Diagnostic Criteria for IBS

Because there is no diagnostic test for IBS, experts have set up guidelines on the (often subjective) types and severity of symptoms to be used in making a diagnosis if IBS. These guidelines are known as the Rome Diagnostic Criteria for Irritable Bowel Syndrome and are now widely accepted by the medical and scientific community.
The Rome Criteria allow for a diagnosis of IBS when there are least 3 months of continuous or recurrent symptoms of the following:

1. Abdominal pain or discomfort relieved with defecation or associated with a change in frequency of stool or associated with a change in consistency of stool and
2. Two or more of the following at least on 1/4th of occasions or days
- Altered stool frequency (for research purposes defined as more than three bowel movements each day or less than three bowel movements each week), or
- Altered stool form (lumpy/hard or loose/watery stool), or
- Altered stool passage (straining, urgency, or feeling of incomplete evacuation), or
- Passage of mucus, or
- Bloating or feeling of abdominal distention.

For additional information and resources on the Rome criteria visit the website for the Rome Committee at http://www.romecriteria.org

Causes

IBS symptoms cannot be traced to a single organic cause. Some researchers think IBS is caused by changes in the nerves that control sensation or muscle contractions in the bowel. Others believe the central nervous system may be affecting the colon of individuals who are particularly sensitive. Because women are two to three times more likely than men to have IBS researchers believe that hormonal changes may also play a role. For many women, symptoms are worse during or around their menstrual periods. Research suggests that people with IBS seem to have a colon that is more sensitive and reactive than usual to a variety of things, including certain foods and stress. Some evidence indicates that the immune system, which fights infection, is also involved. Likely contributing causes of IBS include:

Stress and abnormal contractions of the colon
It is known that stress and anxiety have a number of effects on the intestine and it’s logical that stress would play a part in IBS symptoms. In fact, IBS attacks are often triggered by major stress events such as divorce, death of a loved one or a career change. Like the heart and the lungs, the colon is controlled by the autonomic nervous system through the many nerves that connect it to the brain. The walls of the intestines are lined with layers of muscle that contract and relax as they move food from your stomach through the intestinal tract to the rectum. In reaction to stressful events the colon often either begins violent spasmodic contractions (hence the older term "spastic colon" which was once used to describe IBS) or slows down or stops contracting.

When the contractions are stronger and last longer than normal, food is forced through your intestines more quickly causing gas, bloating and diarrhea. When contractions are weaker, passage slows and stools become hard and dry and constipation occurs. Some evidence suggests that IBS is affected by the immune system, which fights infection in the body. The immune system is also affected by stress. For all these reasons, stress management is an important part of treatment for IBS.

Food allergies
Food intolerances are present in 50% to 65% of the patients with IBS raising the possibility that IBS is caused by food sensitivity or allergy. The best way to detect an association between symptoms of IBS and food sensitivity is to eliminate certain food groups systematically (a process called an elimination diet) which is usually best accomplished under the supervision of a doctor or nutritionist. The most common reactions are to dairy products and grains like wheat and corn. Other foods that frequently trigger IBS sensitivity are citrus fruits, chocolate, beans, cruciferous vegetables (such as broccoli, cauliflower, brussels sprouts, and cabbage), stimulants like caffeine and tobacco, depressants like alcohol and non-nutritive sweeteners like Sorbitol and Xylitol .

Intestinal Flora Imbalance
The health of intestinal tract is maintained by disease fighting beneficial bacteria. It is important to maintain the ratio of beneficial (probiotic) bacteria to pathogenic bacteria (approximately 80% or more to 20% or less). When an imbalance occurs, pathogenic bacteria overgrow, overwhelm beneficial bacteria and stop them from doing their work and produce harmful substances that irritate the lining of the intestines. This irritation can eventually breach the integrity of the intestinal walls allowing toxins to be absorbed into the bloodstream leading to additional serious consequences.

Other GI diseases
The development of IBS following severe gastrointestinal infections (such as those caused by Salmonella or Campylobacter) has been well recognized for many years. The mechanisms by which the infections trigger the development of IBS are not well understood.

Relief & Treatment

It’s not surprising that no “cure” has been found for IBS since it seems to be a collection of syndromes with a number of contributing causes. The first step in treating IBS may be close monitoring of the symptoms, your daily habits, and any other factors that may affect gastrointestinal function. It is strongly advised to work closely with a health care provider though many sufferers simply endure the symptoms because of embarrassment. A variety of symptom related treatments and therapies are available and they can be utilized and combined to effectively reduce the pain and intestinal distress and to effectively “manage” IBS.

Dietary modification
People with IBS commonly describe food intolerances and, for many people, careful eating reduces IBS symptoms. Before changing your diet, the systematic elimination of particular foods can be helpful to determine the relationship between the food and symptoms. Keeping a record of food intake and discomfort can help you make effective changes to your diet. The danger in eliminating foods in a nonsystematic way is that it can erroneously lead people to eliminate important sources of nutrition from their diet. In addition, unnecessary dietary restrictions can further worsen the quality of life in patients who already have enough to cope with.

