OllieJacobs
Subscriber
April is the month of the irritable bowel syndrome, this is a problem that is unfortunately very common, today I am going to contribute with my point of view on the subject and what are the protocols that I follow with my clients .
What is it
Irritable bowel syndrome (IBS) is a chronic, functional disorder that affects the entire intestine. It is the most frequent gastrointestinal pathology and decreases the quality of life.
The main symptom is abdominal pain, which is usually accompanied by bloating, flatulence and diarrhea or constipation. Heartburn, nausea, a feeling of abdominal fullness, muscle pain, fatigue, a sensation of incomplete evacuation and mucus stools may also appear.
Causes
Symptoms can arise from different causes and emotional factors, therefore it is very difficult to know the exact factor that triggers it.
The digestive system of people with IBS is especially sensitive to stimuli, they perceive pain and discomfort with normal amounts of gas, stool or intestinal contractions. It is considered a disorder between the nervous interactions of the gut and the brain, without causing any visible signs of damage to the digestive tract.
To this day it is still unknown whether abnormal contractions of the small intestine and colon are a symptom of this pathology or the cause of it.
Anxiety and stress are powerful triggers as the nervous system becomes even more active during periods of stress. Symptoms worsen in the presence of certain psychological disturbances.
Some foods can cause or aggravate an episode of IBS. Other people get worse when they eat too quickly or after long periods of fasting, and food intolerances tend to occur quite frequently.
The increase, decrease or changes in the gut microbiota can cause a crisis, so it is common for an IBS to appear after a severe intestinal infection.
There is also a certain genetic predisposition: having a family member with IBS increases the chances of suffering from this disorder.
Classification
IBS is classified into three types:
Irritable bowel syndrome with constipation (IBS-C): On days when the person has at least one normal bowel movement, more than a quarter of their stools are hard or lumpy.
Irritable bowel syndrome with diarrhea (IBS-D): On days when the person has at least one normal bowel movement, more than a quarter of their stools are liquid or loose.
Mixed irritable bowel syndrome (IBS-M): On days when you have at least one normal bowel movement, more than a quarter of the stool is hard or lumpy, and more than a quarter of the stool is liquid. or loose.
How is it diagnosed:
For the medical evaluation, the so-called “The Rome IV criteria” are used, which include the presence of recurrent abdominal pain that lasts at least 1 day a week in the last 3 months, together with two or more of the following symptoms:
Pain associated with alterations in stool consistency (the Bristol scale is used for this criteria).
Pain associated with a change in the frequency of bowel movements.
Pain related to bowel movements.
It is recommended that the doctor would perform additional tests to rule out other pathologies.
Treatment
Treatment has to be approached from different points of view.
Nutritional treatment
The foods that are most frequently excluded are wheat, milk and some fruits and vegetables such as cauliflower, broccoli or cabbage, likewise, a diet low in fermentable oligosaccharides, disaccharides and monosaccharides and polyols (FODMAP) can be beneficial to reduce gastrointestinal symptoms.
The general guidelines to follow would be:
Identify foods that are not well tolerated and avoid them whenever possible.
Eat at a leisurely pace.
Increase the consumption of soluble fiber and decrease that of insoluble fiber.
Carry out the food tolerance test.
Drink 2 liters of water a day to ensure good hydration, especially when IBS is accompanied by diarrhea. In the case of constipation, there is no clinical evidence to show that with the ingestion of liquid and without other measures improves constipation, but it can be beneficial when associated with fiber consumption.
Avoid sorbitol and lactose if they are not tolerated.
Do not drink spicy, carbonated drinks, tea, coffee and alcohol.
Avoid citrus fruits, high-fat foods, and spinach.
Medicines
Do not use them without a doctors prescription
Laxatives
They are used when fiber does not improve constipation. Among them, the following stand out:
Formers of fecal mass: They have the property of retaining fluid, which increases the volume of the fecal mass and gives an adequate consistency to the feces to regulate intestinal transit.
Osmotic laxatives: They have limited utility in IBS-C, they relieve constipation, but not bloating or abdominal pain. Like Lactulose, magnesium salts or Polyethylene glycol (PEG), the latter is more effective than lactulose to control symptoms and produces fewer adverse reactions. Can be used for up to 6 months.
Stimulating laxatives: They help the secretion of water and electrolytes in the colon or induce the peristaltic movement of the same.
