Information on IBS, Irritable Bowel Syndrome and IBS Treatment - Dirk Budka
 
 
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Definition and Quality of Life




DEFINITION, SYMPTOMS and DIAGNOSIS, QUALITY OF LIFE QUESTIONNAIRE
DEFINITION OF IBS

AETIOLOGY OF IBS

THE SYMPTOMS

IS IT IBS?

DIAGNOSIS CRITERIA: "ROME-II"

The IBS-Quality Of Life Questionnaire




DEFINITION

Irritable bowel syndrome (IBS) is a benign, chronic disease of altered bowel habits and abdominal pain. It is considered a functional type of bowel disorder and is said to be caused by heavy spasms of the large colon. No organic or structural cause can be detected (using currently available diagnostic modalities) to explain its symptoms. It is the most common functional disorder of the gastrointestinal (GI) tract. Other disorders in this group include functional dyspepsia, functional anorectal pain, and noncardiac chest pain. The many forms and presentations of IBS can make the diagnosis challenging, and its functional nature can make a satisfactory treatment regimen difficult.
IBS is also known as spastic colon, nervous bowel, irritable colon and mucous colitis.


AETIOLOGY

IBS can be developed at any age. But the majority of sufferers have their first symptoms not before the age of 15 and not after 40.
The causes of the Irritable Bowel Syndrome are yet unknown and the complexity of the disease not fully understood. Theories ranges from “psychological”, “post-infection-reaction” within the gastrointestinal tract (GI) to disturbed neuromuscular function (GI-hypersensitivity). There is a wide range of triggers or exacerbating factors like: antibiotic treatment, abdominal surgery and diet.
Gut motility or sensibility is altered with exaggerated response to chemical and physical stimulation. Sufferers seemed to have a high perception of these motor events which explains why psychogenic factors are often thought to be a cause. However, psychological factors like stress are still thought to be important.
It is very easy to misdiagnose IBS because of its non-colonic symptoms, which accompany the abdominal pain/discomfort: early satiety, dysphagia, back pain, urinary frequency and urgency, fibromyalgia, dyspareunia (painful sexual intercourse by women),


SYMPTOMS

The discomfort ranges from cramping-like pains to a continuous dull pain and is often (partly) relieved by bowel movements. Very often the pain appears after food ingestion and is accompanied by sometimes mild to sometimes extreme abdominal bloating. There is often diarrhoea, sometimes alternating with severe constipation.
After the absorption and digestion of the nutrients in the small intestines, the waste moves into the large intestines (also called bowel or colon). Before the waste reaches the rectum, excessive muscular contractions can cause severe pain, diarrhoea and/or constipation.
The cause of the muscle over-activity is not yet fully understood. Researchers believe that food allergies/intolerances/hyper-sensitivities might play a very important role. Nicotine, alcohol, caffeine and stress worsen the problem.
IBS is often diagnosed after the possibility of the existence of other diseases and disorders are eliminated. (Diverticulitis, Colon Cancer, Ulcerative Colitis, Crohn’s Disease)
The spasms maybe detected in a test in which a chalky liquid mixture is infused into the colon and X-ray photographs are taken. Additionally a sigmoidoscopic examination, in which a viewing tube is inserted into the anus and then passed upwards the colon, is helpful to diagnose.


IS IT IBS?

Even the diagnosis "IBS" is now divided in different categories:
  • IBS-C (patient is more constipated)
  • IBS-D (patient suffers more from diarrhoea/soft stools)
  • IBS-A (patient suffers from both)
  • IBS-PI (postinfectious IBS)
  • IBS-RS (IBS related symptoms)

The last two definitions already show, that IBS is not a strict term, but often used as an "umbrella-term" for different expainable or unexplainable digestive disorders and gastrointestinal diseases.

It will take some more time, before new categories and new/clearer definitions will be available.
Example: are short- or long-term bacterial infection simple "IBS?" What about Post Food Poisoning Syndrome (PFPS)? What about dysbacteriosis ? What about SIBO ? Many experts believe that SIBO is not benign.


ROME II DIAGNOSTIC CRITERIA FOR IBS (covering IBS-A, IBS-C, IBS-D


This diagnostic criteria was developed by ten multinational working teams. It was published in 2000 after the teams worked for four years to find a consensus for symptom-based diagnostic standards:

Twelve weeks* or more in the past twelve months of abdominal discomfort or pain that has two out of three features:
a.)
pain-relief/relief of discomfort with defecation;
b.)
onset associated with a change in frequency of stool;
c.)
onset associated with a change in form (appearance) of stool
(* the twelve weeks need not to be consecutive)

The following symptoms are not essential for the diagnosis, but one or more are usually present.

-
abnormal stool frequency (greater than 3 bowel movements per
day or less than 3 bowel movements per week)
-
Abnormal stool form (lumpy/hard or loose/watery) in more than ¼ of defecations
-
Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation)
-
Passage of mucus in more than ¼ defecation
-
Bloating or feeling of abdominal distension in more than ¼ of days



QUALITY OF LIFE QUESTIONNAIRE

This questionnaire (35) was developed to help understanding the brain-gut connection and to give long term patients a measuring tool to help define the severity of their problems.

1. I feel helpless because of my bowel problems.

2. I feel that no one understands my bowel problems.

3. My life revolves around my bowel problems.

4. I am embarrassed by the smell caused by my bowel problems.

5. I am bothered by how much time I spend on the toilet.

6. I feel vulnerable to other illnesses because of my bowel problems.

7. I feel fat because of my bowel problems.

8. I feel like I am losing control of my life because of my bowel problems.

9. I feel my life is less enjoyable because of my bowel problems.

10. I feel uncomfortable when I talk about my bowel problems.

11. I feel depressed about my bowel problems.

12. I feel isolated from others because of my bowel problems.

13. I have to watch the amount of food that I eat because of my bowel problems.

14. Because of my bowel problems, sexual activity is difficult for me.

15. I feel angry that I have bowel problems.

16. I feel like I irritate others because of my bowel problems.

17. I worry that my bowel problems will get worse.

18. I feel irritable because of my bowel problems.

19. I worry that people think that I exaggerate my bowel problems.

20. I feel that I get less done because of my bowel problems.

21. I have to avoid stressful situations because of my bowel problems.

22. My bowel problems reduce my sexual desire.

23. My bowel problems limit what I can wear.

24. I have to avoid strenuous activity because of my bowel problems.

25. I have to watch the kind of food that I eat because of my bowel problems.

26. Because of my bowel problems I have difficulty being around people I do not know well.

27. I feel sluggish because of my bowel problems.

28. I feel unclean because of my bowel problems.

29. Long trips are difficult for me because of my bowel problems.

30. I feel frustrated that I cannot eat what I want because of my bowel problems.

31. It is important to be near a toilet because of my bowel problems.

32. I worry about losing control of my bowels.

33. I fear I won’t be able to have a bowel movement.

34. My bowel problems are affecting my closest relationships.