Many doctors recommend the temporary elimination of dairy products since lactose intolerance is common and can cause symptoms similar to IBS or aggravate IBS. People who avoid lactose should take dietary calcium supplements. Several foods are only partially digested in the intestines. When they reach the colon, further digestion takes place by bacteria, which produce gas as a byproduct of their digestion. As a result, these foods can cause gas and cramps. The most common are the legumes (such as beans) and cruciferous vegetables (i.e., vegetables that have a cross at their base) such as cabbage, brussels sprouts, cauliflower, and broccoli. In addition, some patients have trouble with onions, celery, carrots, raisins, bananas, apricots, prunes, sprouts, and wheat. Digestive enzyme supplements can help with the first stages of digestion and probiotic supplements can insure the bacterial balance necessary to complete digestion.

High-fiber diets keep the colon mildly distended, which may help prevent spasms. Some forms of fiber also keep water in the stool, thereby preventing hard stools that are difficult to pass. Doctors usually recommend a diet with enough fiber to produce soft, painless bowel movements. High-fiber diets may cause gas and bloating, but these symptoms often go away within a few weeks as your body adjusts. Whole grain breads and cereals, fruits, and vegetables are good sources of fiber but are not always convenient. Fiber supplements and high fiber meal replacers can be introduced in these cases.

Drinking six to eight glasses of plain water a day is important, especially if you have diarrhea. Drinking carbonated beverages, such as sodas, may result in gas and cause discomfort. Chewing gum and eating too quickly can lead to swallowing air, which again leads to gas. Also, large meals can cause cramping and diarrhea so eating smaller meals more often or eating smaller portions should help IBS symptoms. It may also help if your meals are low in fat and high in vegetables, fruits and complex carbohydrates such as whole grain breads and cereals.

Stress management
Worry, anxiety and other mental stress are major components in many IBS attacks. If possible, identify and avoid stressors that make your IBS symptoms worse. Making time to relax and spend quiet time alone can be therapeutic and rejuvenating. Yoga and meditation have been used for thousands of years to reduce stress. It is important to prioritize your daily tasks and not to overload your schedule. Besides improving your overall health, regular exercise can provide benefits that are especially valuable to people with IBS. It can help decrease feelings of stress and may help simulate rhythmic contractions of your intestines. Another stress reducing option is psychological therapy including counseling, hypnosis therapy and cognitive behavioral therapy. For stress caused by living with IBS itself, participation to IBS support groups can be very helpful.

Fiber supplementation
As mentioned above it can be helpful to take a dietary fiber supplement since it is often difficult to get sufficient fiber in the diet, particularly when avoiding foods known to increase intestinal gas. Fiber supplementation or high fiber meal replacers can relieve symptoms in some people with IBS, particularly people who have combined abdominal pain and constipation. Fiber supplements may also be helpful in people with diarrhea predominant IBS since it can improve the consistency of stools. Dietary fiber supplements should be increased to the prescribed dose over several weeks to help reduce the symptoms of excessive intestinal gas, which can occur in some people when beginning fiber therapy.

Probiotic supplimentation
Studies indicate that lactobacillus bacteria even as the only treatment can have a significant effect on IBS symptoms (Treatment of Irritable Bowel Syndrome...American Journal of Gastroenterology, 91: 1579-1585, 1966.). As discussed throughout, pathogenic bacteria in the intestinal system can be both a major causative factor and the result of IBS symptoms. Probiotics are beneficial bacteria that attack and reduce pathogenic bacteria allowing for the restoration of intestinal balance necessary to proper digestion. They also play a crucial role in both the protection and regeneration of the intestinal walls. Supplementation with an effective probiotic is an essential part of effectively managing IBS and IBS like symptoms.

Drugs
Although many drugs are available to treat the symptoms of IBS, these drugs do not cure the condition and are used primarily to support other types of treatment. The choice among these drugs depends in part upon whether the sufferer’s primary symptom is diarrhea, constipation or abdominal pain. As a general rule, drugs are reserved for patients whose symptoms have not adequately responded to more conservative measures such as changes in diet and fiber and probiotic supplementation. In those cases, medicines to decrease diarrhea, tranquilizers or drugs that control colon muscle spasms and reduce abdominal pain may be prescribed. Where there is depression and antidepressants are prescribed, they may also function to relieve intestinal symptoms by inhibiting the activity of neurons that control the intestines. In some cases, drugs that affect the nervous system (anticholinergics) are prescribed to relieve painful bowel spasms.

Herbs and natural therapies
A number of herbal and natural therapies have been advocated for the treatment of IBS including: peppermint oil, slippery elm powder (for healing irritated tissues), mint leaves, ginger, chamomile, evening primrose oil and fennel seed.