe enough to impact daily life. For most, lifestyle changes and stress management help reduce symptoms or make them tolerable.

Patients with severe symptoms may require medication in addition to lifestyle adjustments. IBS patients do not have any abnormality or damage in the bowel tissue, and the condition does not cause structural bowel disorders or colon cancer.

What is Irritable Bowel Syndrome (IBS)?

Irritable bowel syndrome is a functional disorder of the digestive system in which there is no structural abnormality in the intestines, yet symptoms such as abdominal pain, abdominal discomfort, bloating, gas, and changes in stool consistency and/or frequency occur. These symptoms are mainly caused by irregularities in bowel movements.

Laboratory tests and examinations targeting the intestines in these patients are normal. It is more common in women than men and usually begins after the age of 20. Symptoms can vary from patient to patient and may change in type and severity over time, even in the same patient.

What Causes Irritable Bowel Syndrome (IBS)?

The exact cause of irritable bowel syndrome is not fully understood. There are various factors believed to contribute to its development. Some of these include:

Irregularities in bowel movements: When the propulsive contractions that move the contents of the intestines downward become irregular, or when contraction-type movements dominate instead of forward-moving ones, symptoms such as gas, bloating, and diarrhea occur. When the regular forward contractions are replaced by irregular and weaker contractions, gas, bloating, and constipation develop.

Nervous system abnormalities: The digestive system has a very dense nerve network, which is why it is sometimes called the “second brain.” There is a strong interaction between the brain and the digestive system. This interaction is two-way: signals originating from the brain (such as stress) can affect the intestinal nervous system, causing irregular movements, or the intestinal nervous system may become hypersensitive (visceral hypersensitivity) and send incorrect signals to the brain. Both mechanisms lead to irregular bowel movements and cause symptoms.

Intestinal infections: Previous intestinal infections are thought to increase the sensitivity of nerve perception within the intestines over time, contributing to irregular bowel movements and hypersensitivity in irritable bowel syndrome.

Severe intestinal infection: Some IBS patients have a history of severe gastroenteritis before their symptoms began. These cases are described as “Post-infectious Irritable Bowel Syndrome (PI-IBS).” Additionally, past intestinal infections and the antibiotics used to treat them can disrupt the gut flora, leading to IBS symptoms.

Flora imbalance: Some IBS patients show disturbances in their gut microflora, characterized by a reduction in beneficial bacteria.

Food intolerance: Approximately 10% of patients with IBS symptoms have complaints related to food intolerance. It would not be accurate to categorize these patients strictly as having IBS. However, dietary habits and certain lifestyle factors (such as consumption of legumes that cause excessive gas, alcohol, and smoking) may trigger or worsen IBS symptoms.

Diverticula: Diverticula are small pouch-like protrusions of the intestinal wall that are more common in the large intestines of people who consume low-fiber diets and usually appear at older ages. These diverticula can cause symptoms similar to those of irritable bowel syndrome.

What Are the Symptoms of Irritable Bowel Syndrome (IBS)?

The most prominent complaints of patients with irritable bowel syndrome are abdominal pain, abdominal discomfort, excessive gas, bloating, and irregular bowel movements. Other symptoms can be described as follows:

Frequent and irregular bowel movements with soft stool consistency, often described as diarrhea
Hard stool consistency, described as constipation. Unlike normal constipation, patients often experience abdominal pain, excessive gas, and bloating alongside constipation
Changes in symptoms after bowel movements; in most patients, symptoms improve or decrease, but a small group may experience worsening symptoms
Urgent need for bowel movements, especially occurring immediately after meals
Feeling of incomplete evacuation after bowel movements
Presence of mucus in stool (if excessive and dirty-looking, other causes should be investigated)
Symptoms usually do not occur during sleep and do not wake the patient up

Are There Any Symptoms of Irritable Bowel Syndrome (IBS) Outside of the Bowel Complaints?

Patients with irritable bowel syndrome often experience migratory musculoskeletal pains. Other frequently accompanying complaints include:

Sleep problems
Headaches
Fatigue
Chest pain
Fibromyalgia (especially back pain)
Chronic pelvic pain
Anxiety and depression

Who Is Affected by Irritable Bowel Syndrome (IBS)?

Irritable bowel syndrome is one of the most common disorders in all populations, affecting approximately 15-20% of people. It is more frequent in women than in men. IBS is more commonly seen in individuals who are overly sensitive in social relationships, meticulous, emotional, and tend to experience events intensely within their inner world. Therefore, stress is one of the most important factors triggering symptoms in such individuals. If a family member has IBS, the likelihood of other family members having it is higher. IBS usually begins in young adulthood.

What Worsens Irritable Bowel Syndrome (IBS)?

Since IBS is a chronic condition, it is important to know the factors that trigger symptoms. Factors that can provoke IBS symptoms include:

Foods: Published studies indicate that about 10% of patients with IBS-like symptoms have food intolerances. However, in IBS patients, some foods can trigger or worsen symptoms. Especially legumes, citrus fruits, cabbage, radish, and other foods that produce excessive gas in the intestines, as well as carbonated beverages.
Stress: Conditions such as anxiety, depression, and emotional, physical, or sexual trauma. In most IBS patients, increased stress plays a significant role in symptom flare-ups or worsening.
Aerophagia: Most of the gas in our intestines comes from air swallowed unconsciously. Normally, this does not cause significant discomfort, but due to increased intestinal sensitivity in IBS patients, discomfort can arise. Also, if these patients eat quickly, the amount of swallowed air increases, which leads to more bloating.
Menstrual cycle: In women, symptoms can be triggered or worsened during menstruation or the premenstrual period.
Certain medications: Anti-rheumatic painkillers and antibiotics can also act as triggers.

