Irritable bowel syndrome (IBS) is a common condition affecting the gastrointestinal (GI) tract. It is estimated that between 10 and 20% of the Western world suffer from this chronic condition (1)!
So there is a high probability that someone you know is dealing with IBS, even if they have never sought an official IBS diagnosis nor treatment from a medical provider.
What does Irritable Bowel Syndrome feel like?
For some people irritable bowel is a trivial complaint, and for others it can temporarily debilitating. The hallmark of IBS is recurrent abdominal pain or discomfort associated with a change in bowel habits, ranging from constipation to diarrhea.
Pain is often felt as a dull ache in the lower abdomen, with one side tending to feel worse than the other (some texts say the lower left is the worst, and others say the lower right). The dullness may be punctuated by sharp or stinging pain, which comes in waves.
Often a bowel movement will relieve these symptoms until the person with IBS eats again. Sometimes a bowel movement may not help.
Symptoms can be triggered by stress or after eating certain foods. The intensity, frequency, and type of symptoms may differ between patients and can vary within an individual on a week-to-week or month-to-month basis. Every IBS experience is a little bit different, which makes it hard to treat and diagnose for many people.
What are the symptoms of Irritable Bowel Syndrome?
These are the most common symptoms and they may change in severity from one IBS episode to another (2).
- Abdominal pain: mostly in the lower right or left corner and can be mild to extremely severe; the pain often goes away after a bowel movement
- Altered bowel habits: you may have diarrhea or constipation or both
- Bloating: swelling or distention of the abdomen that increases throughout the day but settles at night
- Flatulence: excessive gas that may cause bloating or pain
- Bowel urgency: experiencing an urgent need to move your bowels.
How can I get a diagnosis of IBS?
There is no particular laboratory test that can tell whether or not someone has an irritable bowel. This makes IBS is a diagnosis of exclusion, which means practitioners base their diagnosis on the symptoms themselves and when tests for other conditions with similar symptoms are negative.
Women are two times more likely to be diagnosed with the syndrome than men. This may be due to hormonal fluctuations in women, which can make symptoms worse, but may also be due to women being more likely to visit their doctors than men.
IBS is often confused with IBD or inflammatory bowel disease, which includes serious gut diseases such as ulcerative colitis and Crohn’s disease. While they share some common symptoms, they are not the same (3). There is no significant inflammation of the bowel with IBS. Some doctors used the term irritable bowel instead of IBS to prevent confusion.
Many people with IBS symptoms do not consult a healthcare professional, therefore the true proportion of people suffering from this illness likely exceeds the number of those actually diagnosed. While it is not true IBD, Irritable bowel can significantly impact a person’s quality of life and social functioning, so it’s helpful for patients to get a timely diagnosis and proper management (4).
What causes IBS?
Currently the cause of IBS is not definitive, and since there is no measurable inflammation in the lining of the bowel, there are a variety of theories on what is really happening with irritable bowel disorder.
Gastroenterologists have different perspectives on the source of IBS, often in disagreement with each other. They also have different views on how it should be treated. Therefor going to more than one gastro doctor and getting a second opinion may be necessary for the proper medical management of IBS symptoms.
However, most experts agree that the origin and development of IBS, like other chronic problems, is multifactorial in nature. Several factors have been implicated including: genetics, change in diet, bacterial overgrowth (gut dysbiosis), stress, visceral hypersensitivity, low-grade inflammation, leaky gut, and disordered signaling between gut and the brain (5,6).
Factors that may influence development of IBS
- Genetics: In clinical practice, about 37% of patients with IBS have a family history of the disorder (7).
- Intestinal microbiota: Gut bacteria, as detected by fecal samples, differ between healthy controls and people with IBS (8,9,10). Aging, antibiotics, and other environmental factors can disturb the normal gut microbiota.
- Diet: Several food items containing indigestible carbohydrates known as FODMAPS (fermentable oligo-, di-, monosaccharides, and polyols) may trigger gastrointestinal symptoms in IBS (11).
- Stress: Severe stress in early life seems to play a part in the development of IBS later in life.
