Irritable bowel: causes and treatment of irritable bowel syndrome

Irritable bowel: causes and treatment of irritable bowel syndrome

Unpleasant abdominal pressure through to abdominal pain, a feeling of fullness,  flatulence  and  diarrhea  – irritable bowel syndrome (IBS or simply irritable bowel syndrome) has many faces. Irritable bowel syndrome is harmless, but often very uncomfortable for those affected. The symptoms are diverse – as is the name of the disease: In addition to irritable bowel syndrome, the terms irritable bowel syndrome (IBS), irritable colon, irritable bowel syndrome (IDS) or nervous bowel are also commonly used. What is known about the causes of irritable bowel syndrome, what signs can point to irritable bowel syndrome and what role do medication and nutrition play in therapy?

What is an irritable bowel?

Irritable bowel is a generic term for functional gastrointestinal diseases. These are constant or recurring complaints in the gastrointestinal tract for which no physical cause can be found. In fact, the diagnosis of irritable bowel syndrome should only be made after other diseases have been ruled out using various diagnostic measures.

Precise information on the frequency of irritable bowel syndrome in Germany is difficult; Estimates are 10 to 20 percent (or even higher) of the total population. Women are affected more often than men.

What is the cause of irritable bowel syndrome?

It is still not fully understood how irritable bowel syndrome develops. However, there are different theses, which we will explain in more detail below.

Impaired intestinal motility

Researchers suspect that impaired intestinal motility and hypersensitivity of the gastrointestinal tract play together in the disease. The intestinal muscles work too fast or too slow or react incorrectly to stimuli. Due to this lack of coordination, both the chyme and the intestinal gases are transported in a delayed and then accelerated manner, which can result in symptoms such as a feeling of pressure and fullness, flatulence and  constipation  alternating with diarrhoea. Increased activity of nerve and epithelial cells in the gut due to disrupted bile acid metabolism could also trigger the health problems.

Hypersensitivity of the nerves

Also noticeable is an increased sensitivity of the nerves, in particular an increased sensitivity to pain of those affected in the area of ​​​​the intestine: normal nerve stimuli such as the stretching of the intestine are interpreted by the nervous system as pain – which explains why cramp-like abdominal pain or an unpleasant feeling of fullness occur especially after eating . Presumably there are other triggers or can worsen the symptoms of irritable bowel syndrome. In general, a connection between an increased sensitivity of the nerves in the intestine to stimuli (hypersensitivity) and the development of IBS is suspected.

psychological factors

Psychological factors such as stress, fear or grief could also play a role in the development of irritable bowel syndrome. It has been proven that the psyche can influence intestinal activity and that people in stressful situations  develop stomach pain  or diarrhea, for example. Conversely, long-standing irritable bowel syndrome can in turn cause psychological problems.  Irritable bowel syndrome is more common in anxiety disorders or  depression .

gastrointestinal infections

Gastrointestinal infections are discussed as another possible trigger for an irritable bowel syndrome. As a result of such a disease, the intestinal flora, i.e. the balance of bacteria in the intestine, can be disturbed, which could promote the development of IBS.

Increased permeability of the intestinal wall

Tissue samples from the large intestine have been used to determine that some people affected have an increased permeability of the intestinal wall (increased permeability). This allows harmful substances to pass through the intestinal barrier and thus trigger an immune reaction, which is shown, for example, by increased inflammation values. It has not yet been conclusively clarified whether the excessive permeability of the intestinal wall is a cause or a consequence of IBS.

Other triggers possible

In general, many different influencing factors on the development of irritable bowel syndrome are discussed. In addition to those already mentioned, potential causes include genetic factors, hormonal influences or altered signal processing in the brain.

Whether an unhealthy diet or the consumption of alcohol and nicotine contributes to the development of irritable bowel syndrome has not yet been scientifically clarified. Excessive colonization with intestinal fungi (Candida) is often held responsible – there is no scientific proof for this thesis either.

Irritable bowel: symptoms

The symptoms of irritable bowel syndrome are diverse and can lead to very different problems in the gastrointestinal tract.