Spasmolytics
Spasmolytics are the first line of pharmacological treatment for abdominal pain associated with IBS. They act on the smooth muscle of the intestine, inhibiting its motility, which is why they are effective in treating pain and abdominal distention that occurs in IBS.
The most commonly used drugs are: otilonium bromide, butylscopolamine bromide, mebeverine, pinaverium bromide and trimebutine.
Antidiarrheal
They work by reducing intestinal motility and increasing electrolyte and water reabsorption. Indicated in patients with IBS and a predominance of diarrhea. The most used are:
Loperamide: it must be used with caution in patients with changing stools.
Rifaximin: is an antibiotic that prevents the adherence of pathogens to the intestinal mucosa and their proliferation. It helps to relieve the symptoms of pain and bloating, and also to increase the consistency of the stool.
5HT4 serotonin receptor agonists
They act by stimulating peristalsis and reducing visceral sensitivity, thus improving intestinal transit and, therefore, pain.
Linaclotide
It works in the intestine, relieving swelling and pain and restoring its normal function. It binds to a receptor on the intestinal surface, blocking the sensation of pain and allowing the passage of liquid into the intestine, which softens the stool and favors its exit. It is the drug of choice in IBS with a predominance of constipation and abdominal discomfort, when there has been no response to dietary fiber or laxatives.
Probiotics for treating IBS
Probiotics confer a benefit in the treatment of IBS, since they relieve and improve the symptoms of patients.
Bifidobacterium longum strain 35624 is a probiotic strain that has been shown through clinical studies to be effective in treating the typical symptoms of irritable bowel: bloating, flatulence, abdominal pain, constipation and / or diarrhea.
The Lactobacillus plantarum CECT 7484, Lactobacillus plantarum CECT 7485 and Pediococcus acidilactici CECT 7483 strains that have been shown to be effective in relieving IBS symptoms and improving symptoms in patients with lactose intolerance.
From my point of view
Each person and treatment is completely different, so it is very difficult to choose general guidelines.
As a general guideline, once it has been diagnosed, I would do the following:
Follow a diet low in FODMAPS and see what foods act as a "trigger" to activate IBS.
Have an emotional situation as stable as possible.
Use some of the probiotics that I have mentioned, since all are recommended by the World Gastroenterology Guide for use in IBS for their safety and efficacy.
Only use the medications as a last resort.
What is it
Irritable bowel syndrome (IBS) is a chronic, functional disorder that affects the entire intestine. It is the most frequent gastrointestinal pathology and decreases the quality of life.
The main symptom is abdominal pain, which is usually accompanied by bloating, flatulence and diarrhea or constipation. Heartburn, nausea, a feeling of abdominal fullness, muscle pain, fatigue, a sensation of incomplete evacuation and mucus stools may also appear.
Causes
Symptoms can arise from different causes and emotional factors, therefore it is very difficult to know the exact factor that triggers it.
The digestive system of people with IBS is especially sensitive to stimuli, they perceive pain and discomfort with normal amounts of gas, stool or intestinal contractions. It is considered a disorder between the nervous interactions of the gut and the brain, without causing any visible signs of damage to the digestive tract.
To this day it is still unknown whether abnormal contractions of the small intestine and colon are a symptom of this pathology or the cause of it.
Anxiety and stress are powerful triggers as the nervous system becomes even more active during periods of stress. Symptoms worsen in the presence of certain psychological disturbances.
Some foods can cause or aggravate an episode of IBS. Other people get worse when they eat too quickly or after long periods of fasting, and food intolerances tend to occur quite frequently.
The increase, decrease or changes in the gut microbiota can cause a crisis, so it is common for an IBS to appear after a severe intestinal infection.
There is also a certain genetic predisposition: having a family member with IBS increases the chances of suffering from this disorder.
Classification
IBS is classified into three types:
Irritable bowel syndrome with constipation (IBS-C): On days when the person has at least one normal bowel movement, more than a quarter of their stools are hard or lumpy.
Irritable bowel syndrome with diarrhea (IBS-D): On days when the person has at least one normal bowel movement, more than a quarter of their stools are liquid or loose.
Mixed irritable bowel syndrome (IBS-M): On days when you have at least one normal bowel movement, more than a quarter of the stool is hard or lumpy, and more than a quarter of the stool is liquid. or loose.
