Anahite Afshar

IRRITABLE BOWEL SYNDROME (IBS)
Bloating, profuse flatulence, abdominal cramps, constipation, diarrhea, ...
Are these symptoms a little too familiar to you? Maybe you suffer from the syndrome of
the irritable bowel.
What is this?
It is a functional disorder of the intestines. A functional disorder is a disease whose
all of the symptoms have no clearly identified medical cause. Thus, the tests
show no abnormalities of the digestive system and the diagnosis is based solely on
symptoms that appear unexplained.

The most commonly reported symptoms are:

- Bloating
- Abundant flatulence (gas)
- Discomfort, cramps and abdominal pain
- Urgent need to have a bowel movement
- Changes in usual stool consistency
- Feeling of incomplete evacuation
- Constipation
- Diarrhea
- Alternating constipation and diarrhea
- The types of symptoms and the severity of these may vary from person to person. THE
- patients with IBS can also be categorized according to the predominance of
- symptoms (constipation, diarrhoea, mixed or unclassified).

How do I know if I have IBS?

- Everyone experiences bloating, constipation or diarrhea on occasion and does not necessarily have IBS.

For a diagnosis of IBS to be made, there must be chronic abdominal pain:

- At least one day per week

- For at least 3 months

- either associated with at least 2 of the following points: In relation to defecation, Associated with a change in the frequency of stools, the aspect (appearance) of stools (see Bristol scale, sensitive hearts
refrain).

See Bristol scale for assessment of stool consistency.

If you think you have IBS, see your doctor to rule out any other conditions
medical condition affecting the digestive system (celiac disease, diverticulosis, Crohn's disease, colitis
ulcer, etc.).

Why do I suffer from IBS?

- About 15% of the population has IBS at some point in their life, and the disorder is much more common in women.

- We no longer speak of irritable "colon", but of irritable bowel, because the motor abnormalities causing abdominal pain affect the small intestine more than the colon.

- However, the pathophysiological mechanisms of irritable bowel syndrome remain poorly understood.

There are, however, so-called “peripheral” mechanisms:

- Disorders of the intestinal motricity, that is to say that the contractions of the intestine would be abnormal and would cause pain and changes in the consistency of the stool. For example, a bowel that contracts too quickly would be associated with diarrhea. Food would move too quickly through the intestine, limiting water absorption and resulting in more liquid stools. On the other hand, a bowel that contracts too slowly would be linked to constipation.

- Intestinal wall abnormalities: micro-inflammation, increased intestinal permeability, mucosal immunity abnormalities, etc. which could cause pain and changes in stool consistency.

- Intraluminal factors, i.e. inside the digestive system: Abnormalities of the intestinal microbiota or disturbances of the intestinal flora (taking of antibiotics, gastrointestinal infection, etc.) which could cause decrease in good bacteria and lead to an increase in the rate of pathogenic bacteria; A malabsorption of bile acids which could disturb the digestion of fats; Inadequate diet (allergies, intolerances, poor eating habits, chronic alcohol abuse, etc.) .

- As well as so-called “central” mechanisms: Visceral hypersensitivity (people suffering from IBS would feel bowel movements, normally imperceptible, as being pain); An anomaly of pain control mechanisms (exacerbated feelings of discomfort); Psychosocial factors (trauma, intense stress, etc.).

It is therefore unlikely that a single entity is responsible for the various presentations of this disorder. In fact, there may even be several forms of IBS.

Is it serious doctor?

- It is unfortunately still an incurable disorder, but do not panic (especially not, because stress tends to exacerbate the symptoms)

- IBS is not serious in itself, nor does it cause other health damage.

- Nevertheless, the symptoms can be particularly unpleasant, even to the point of affecting physical, mental and social well-being and the quality of life in general. That is why it should be taken very seriously.

Although to date there is no treatment that can cure IBS indefinitely, it is quite possible to manage the symptoms. What should I do to get better?

- Who says multiple causes, also says multiple treatments.

- To relieve the symptoms of IBS, doctors may prescribe certain medications that act on the movements and spasms of the intestine in order to reduce pain.

- However, the most effective treatment for managing the symptoms of IBS is diet and lifestyle modification.

The role of food

- 2 out of 3 people with IBS see a direct link between diet and symptoms, whether caused or exacerbated by food intake.

- As the causes can vary, it is very difficult to provide general nutritional advice valid for all.

- This is why the first step is to complete a food diary to determine if there is a link between certain aspects of the diet and the symptoms.

- A nutritionist will be able to help you see things more clearly and guide you.

Here are some solutions that can already help you:

- Eat at regular times, avoid skipping meals and split meals, avoiding large portions to promote good elimination habits.

- Eat slowly and take the time to chew the food well before swallowing it to facilitate digestion.

- Gradually increase your dietary fiber intake: vegetables, fruits, legumes, nuts and whole grains. It is also possible to play on the type of fiber (soluble and insoluble) to relieve 

 

Shepherd, Sue & Gibson, Peter. (2016). Le Programme Fodmaps : la méthode et 80 recettes pour éliminer les aliments qui irritent vos intestins. Marabout. 416 p.

Coffin B. (2013).Est-il possible de faire un diagnostic positif du syndrome de l’intestin irritable Colon Rectum, 7:67-74

Duboc H. (2013).Microbiote et syndrome de l’intestin irritable (SII) : où en sommes-nous, où allons-nous ? Colon Rectum, 7:81-85

Duboc H, Dior M & Coffin B. (2016). Le syndrome de l’intestin irritable : nouvelles pistes physiopathologiques et conséquences pratiques. La Revue de médecine interne 37:536–543

Heizer WD, Southern S & Mcgovern S. (2009). The Role of Diet in Symptoms of Irritable Bowel Syndrome in Adults: A Narrative Review. Journal of the AMERICAN DIETETIC ASSOCIATION, 109:1204-1214.

Hoveyda N, Heneghan C, Mahtani KR, Perera R, Roberts N & Glasziou P. (2009). A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome. BMC Gastroenterology, 9:15

Jouet P. (2013). Physiopathologie du syndrome de l’intestin irritable (SII). Colon Rectum, 7:75-80

Sabaté JM. (2013). Liens entre alimentation et syndrome de l’intestin irritable. Colon Rectum, 7:86- 92

American College of gastroenterology. [En ligne]. http://gi.org/

- Société Canadienne de recherche intestinale. [En ligne]. http://www.mauxdeventre.org/

- Ordre professionnel des diététistes du Québec; Manuel de nutrition clinique. [En ligne].http://www.opdq.org/.

- Association de patients

Anahite Afshar, Nutritionniste/Diététiste