The diagnosis and treatment for IBS are determined on symptoms and a thorough investigation from the doctor or health practitioner. Thus it’s vital to understand how you feel and identify the reasons behind it.
Firstly, we as patients must describe the severity and frequency of the pain. ‘Chronic’ symptoms are long-lasting and persistent while ‘acute’ ones appear suddenly or have only started recently and hence are short-lived. It’s about the pain duration not the way it feels. For example, if diarrhoea occurs once a day or just a few times in a month, this is not classified as ‘chronic’ and might be due to poor hygiene or bacterial infection rather than something more serious.
After analysing your bowel movements, we then need to move to the abdominal pain which is the prime symptom of IBS. Studies show that the pain occurs due to ‘visceral hypersensitivity’ whereby the gut is very sensitive to bowel and bodily changes. This suggests that the pain is not actually in the gut but in the brain. The gut and the brain develop from the same part of the human embryo which explains why our intestines have such a rich nerve supply. We have all heard the expression – ‘Listen to your gut feeling’ – and it’s not surprising – your gut is your ‘little brain’.
In addition, the gut shares many nerves and chemical transmitters as the brain which shows their interconnection, known as the Gut-Brain axis. Nerve signals are exchange daily between the gut and the brain which includes stress responses and ways of controlling anxiety and fear. The majority of people, however, do not feel this process and experience hardly any discomfort (pain). However, since we are all different, in many IBSers, the environmental pressures often lead to increased brain sensitivity which is then transmitted or felt in the gut.
Imagine, for example, a stressful situation, such as taking a test or public speaking. We all experience both emotional and physical responses which is our nervous system’s way to meet a challenge. Emotionally, we might feel fear, anxiety or doubt, accompanied by physical sensations such as muscle tension, sweating, breathlessness or abdominal cramps. We differ in how we react to such stressful events and for many the response is felt in the gut which may be even hereditary. These people are known as the ‘Gut Responders’. I classify myself as such and have found this reaction to emanate from my childhood. I was a very emotional kid, expressing all my feelings often to the extreme. I also went through several love and friendship traumas that I believe had left their print on my ‘insides’. My mother was also quite a sensitive woman and used to suffer from stomach upset at young age. So, my dear busy bees, dig deep into your past and stressful life events to find patterns and occurring symptoms.
The gut-brain connection also explains the vise versa process. If the gut is experiencing constipation, bacterial infection or food intolerance, the brain will respond with fatigue, poor sleep and a headache. Research shows that eating spicy or too fatty meals right before bed might lead to interrupted sleep or even nightmares as the digestion required fires up metabolism which activates the brain. When it comes to identifying the pain origin, the situation becomes more complex as nerves pass from the abdominal organs to the spinal cord, connecting to other nerves that send information to the brain. If for example, a nerve from the gut enters the spine where a muscle nerve is, the pain may seem to be from that muscle, known as ‘referred pain’.
The gallbladder is another example. Since it lies under the lower ribs on the right, we would expect pain at this place. However, the ‘true’ pain is felt in the middle of the upper abdomen, spreading to the right shoulder blade. It is only during gallbladder inflammation that the pain reaches surrounding tissues, causing symptoms on the right-hand side of the upper abdomen.
The next step is to notice when the pain comes. Is it after a particular meal or physical activity? What makes the pain better or worse – is it posture, heavy breathing or a way of eating? Are there any other symptoms, such as blood in urine or headaches? Since the whole gut appears sensitive, it’s it the nature of the pain not the site that is important. Women might also notice increased pain in the days leading up to a period.
After the pain investigation follows the stool examination as there is often a change in the frequency and appearance of the stools. Below is a guidance, widely used by me and my colleagues in this process:
Stools at the lumpy end are hard to pass and require more straining which is associated with constipation. This is defined as 3 bowel movements or less per week plus 2 or more of the following symptoms:
- straining and lumpy hard stools
- sensation of incomplete bowel movement or blockage
- using hands to assist the bowel movement and straining.
Scientifically, constipation can be confirmed by either measuring the ‘whole gut transit time’ (WGTT) or by weighing the stools over a 24-hour period. The first method involves swallowing special markers that show up on x-rays while the latter requires faces collection over a day. The WGTT method is most reliable but since both techniques take time and effort, the stool guide is considered good enough to determine constipation.
Bloating usually comes with constipation. This is when the abdomen swells and is caused by constipation or gas. Excess gas is due to the fermentation of foods residues by the bacteria in the large intestines, or air swallowing which characterises anxiety. If the latter is the cause, we expell the swallowed air by belching. If you do this, then your gas doesn’t come from the bowel.
It occurs when we pass two or more loose stools each day and can be a result of the following:
- increased secretion of fluids
- reduced fluids absorption
- chemicals that increase the flow of fluids into the bowel
- increased bowel motility (movement)
In addition, IBS-D may be triggered by increased over-production of prostaglandins – hormone-like chemicals or increased bowel mobility. Infection is another common reason this comes from food poisoning or poor hygiene. The difficulty comes in specifying the type – is it too frequent bowel movements or just loose stools?
In many case, we also see alternation between constipation and diarrhoea. Thus the key to understand your IBS type is to analyse the stools. ‘Overload and overflow’ happens when we pass small hard stools for a week to 10 days and because the bowel has not emptied completely, the amount that builds up gets triggered later to cause a bout of overflow diarrhoea. In this instance, the diarrhoea is what gets treated while actually the underlying cause is chronic constipation which will get worse as the treatment prescribed aims to confirm it even further.
When it comes to IBS-D, we need to be aware that certain medication can cause the issue as a side effect. Some include antibiotics, beta blockers, calcitonin, cancer drugs, iron preparations, metformin, magnesium salts, statins and thyroxine.
This is the general symptomatology of IBS and we all need to go through this process to better understand our ‘guts’. There are, of course, other symptoms, such as tiredness, headache, joint pain and nausea. They key is to be your own detective and really tune in with your guts:)
Hope the above helps. Please feel free to share with friends and family and post your comments below.
In Health & Balance,