- Leaky gut: Increased intestinal permeability may trigger inflammation and alter the normal gut bacteria, which could lead to IBS (12).
The gut-brain axis as a source of Irritable Bowel Symptoms?
Chiropractors and chiropractic procedures may help the body through IBS symptoms through the relationship of the the digestive system and nervous sytsem.
Chiropractors and gastroenterologists accept the role of gut-brain connection in influencing symptoms of IBS. Our understanding of these interactions has advanced significantly in the last decades.
Research suggests that the enteric nervous system (ENS)—the nervous system of the gut—is in direct communication with the brain or central nervous system (CNS) (13). For the digestive system to function at high levels, there should be a smooth flow of messages between the two systems.
A miscommunication between ENS and CNS could be the root cause of your IBS symptoms. Misalignment of the spine, for instance, particularly in the lumbar vertebrae or upper neck vertebra can cause nerve interference that impedes the functional flow of these messages.
The relationship between spinal alignment, the Vagus Nerve (Vagal Tone) and digestive function is one way the ENS and CNS may be contributing to IBS.
References
(1) Saito YA, Schoenfeld P, Locke GR III. The epidemiology of irritable bowel syndrome in North America: a systematic review. Am J Gastroenterol. 2002;97(8):1910–1915 [PMID: 12190153. https://doi.org/10.1111/j.1572-0241.2002.05913.x.
(2) El-Salhy M, Hatlebakk JG, Hausken T. Understanding and Controlling the Irritable Bowel. Springer International Publishing; 2015. Accessed February 15, 2021. https://www.springer.com/gp/book/9783319156415
(3) Quigley EM. Overlapping irritable bowel syndrome and inflammatory bowel disease: less to this than meets the eye?. Therap Adv Gastroenterol. 2016;9(2):199-212. doi:10.1177/1756283X15621230
(4) Tang LY, Nabalamba A, Graff LA, Bernstein CN. A comparison of self-perceived health status in inflammatory bowel disease and irritable bowel syndrome patients from a Canadian national population survey. Can J Gastroenterol. 2008;22(5):475-483. doi:10.1155/2008/109218
(5) El-Salhy M. Recent developments in the pathophysiology of irritable bowel syndrome. World J Gastroenterol. 2015;21(25):7621-7636. doi:10.3748/wjg.v21.i25.7621https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/symptoms-causes
(6) Hellström PM. Pathophysiology of the irritable bowel syndrome – Reflections of today. Best Practice & Research Clinical Gastroenterology. 2019;40-41:101620. doi:10.1016/j.bpg.2019.05.007
(7) Whorwell PJ, McCallum M, Creed FH, Roberts CT. Non-colonic features of irritable bowel syndrome. Gut 1986; 27: 37-40
(8) Carroll IM, Ringel-Kulka T, Keku T, Chang YH, Packey CD, Sartor RB, Ringel Y. Molecular analysis of the luminal- and mucosal-associated intestinal microbiota in diarrhea-predominant irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol 2011; 301. DOI: 10.1152/ajpgi.00154.2011
(9) Ponnusamy K, Choi JN, Kim J, Lee SY, Lee CH. Microbial community and metabolomic comparison of irritable bowel syndrome faeces. J Med Microbiol 2011; 60:817-827. DOI: 10.1099/jmm.0.028126-0
(10) Rinttilä T, Lyra A, Krogius-Kurikka L, Palva A. Real-time PCR analysis of enteric pathogens from fecal samples of irritable bowel syndrome subjects. Gut Pathog 2011;3 6. DOI:10.1186/1757-4749-3-6
(11) El-Salhy M. Irritable bowel syndrome: diagnosis and pathogenesis. World J Gastroenterol. 2012;18:5151–5163
(12) Campos M. Leaky gut: What is it, and what does it mean for you? – Harvard Health Blog. Harvard Health Blog. Published September 22, 2017. https://www.health.harvard.edu/blog/leaky-gut-what-is-it-and-what-does-it-mean-for-you-2017092212451
(13) Malagelada JR. The Brain-Gut Team. Digestive Diseases. 2020;38(4):293-298. doi:10.1159/000505810
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