IBS - SYMPTOMS AND DIAGNOSIS

Symptoms of IBS are common

Most children with ASD have Irritable Bowl Syndrome (IBS). It is a common gastrointestinal condition affecting up to 40% of the adult population (5-20% of men and 15-25% of women). The classic gastrointestinal symptoms of IBS are chronic or recurrent abdominal pain or discomfort associated changes in bowel habits (diarrhoea and/or constipation).

Rome IV Criteria for IBS

Recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following :

  • Related to defecation.
  • Associated with a change in frequency of stool.
  • Associated with a change in form (appearance) of stool.
  • Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis.

Identifying IBS Subtypes

The three main subtypes of IBS are described in the table below:

Rome IV IBS criteria

  • IBS-C (predominant constipation),
  • IBS-D (predominant diarrhoea), and
  • IBS-M (IBS with mixed bowel habits), 
  • IBS-U People whose symptoms do not fit into any category are considered to have IBS unclassified.

Symptoms that cumulatively support the diagnosis of IBS:

  • Abnormal stool frequency (perhaps more than 3 bowel movements per day or less than 3 bowel movements per week)
  • Abnormal stool form (lumpy/hard or loose/watery)
  • Abnormal stool passage (straining, urgency, feeling of incomplete evacuation)
  • Passage of mucus
  • Bloating or feeling of abdominal distension

The Four Categories of IBS

The Rome IV criteria, the de facto standard for diagnosing IBS, makes the distinction that IBS can be subdivided into two major categories, In our experience, after having looked at hundreds of faecal microbiology profiles, each is associated with a different profile of intestinal bacteria balance. The profiles can only be identified by a Faecal Microbiology Analysis from Bioscreen Medical. To our Knowledge this Laboratory is the only commercial lab that refrigerates the faecal sample and transports it in an anaerobic (oxygen free) chamber prior to culturing  analysis. They have also developed unique techniques for growing and counting and identifying the main species of both Aerobic and Anaerobic gut bacteria that are normally resident in the human gut (comensal bacteria).

IBS-C : Predominantly constipation.

  • Symptoms tend to alternate between constipation and normal stools.
  • Symptoms of cramping pain in the lower abdomen are commonly triggered by eating.
  • This profile is more likely to be associated with a low E-Coli count in the Faecal analysis. We think that this is probably due to the fact that E-Coli makes the amino acid Tryptophan which is a precursor to the Neurotransmitter Serotonin. Serotonin is not only the "feel good" Brain Neurotransmitter but is also needed to initiate and maintain the peristaltic activity, responsible for good gut motility.
  • A diet high in sugar and refined carbohydrates, as both are easily fermented and  converted to lactic acid which inhibits the growth and motility of E-coli and promotes the growth of Streptococcus and Bifidobacteria.

IBS-D:  Predominantly diarrhoea

  • The person may tend to experience diarrhoea early in the morning or after eating.
  • The need to void the bowel is typically urgent, and cannot be delayed.
  • There may also be an incontinence problem.

IBS-M: IBS with mixed bowel habits

  • Symptoms vary between diarrhoea or loose stools, normal stools and constipation.

IBS-U IBS with unclassified category.

This category includes people with some IBS symptom, who do not fit into any of the first three categories.

IBS and work disruption

  • Studies indicate that people with IBS miss 3-4 times more work days annually as the US national average of 5 days a year.
  • This makes IBS one of the most common reasons for work or school absenteeism, second only to the common cold.

IBS affects more women than men

According to UNC Centre for Functional GI & Motility Disorders: National Survey of the Effects of Changes in Female Sex Hormones on Irritable Bowel Symptoms the following findings were made.

  • Women are 2-3 times more likely to suffer from IBS than men.
  • Among women, IBS is most prevalent during the menstruation years.
  • Over 50% of women seeing a gynecologist for lower abdominal pain have IBS.
  • Women with IBS are three times more likely to undergo a hysterectomy than those without IBS.
  • Women with IBS are more likely to be eventually diagnosed with endometriosis than women with other bowel symptoms, suggesting the possibility of a common denominator.
  • Over 60% of patients with IBS report rheumatological symptoms, such as skin rashes, muscle spasms, headaches, muscle aches or Fibromyalgia.

Hormonal changes and IBS

  • Menstruation is associated with exacerbation of IBS symptoms in the majority of women.
  • Pregnancy appears to improve IBS symptoms temporarily for many women.
  • Oral estrogen and progesterone supplements do not seem to have any effect on IBS symptom levels.
  • Hysterectomy or tubal ligation appear to have little effect on IBS severity.
  • Endometriosis increases bloating symptoms but not other IBS symptoms.

Sexual or physical abuse as a risk factor in IBS.

Among women in a referral-based gastroenterology clinic:

  • 51% reported a history of sexual and/or life threatening physical abuse
  • Patients with functional disorders (e.g., IBS and unexplained abdominal pain) had experienced more severe types of abuse such as rape and life threatening physical violence

Patients with abuse history (compared to patients without abuse):

  • had on average three more medical symptoms (e.g., pelvic pain, headaches, genitourinary complaints, shortness of breath)
  • Patients with functional disorders (e.g., IBS and unexplained abdominal pain) had experienced more severe types of abuse such as rape and life threatening physical violence
  • reported greater pain
  • Had twice the number of days spent in bed due to illness
  • Greater disability in all areas of functioning (e.g., physical work, home management, psychosocial) more physiological distress.