Among other things, these signs can indicate IBS:

  • cramping abdominal pain
  • bloating
  • Diarrhea
  • constipation
  • gas

It is also typical that the stomach pain and the feeling of fullness usually improve after a bowel movement. Irritable bowel syndrome is divided into different types (e.g. IBS-D, i.e. irritable bowel syndrome with leading diarrhea) depending on which symptoms occur particularly frequently.

You can find more detailed information on the  symptoms of irritable bowel here .

Diagnosis of irritable bowel syndrome

The diagnosis of an irritable bowel is difficult due to the unclear causes and diverse symptoms. The so-called Rome IV criteria, which should be consulted by the doctor, provide clues. These criteria include the following points:

  1. Stomach pain occurs regularly at least once a week.
  2. The symptoms have existed for at least three months and first appeared at least six months before the examination date.
  3. The symptoms are related to bowel movements.
  4. The consistency of the stool and the frequency of bowel movements are altered.

In addition, the diagnosis is made by excluding other diseases as triggers. Intestinal infections, for example, but also serious illnesses must be ruled out. These include  colon cancer  and chronic inflammatory bowel diseases such as  Crohn’s disease , but also  stomach ulcers  and stomach cancer,  celiac disease  and  liver diseases .

Various measures are used for exclusion diagnostics:

  • a palpation of the rectum
  • Gastroscopy and  colonoscopy
  • ultrasound scans
  • Stool and blood tests

When discussing the medical history, specific questions are also asked that are intended to provide information about the possible presence of other diseases – for example, when the symptoms appear, how long they have existed, or whether there are accompanying symptoms such as fever and weight loss.

Tests to rule out lactose or fructose intolerance  or an  allergy are often   carried out in the case of irritable bowel syndrome.

What to do with irritable bowel? therapy and tips

Although irritable bowel syndrome is harmless in itself, it is often very stressful for those affected and associated with restrictions in everyday life. Treatment for irritable bowel is primarily aimed at relieving the symptoms and reducing the frequency of their occurrence. Complete healing of the irritable bowel is usually not to be expected. It makes sense to find possible causes and to eliminate or avoid them as far as possible.

In the case of acute pain, it helps many sufferers to treat the irritable bowel by applying heat, for example with a heating pad or spelled pad on the stomach. A gentle circular abdominal massage in a clockwise direction often relieves the pain of irritable bowel syndrome.

Treating irritable bowel syndrome: Medication does not always help

Whether medication makes sense as part of the treatment should be discussed with a doctor. There is no classic drug for the treatment of irritable bowel syndrome, instead a suitable therapy is selected depending on the symptoms. It is then often first tried for a limited period of time to see whether the medication is working. Some of the available medications only work for some people:

  • Antispasmodic agents  (spasmolytics) such as butylscopolamine help in individual cases, but should not be taken permanently because of their side effects.
  • Substances against flatulence  such as simethicone rarely bring about an improvement in symptoms, but are worth a try.
  • Laxatives are not recommended for treatment  . In the long run, they lead to getting used to it, which is counterproductive in the case of chronic irritable bowel syndrome.
  • Constipating substances  such as  loperamide  should only be taken for a short time.
  • Abdominal pain may be relieved by  antidepressants  as they raise the pain threshold. These remedies should only be used if a mental illness is present at the same time as IBS or if the pain is particularly severe.

When choosing the medication, it is also important to know whether the affected person suffers more from diarrhoea, constipation or both symptoms.

Reduction of psychological stress

Strong mental stress can also influence the symptoms of irritable bowel syndrome. Depending on the extent of the symptoms, cognitive  behavioral therapy , autogenic training or other relaxation techniques can help to alleviate the symptoms.

In the case of very high levels of suffering or pronounced symptoms, psychotherapeutic support can also improve the irritable bowel syndrome. Methods used are, for example, behavioral therapy, talk therapy or hypnosis.