How is it diagnosed:
For the medical evaluation, the so-called “The Rome IV criteria” are used, which include the presence of recurrent abdominal pain that lasts at least 1 day a week in the last 3 months, together with two or more of the following symptoms:
Pain associated with alterations in stool consistency (the Bristol scale is used for this criteria).
Pain associated with a change in the frequency of bowel movements.
Pain related to bowel movements.
It is recommended that the doctor would perform additional tests to rule out other pathologies.
Treatment
Treatment has to be approached from different points of view.
Nutritional treatment
The foods that are most frequently excluded are wheat, milk and some fruits and vegetables such as cauliflower, broccoli or cabbage, likewise, a diet low in fermentable oligosaccharides, disaccharides and monosaccharides and polyols (FODMAP) can be beneficial to reduce gastrointestinal symptoms.
The general guidelines to follow would be:
Identify foods that are not well tolerated and avoid them whenever possible.
Eat at a leisurely pace.
Increase the consumption of soluble fiber and decrease that of insoluble fiber.
Carry out the food tolerance test.
Drink 2 liters of water a day to ensure good hydration, especially when IBS is accompanied by diarrhea. In the case of constipation, there is no clinical evidence to show that with the ingestion of liquid and without other measures improves constipation, but it can be beneficial when associated with fiber consumption.
Avoid sorbitol and lactose if they are not tolerated.
Do not drink spicy, carbonated drinks, tea, coffee and alcohol.
Avoid citrus fruits, high-fat foods, and spinach.
Medicines
Do not use them without a doctors prescription
Laxatives
They are used when fiber does not improve constipation. Among them, the following stand out:
Formers of fecal mass: They have the property of retaining fluid, which increases the volume of the fecal mass and gives an adequate consistency to the feces to regulate intestinal transit.
Osmotic laxatives: They have limited utility in IBS-C, they relieve constipation, but not bloating or abdominal pain. Like Lactulose, magnesium salts or Polyethylene glycol (PEG), the latter is more effective than lactulose to control symptoms and produces fewer adverse reactions. Can be used for up to 6 months.
Stimulating laxatives: They help the secretion of water and electrolytes in the colon or induce the peristaltic movement of the same.
Spasmolytics
Spasmolytics are the first line of pharmacological treatment for abdominal pain associated with IBS. They act on the smooth muscle of the intestine, inhibiting its motility, which is why they are effective in treating pain and abdominal distention that occurs in IBS.
The most commonly used drugs are: otilonium bromide, butylscopolamine bromide, mebeverine, pinaverium bromide and trimebutine.
Antidiarrheal
They work by reducing intestinal motility and increasing electrolyte and water reabsorption. Indicated in patients with IBS and a predominance of diarrhea. The most used are:
Loperamide: it must be used with caution in patients with changing stools.
Rifaximin: is an antibiotic that prevents the adherence of pathogens to the intestinal mucosa and their proliferation. It helps to relieve the symptoms of pain and bloating, and also to increase the consistency of the stool.
5HT4 serotonin receptor agonists
They act by stimulating peristalsis and reducing visceral sensitivity, thus improving intestinal transit and, therefore, pain.
Linaclotide
It works in the intestine, relieving swelling and pain and restoring its normal function. It binds to a receptor on the intestinal surface, blocking the sensation of pain and allowing the passage of liquid into the intestine, which softens the stool and favors its exit. It is the drug of choice in IBS with a predominance of constipation and abdominal discomfort, when there has been no response to dietary fiber or laxatives.
Probiotics for treating IBS
Probiotics confer a benefit in the treatment of IBS, since they relieve and improve the symptoms of patients.
Bifidobacterium longum strain 35624 is a probiotic strain that has been shown through clinical studies to be effective in treating the typical symptoms of irritable bowel: bloating, flatulence, abdominal pain, constipation and / or diarrhea.
The Lactobacillus plantarum CECT 7484, Lactobacillus plantarum CECT 7485 and Pediococcus acidilactici CECT 7483 strains that have been shown to be effective in relieving IBS symptoms and improving symptoms in patients with lactose intolerance.
From my point of view
Each person and treatment is completely different, so it is very difficult to choose general guidelines.
As a general guideline, once it has been diagnosed, I would do the following:
Follow a diet low in FODMAPS and see what foods act as a "trigger" to activate IBS.
Have an emotional situation as stable as possible.
Use some of the probiotics that I have mentioned, since all are recommended by the World Gastroenterology Guide for use in IBS for their safety and efficacy.
Only use the medications as a last resort.