What Are the Risk Factors for Irritable Bowel Syndrome (IBS)?

Anyone can occasionally experience IBS-like symptoms due to certain foods, stress, travel, or climate changes, but these are usually temporary. For patients who meet the criteria for the chronic condition called irritable bowel syndrome, some risk factors can be identified:

Being a young adult (more common under age 50)
Female gender
Having a family member with irritable bowel syndrome
Presence of anxiety disorders or depression
History of trauma such as sexual or emotional abuse

How is Irritable Bowel Syndrome (IBS) Diagnosed?

Huzursuz Bağırsak Sendromu

Irritable Bowel Syndrome (IBS) is a functional disorder diagnosed by excluding other diseases that cause similar symptoms.

A detailed evaluation of the patient's complaints is essential. Symptoms such as weight loss, anemia, bloody or mucus-containing stools, significant loss of appetite, a family history of early-onset colon cancer (under 50 years),pain or urgent need to defecate waking the patient from sleep require ruling out diseases other than IBS first.

The diagnostic criteria include symptoms lasting at least 6 months, the onset of abdominal pain or discomfort accompanied by a change in bowel habits, and improvement of symptoms after defecation or passing gas (although symptoms may worsen in a small group of patients). Changes in bowel habits may present as non-bloody diarrhea or constipation without prominent mucus, or a cycle of diarrhea and constipation.

Other supporting findings for IBS include urgent bowel movements especially after meals, particularly breakfast, and the feeling of incomplete bowel emptying.

Symptoms do not always remain constant; they may worsen at times or completely disappear in some patients. It is important to consider whether triggering foods are involved, especially during symptom flares, to differentiate from food intolerances (such as gluten or lactose). Some IBS patients may also experience stomach bloating, indigestion, frequent belching, and musculoskeletal complaints like fibromyalgia.

Following detailed history and physical examination, further investigations such as endoscopy, colonoscopy, computed tomography (CT),and stool tests (to exclude other diseases) may be performed to confirm the diagnosis.

What is the treatment for Irritable Bowel Syndrome (IBS)?

Before starting treatment, it should be clearly explained to the patient that IBS is a chronic condition and there is no definitive cure. Lifestyle and dietary changes are important parts of treatment:

Reducing stress; psychiatric support if necessary
Avoiding or reducing foods that trigger symptoms
Consuming fiber-rich foods
Drinking plenty of fluids
Regular exercise

Treatment should be tailored according to the type (diarrhea-predominant or constipation-predominant),severity, and frequency of symptoms. The main goal of treatment is to reduce symptoms to a level that does not disrupt the patient’s social and psychological well-being, and to keep the condition under control as much as possible. There is no single treatment method, and cooperation between the patient and physician is very important for management.

When lifestyle and dietary modifications are insufficient, medications aimed at relieving symptoms may be added. Medication varies depending on the type of IBS:

Anti-diarrheal drugs for diarrhea
Laxatives (stool softeners) to prevent constipation
Drugs that help regulate bowel movements
Pain relievers

If symptoms remain bothersome, especially the use of “tricyclic antidepressants,” psychiatric support may be beneficial as part of the treatment.

How to Follow a Diet for Irritable Bowel Syndrome (IBS)?

There is no standard special diet that can be recommended to everyone. Similar to medication recommendations, dietary advice should be tailored according to the type and severity of the patient's symptoms. For some patients, managing this process with the support of a dietitian may be more effective.

First of all, during the diagnostic process, it is important to determine whether there is any food intolerance (tests may be done if necessary),such as gluten or lactose intolerance. Since identifying foods that trigger symptoms is important for recommending a diet, keeping a food diary to track and identify these foods may be suggested.

As for the dietary style:

Consume fresh fruits, vegetables (except cauliflower, broccoli, cabbage, leek, etc.),and high-fiber grains (like flaxseed, oats, etc.)
Drink plenty of water
Reduce caffeine intake or stop it if necessary
Regularly consume probiotic foods such as homemade yogurt, kefir, tarhana, and sauerkraut
Avoid fried and high-fat foods
Avoid foods and drinks containing artificial sweeteners
Avoid excessively spicy foods
Stay away from alcohol and smoking
Eat slowly and chew food thoroughly
Avoid carbonated drinks
Avoid eating late at night

Can Irritable Bowel Syndrome (IBS) Be Prevented?

Changes in daily lifestyle and eating habits are important for preventing IBS symptoms and reducing their severity and frequency.

Getting regular and sufficient sleep
Exercising regularly
Avoiding stress as much as possible

What Are the Alternative Treatments for Irritable Bowel Syndrome (IBS)?

Alternative treatments may not be effective for every patient but can be beneficial for some.

Probiotics containing beneficial bacteria such as Lactobacillus and Bifidobacterium
Herbal teas like chamomile, fennel, and peppermint (these can relax intestinal muscles and reduce abdominal bloating and discomfort)
Psychiatric support and medication, especially for patients with severe stress and anxiety

When Should Patients with IBS-like Symptoms See a Doctor?

Symptoms similar to those of IBS can also be seen in diseases such as colon cancer, inflammatory bowel diseases (IBD),some infectious colitis, hyperthyroidism, celiac disease, food allergies and intolerances, intestinal strictures, adhesions, diverticular disease of the colon, and microscopic colitis.

Therefore, patients should definitely consult a doctor if any of the following conditions occur:

Unintentional weight loss
Loss of appetite
Waking up at night due to diarrhea or the need to defecate
Blood or mucus in stool
Iron deficiency anemia
Vomiting along with symptoms
Symptoms not relieved by defecation or passing gas
Difficulty swallowing
Early-onset (under 50 years) colon cancer in close family members