What is irritable bowel syndrome (IBS)?
Irritable bowel syndrome (IBS) is a symptom-based diagnosis characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits. As a functional bowel disorder, IBS has no known organic cause. Diarrhea or constipation may predominate, or they may alternate.
Signs and symptoms of IBS
The primary symptoms of IBS are abdominal pain or discomfort in association with frequent diarrhea or constipation. There may also be urgency for bowel movements, a feeling of incomplete evacuation, bloating or abdominal distention. In some cases, the symptoms are relieved by bowel movements. People with IBS, more commonly than others, have gastroesophageal reflux, symptoms relating to the genitourinary system, chronic fatigue syndrome, fibromyalgia, headache, backache and symptoms such as depression and anxiety.
The second brain in the gut
The digestive system is made up of such a huge number of nerve cells that it has started to be referred to as a second brain in the belly. The gut’s nervous system communicates intensely with your brain, primarily via the vagus nerve. In fact, a stunning 90% of the fibres in the vagus nerve carry information from the gut to the brain, rather than in the other direction. This two-way communication system is referred to as the brain-gut axis.
Nearly every chemical that controls the brain is also found in the gut, which is why various medications that attempt to affect depression or sleeping disorders throw the digestive system off balance. Altering the mix of our neurotransmitters is a tricky, complicated business for the brain and gut. The hormone serotonin, for example, has become known as one of the ‘feel good’ hormones, without which we go in the direction of depression. In fact, 95% of the body’s serotonin is in the gut. Some experts have suggested that antidepressants should work on the gut rather than the brain.
Gut bacteria and the immune system
Your gut is an incredibly important part of your immune system. In fact, 70-80% of the body’s immune system is within your digestive system. Your gut contains specialised immune cells and trillions of “friendly” bacteria (known as gut flora or microbiota), which have co-evolved to work symbiotically with us, producing enzymes that break down food. It seems that this bacterial system is also a cornerstone to both mental and physical health.
Research is also starting to show how gut bacteria communicates with the guts nervous system, thus further enmeshing physiology and psychology. Poor intestinal flora can contribute to a wide range of psychological conditions including depression, anxiety, OCD and ADHD. Some kinds of gut bacteria have been shown to reduce anxiety or decrease insomnia. Probiotic treatments (i.e. consuming the friendly bacteria) have also been found to have an effect on OCD and ADHD.
Evidence of bacterial involvement in IBS comes from the effectiveness of probiotics in reducing symptoms. Probiotics are known as “friendly” bacteria because they are thought to be helpful to the health of your digestive system. Although most of the reports of the helpfulness of probiotics for IBS comes from anecdotal reports, one particular type of probiotic, Bifidobacterium infantis has been clinically shown to reduce IBS symptoms. It is thought that taking a probiotics supplement helps return the bacteria within the gut flora to a more optimal state of balance.
Psychological treatment for IBS
Currently, the goal of treatment for those with irritable bowel syndrome (IBS) is to improve the quality of life through a reduction in symptoms. While the majority of treatment approaches involve the use of traditional medicine, more and more patients seek out a non-drug approach to managing their symptoms. Current forms of non-drug psychologic treatment for IBS include cognitive behavioural therapy (CBT) and psychotherapy, all of which have been proven efficacious in clinical trials. Incorporating the constructs of mindfulness and acceptance into the psychologic treatment of IBS may be of added benefit due to the focus on changing awareness and acceptance of one’s own state.
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