Those affected are often concerned about their health. It is therefore important for them to know that the disease affects their quality of life, but not their life expectancy. An irritable bowel does not increase the risk of colon cancer or other complications.

Acupuncture as a therapy option

There are a number of promising studies on the effectiveness of acupuncture in irritable bowel syndrome – acupuncture can help in particular with diarrhea as part of the symptoms and as a supplement to other forms of therapy. The effect of acupuncture concerns both the alleviation of symptoms and the increase in quality of life. Side effects are usually only mild pain and bruising.

The role of diet in irritable bowel syndrome

An important general measure in the treatment of irritable bowel syndrome and thus also to prevent the symptoms is to change your diet.

There are  no general recommendations. Rather, in the case of IBS, it makes sense to talk to the doctor about a sensible change in diet that suits the main symptoms that are occurring. Medical nutritional advice is also useful in the run-up to a change in diet in order to avoid deficiency symptoms caused by the omission of foods.

A healthy, balanced diet with lots of fiber and sufficient liquid is generally recommended. So-called soluble  fibers  are particularly important. They serve as food for the healthy intestinal bacteria and are contained, for example, in fruit and vegetables, but also in  oats  and  barley  .

Wichtig sind regelmäßige Mahlzeiten, bei denen man das Essen in Ruhe genießen und nicht hastig herunterschlingen sollte. Häufigere und dafür kleinere Mahlzeiten sind empfehlenswert. Auf stark blähende, fettreiche, sehr heiße, scharf gewürzte oder kalte Speisen sollte größtenteils verzichtet werden. Sind Unverträglichkeiten bekannt, sollten diese berücksichtigt werden. Kaffee und Alkohol sollten allenfalls in Maßen getrunken werden.

Viele Betroffene profitieren vom regelmäßigen Verzehr von Probiotika (zum Beispiel Joghurt, Apfelessig oder bestimmte Käsesorten). Probiotische Präparate zum Ausgleich der Darmflora sind auch in der Apotheke erhältlich.

In addition, the so-called  low-FODMAP diet is  part of many treatment approaches for irritable bowel syndrome. Low stands for “little” or “low”, FODMAP for fermentable oligo-, di- and monosaccharides and polyols. These short-chain carbohydrates are difficult to absorb through the small intestine. When they are converted, gases are produced in the large intestine, which in turn causes flatulence. Abdominal pain is also attributed to the consumption of FODMAPs. If IBS is known, a low-FODMAP diet should be considered as a possible treatment option.

In general, it is advisable to drink a lot if you have gastrointestinal problems. Low-carbonated, well-tolerated drinks, such as (not too hot) herbal tea or still water, are best suited.

Home remedies and tips for irritable bowel syndrome

In addition to medical treatment, those affected can also use home remedies and behavioral changes to help alleviate the symptoms of IBS.

Herbal medicine offers  caraway or peppermint oil  for consumption (in the form of  tea  or capsules).  Psyllium seeds  or psyllium husks have a mild laxative effect on irritable bowel syndrome. Bulking substances taken in with food, such as  linseed  and wheat bran, stimulate intestinal activity, but must be taken with plenty of fluids.

Healing clay is also   said to have a positive effect on the symptoms of irritable bowel syndrome. A study on the subject confirmed that those affected experienced an improvement in diarrhea symptoms and general quality of life when they took healing clay twice a day. However, the study group examined was very small with 80 participants.

Further tips against irritable bowel syndrome:

  • Getting enough exercise can help relieve your symptoms. Exercise regularly – this will keep your body fit and help you reduce stress.
  • Build fixed periods of rest and recovery into your everyday life so that you can switch off in a targeted manner. Relaxation techniques such as yoga or progressive  muscle relaxation are also  suitable for reducing stress.
  • In the case of acute problems, a hot-water bottle or heat pack can help alleviate the symptoms.

It can be helpful to keep a diary to track down the cause of your symptoms. On the one hand, you can note when the pain occurred, what foods you ate and how severe your symptoms were. On the other hand, the diary can also be used to note how you felt on the individual days and how great the stress was at work or in your social environment, for example.

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