Shweta, a 30 year old professional felt constant discomfort and bloating in her abdomen. She sometimes found it hard to manage at office as she had bouts of constipation alternated with diarrhoea while at work. Her work was extremely stressful resulting in head aches and tightening of the muscles in her neck and shoulders. She was advised some tests by her doctor and was diagnosed with Irritable Bowel Syndrome (IBS).

IBS is a common gut disorder whose symptoms include stomach pain, bloating, and sometimes incidents of diarrhoea and/or constipation. This could be caused due to over activity of some parts of the digestive tract. Once food is ingested it passes down the gut by movements known as peristalsis (Peristalsis is a series of wave-like muscle contractions that moves food to different processing stations in the digestive tract. The process of peristalsis begins in the esophagus when a bolus of food is swallowed- medlineplus.gov). Pain can occur when the contractions of nerves or muscles of the gut become abnormal or overactive, depending on which area in the gut this happens, it could result in either constipation or diarrhoea. Sometimes anxiety, stress or emotional upsets trigger symptoms.

These symptoms can come and go and while there is no cure, with changes in diet, lifestyle and treatment one can live a normal life. The gut looks normal without any visible changes during IBS but the symptoms and blood tests are often what help in diagnosis.

Symptoms can include the following -

Abdominal pain and discomfort: The pain is usually intermittent and occurs in different parts of the abdomen, this pain could last for a few minutes or longer. Passing stools or gas usually causes relief.

Bloating: The abdomen usually looks bloated and swollen due to gas formation

Bowel movements: Some people experience diarrhoea or constipation, though some may have both. The stools are small and pellet or ribbon like and are loose and watery or could be mixed with mucus. Even after passing stools there may be a feeling like the rectum is not emptied completely. In the morning, there could be an urgency to use the toilet several times on waking up, during and after breakfast.

In addition to the above symptoms the doctor may also ask that tests be done.

These tests include:

Stool sample- which helps rule out other gut infections, ovarian cancer, Crohn's disease, Ulcerative Colitis and Coeliac disease

CBC- Complete Blood Count to check for anaemia. Iron deficiency anaemia is also associated with gut disorders.

ESR (Erythrocyte Sedimentation Rate) and C reactive protein- to check for inflammation

Blood tests- to check for coeliac disease and in women to rule out ovarian cancer

Treatment:

Managing stress- Avoiding stressful situations and learning to manage stress helps ease symptoms. Sometimes therapy and counselling can also be beneficial.

Regular exercise- being active helps increase levels of fitness which helps reduce symptoms

Medications-
• Antispasmodic medicines for abdominal pain help by relaxing the muscles in the wall of the gut.
• Soluble fiber and laxatives ( used for a short while) help relieve constipation
• Antidiarrheal medications can also help with diarrhoea, these work by slowing the movement of stool through the colon
• Enteric coated peppermint capsules have shown to be effective to treat bloating
Note: Never attempt to self-medicate. Medication needs to be taken only under the recommendation of a Physician, since self-medication can have adverse health effects.

Diet Therapy:

For those with IBS, even while following a healthy balanced diet, certain foods can trigger or aggravate symptoms. There is no particular ‘diet' that works for everyone. Keeping an individual food and lifestyle diary in these instances may help; this should be maintained for at least 2-3 weeks. Everything that is eaten or drunk should be noted along with incidents of stress and any exercise done. This can also be helpful when a medical practitioner decides on the best mode of treatment. Maintaining the diary after starting with treatment helps to assess whether a treatment has shown a positive improvement in symptoms or not.

In addition the following guidelines may also be beneficial:

1. Eat meals on time and do not leave long gaps between meals, healthy snacks in between help to ensure that calories are spread well over the day without causing overeating. Chew food slowly and avoid any distractions or stressful situations while eating.

2. Avoid caffeine (tea, coffee, chocolate, colas, soft drinks) and stress on plain water. If your water intake is low, aim for at least 8 glasses of water during the day to start with, gradually increase your intake. Carrying a bottle of water with you can be a helpful reminder to drink more. Water is important for good bowel movements as it softens the stools.

3. The consensus on fiber has been conflicting, since it is advised to limit the intake of high fiber food and limit fresh fruit to 3 portions per day (1 portion being 80 g). However, in some individuals an increase in fiber intake was found to be beneficial. The type of fiber is important, soluble fiber which dissolves in water easily helps to ease symptoms, whereas insoluble fiber (especially bran) did not seem to have the same effect. For those with constipation high fiber intake was beneficial, but in those who had diarrhoea fiber seemed to make the symptoms worse. Sources of soluble fiber include- oats, psyllium husk, nuts, seeds (like linseed), fruits (in the recommended amounts) and pectins.

4. Artificial sweeteners like sorbitol found in chewing gum, drinks, diabetic friendly and slimming products should be avoided.

5. Oats and linseeds was found to be helpful to reduce gas and bloating.

6. FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols)

These are carbs in foods that aggravate the symptoms of IBS.

Foods in this list include:
• Fruits like apples, cherries, peaches and nectarines.
• Vegetables- peas, cabbage, broccoli and Brussels sprout (choti gobi).
• Artificial sweeteners like sorbitol ( as mentioned above)
• Dairy products- milk, ice cream, cream and cheese

While avoiding certain foods, it is better to consult with a qualified Dietitian for help with an exclusion diet. This is important to avoid eliminating whole food groups and preventing nutritional deficiencies. It would also help to identify possible triggers caused by certain foods. People have found this approach helpful to identify a particular food or foods that cause symptoms. By avoiding them, this can help control symptoms and experience relief. Trigger foods commonly include but are not limited to the following: Wheat (in bread and cereals), barley, dairy, caffeine, few fruits and onions

7. Probiotics contain good gut friendly bacteria; these may help to ward off bad bacteria that cause IBS symptoms. Probiotics are available as drinks or capsules and are also found in certain dairy products like curd and buttermilk.

IBS is a condition that does not shorten your lifespan. It causes discomfort which can be managed with diet and lifestyle changes. It does not lead to serious conditions like cancer of the bowel or gut or blockages.