“I think I have irritable bowel”, “I have been told that I have irritable bowel”, “today he did not come to work for irritable bowel”, and similar expressions are very common in a wide sector of the population affected by this problem, one way or another.
In a very recent study it has been estimated that, in our country, the average prevalence is 4.2%, that is, that almost two million compatriots have, or have, an irritable bowel, whether they know it or not and receive it or not. some treatment for it. And this prevalence is nothing compared to that of Mexico City, for example, where at some point it has reached more than a third of the population.
Women and young people, less than 50 years old, suffer from it more frequently, as do those who have fibromyalgia, chronic fatigue syndrome, anxiety, depression or stress, with which it is associated.
But what is “irritable bowel” really? The first thing to know is that the proper term is “irritable bowel syndrome” (IBS), because the disorder is not limited to the colon, but affects the small intestine as well. It is a functional disorder, that is, in which intestinal function is altered, without detecting any (organic) disease itself, such as colitis, polyps or colon cancer.
Although the definitive diagnosis must be established by the doctor, who will advise us on a series of hygienic-dietary measures to follow and the most appropriate treatment for each case, we can know, with a high degree of probability, if we have IBS, or not , attending to a series of criteria that are specified in simple and easy-to-answer questions, together with a series of conditions.
These criteria to make the diagnosis, called Rome (in its IV edition) are: having abdominal pain (it is the essential symptom, condition sine qua non to have irritable bowel), which must be chronic, recurrent and intermittent and appear at least one day a week, and the pain must be related to defecation and be associated with a change in frequency and / or shape of feces. These symptoms must be chronic, have had them for at least six months and be present for the last three.
When diarrhea occurs, it is usually characterized by loose, frequent stools of small or moderate volume. Bowel movements usually occur during waking hours, most often in the morning or after meals. Most bowel movements are preceded by lower abdominal pain, urgency, and a sensation of incomplete evacuation.
Abdominal distention is not a fundamental symptom, but it is a common one. Patients often express it as “swelling.”
All this is valid for more or less young people and without any warning sign, such as: anemia, involuntary weight loss, expulsion of blood in the stool, having a history of colon cancer, noticing a lump in the abdomen, or that the symptoms have started beyond the age of 50. In such situations, it is advisable to go to our Primary Care doctor or the gastroenterologist, so that the pertinent studies and tests are carried out in order to rule out any organic disease.
Thinking about all this, to facilitate the diagnosis of IBS, mainly for doctors, but also for interested patients, a kind of medical calculator available online has been developed and created by Dr. Douglas Drossman, a world authority on everything related to IBS, in order to guide and help in these cases. But, as has already been said, the last word in the diagnosis belongs to the doctor.
Within IBS there are different variants, or subtypes, depending on the predominant pattern adopted by the stool, be it diarrhea or constipation. Thus, there is a subtype in which constipation predominates (IBS-C), another predominantly diarrhea (IBS-D) and a third in which there is a mixed or alternating diarrhea / constipation bowel habit (IBS-M).
This classification guides the doctor to give recommendations and advise the most appropriate treatment for each patient. However, there are a number of general recommendations that these patients can follow, before and after seeing their doctor.
When the symptoms are mild and intermittent, and do not deteriorate the quality of life, it is recommended to modify the lifestyle and make some changes in the diet. In patients with moderate symptoms who do not respond to initial treatment, and in those with more severe symptoms that deteriorate their quality of life, the use of certain medications is desirable.
Regular physical exercise, sleeping an adequate number of hours and meditation, mindfulness type, and some type of psychotherapy are highly recommended.
For those who have IBS, it may be beneficial to reduce the consumption of certain highly fermentable and malabsorptive carbohydrates from the diet, called FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols), always with the supervision of a dietitian to prevent nutritional deficiencies from occurring.
On the other hand, in the case of IBS with diarrhea associated with lactose consumption, which is very common in our environment (in Spain, between 19% and 28% of the population have lactose intolerance), it is recommended to exclude it from the diet for 4-8 weeks and subsequent reintroduction to levels that do not produce symptoms.
In cases of diarrhea, the exclusion of gluten (particularly wheat-based products) can also be assessed in a complete and temporary way, controlled by a professional, for its subsequent gradual reintroduction, in order to rule out a possible gluten sensitivity, different from celiac disease, which might make some IBS symptoms worse.
Abdominal pain can improve with oil Mentha piperita, aloe vera extract and infusions of Matricaria chamomilla (chamomile), for its effect in reducing intestinal spasms.
Juan J. Sebastián Domingo is Head of the Digestive System Service at the Royo Villanova Hospital (Zaragoza) and Associate Professor at the Department of Medicine, Psychiatry and Dermatology at the University of Zaragoza.
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