WHAT IS IBS?

Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder seen in general practice, representing over 30% of all referrals to gastroenterologists. Although IBS is often a diagnosis of exclusion, clinical judgment must be used to determine the extent of the diagnostic process required. A detailed case history and physical examination are invaluable when diagnosing IBS. The definition of IBS is a functional disorder of the large intestine with no evidence of accompanying structural defect. Distention, relief of pain with bowel movements, and the onset of loose or more frequent bowel movements with pain seem to correlate best with the diagnosis of IBS. Nervous indigestion, spastic colitis, mucous colitis, and intestinal neurosis are less popular terms that are sometimes used instead of IBS. Splenic flexure syndrome is a variant of IBS in which gas in the bowel leads to pain in the lower chest or the left shoulder.

ARE YOU SUFFERING FROM ANY OF THE FOLLOWING?

• Abdominal pain

• Altered bowel function, constipation, or diarrhoea

• Hypersecretion of colonic mucus

• Dyspeptic symptoms (flatulence, nausea, anorexia)

• Varying degrees of anxiety or depression

Many patients with IBS also have extraintestinal symptoms, including sexual dysfunction, dyspareunia (painful sexual intercourse), fibromyalgia, urinary frequency and urgency, poor sleep, menstrual difficulties, lower back pain, headaches, chronic fatigue, restless legs syndrome (RLS) and insomnia. These conditions tend to increase in number with the severity of IBS. The more extraintestinal symptoms a patient presents with, the more likely he or she is to have a severe case of IBS.

WHAT CAN BE DONE?

In most cases, a comprehensive stool and digestive analysis (CDSA) with special attention to dysbiosis, complete blood count, and measurements of erythrocyte sedimentation rate (ESR), free thyroid T3 hormone level, and coeliac testing should be performed to establish the diagnosis and exclude other diseases. If diarrhoea-predominant IBS symptoms are more pervasive, then additional testing will have to be completed.

When testing confirms a diagnosis of IBS the following therapeutic actions are considered:

Improve transit time, improve peristalsis, decrease mucosal permeability, correct dysbiosis, address neurotransmitter function, improve stomach function, decrease nausea, decrease flatulence, decrease abdominal distension, manage stress and identify and treat food intolerances or allergies.

All these actions can be achieved with herbal, nutritional and lifestyle interventions.

IBS symptoms should substantially improve within a 4-week period. No more bloating, no more mood swings and less time on the toilet.