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Irritable bowel syndrome

With IBS, the patient has a range of symptoms in the gastrointestinal area – however, without organic causes. They are functional disorders of the digestive system. You can read about who is affected, possible diagnoses and treatment here.

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IBS) is one of the most common functional disorders of the gastrointestinal tract. The entire digestive system is affected, not just the large intestine. In spite of thorough medical examinations, no organic reason for the frequently severe digestive problems can be found.


It has been estimated that around 20 % of the population of industrial nations suffer to a greater or lesser extent from IBS. Women are twice as likely to be affected as men. The symptoms usually first occur between the ages of 20 and 30 and often continue for months or years. Taking antibiotics in conjunction with a bowel infection can frequently be established as a trigger (so-called post-infectious irritable bowel syndrome). The patient’s quality of life is often considerably reduced.

Which symptoms occur with IBS?

Typical symptoms of IBS are abdominal pains and cramps, flatulence and constipation and/or diarrhoea. Stress intensifies the symptoms additionally. Symptoms sometimes disappear after a bowel movement or become more intense after eating, particularly if too much has been eaten. In that case, it may be that the digestive enzymes are insufficient and putrefactive or fermentative dyspepsia can arise which in turn leads to flatulence. Sometimes it feels as if the bowels cannot be really emptied. Other symptoms can include heartburn, burping and bowel noises. IBS can only really be diagnosed after it has been ruled out that other serious organic diseases are the cause of the symptoms.  This condition causes a great deal of strain, but it is not dangerous.

 

Irritable bowel syndrome (IBS) is present when the following three points are fulfilled:

  1. There are chronic symptoms; i.e. lasting longer than 3 months (e.g. abdominal pains, flatulence) which the patient and doctor relate to the bowels and which are usually accompanied by changes in bowel movements (diarrhoea, constipation or alternating diarrhoea and constipation).
  2. The symptoms are the reason why the patient seeks help and/or becomes concerned. The symptoms must be so severe that their quality of life is significantly reduced.
  3. No changes which are characteristic for other conditions may be present which are probably responsible for the symptoms.

Accompanying issues

Patient who are suffering from IBS frequently also have the following problems or symptoms:

  • Anxiety disorders
  • Depression
  • Sleeplessness
  • Chronic fatigue syndrome (CFS)
  • Headaches (migraine)
  • Fibromyalgia (a condition causing pain all over the body)
  • Menstruation pains

What can cause irritable bowel syndrome?

In people with irritable bowel syndrome, food goes through the digestive tract too quickly or too slowly. Patients can therefore suffer from diarrhoea (food passes the bowls too quickly so that liquids cannot be absorbed and the stools remain in liquid form) or constipation (passage is too slow). The bacteria which have settled in the bowels are often of the wrong kind (the normal intestinal bacteria which help digest food are in a minority, and harmful gas-forming bacteria predominate), increased amounts of gas are formed leading to a feeling of bloatednesswind and severe abdominal pains. In addition, the sensitivity to pain is higher among IBS patients, also due to a lower pain threshold in relation to stretching stimuli. The intestinal barrier which protects against harmful substances is weakened, and the intestinal wall becomes more permeable (leaky gut): the removal of harmful substances no longer takes place properly. Stress intensifies the symptoms. Patients with irritable bowel syndrome have an increased tendency to depression and anxiety disorders. A dysfunction of the autonomous nervous system along with psychosomatic disorders is also being discussed in medical science.

What do I really need? - Possible medical causes for the triggering of IBS

In medical science, various theories for the cause of IBS have been put forward. These include bacterial infections of the gastrointestinal tract, a disorder of the immune function in the digestive system, and abnormal bowel peristalsis (motility disorder). Scientists have been able to establish a whole range of typical changes in the bowels of patients. These changes, however, are not only caused by IBS, but partly also by chronic inflammatory bowel disease, diverticulitis and food intolerances.

Serotonin production imbalance

The messenger substance serotonin is also responsible for how pain is perceived. If the nervous system of the bowels is stimulated by IBS, it can no longer correctly regulate how much messenger substances are produced. It can then happen that patients feel their bowels more strongly and experience pain, whereby among ‘healthy’ people these stimuli do not exceed the threshold of perception.

Disturbed bowel motility (the ability of the intestines to move)

The intestinal wall of IBS patients reacts highly sensitively to stretching stimuli created by food. The bowels possess their own nervous system in the intestinal wall (the enteric nervous system, ENS), sometimes referred to as the brain of the abdomen. It signalises when food has reached the bowels and is stretching the wall. Together with the messenger substance serotonin, ENS controls digestion by stimulating the bowel muscles to tense and relax alternately, thus created a peristaltic wave and moving the food forwards. In IBS this intestinal nervous system is disrupted and irritated – it issue erroneous instructions to the bowel muscles. This leads to unsynchronised bowel movements and digestion is thus impaired overall. The chyme or food pulp is either moved too quickly leading to diarrhoea (irritable bowel syndrome with diarrhoea), or the opposite happens:  if the muscles move too slowly, constipation can arise (irritable bowel syndrome with constipation). Irritable bowel cramps and flatulence occur when the muscles contract too strongly and no longer relax completely.

Infections of the gastrointestinal tract as the cause of IBS (post-infectious IBS)

Several studies have confirmed that an irritable bowel can be a consequence of gastrointestinal infections (so-called stomach bugs). Bowel infections with specific bacteria (such as Campylobacter jejuni, Clostridum dificile and harmful E.coli) tend to cause irritable bowel more than other pathogens. An enteric (affecting the bowels) infection is, however, only responsible for one in ten cases.  If a bowel infection is the cause of IBS, patients typically develop characteristic diarrhoea symptoms. Antibiotics – which are often too hastily deployed against bowel infections – also damage the intestinal biotope and can trigger an irritable bowel.

Increased immune activity in the intestinal mucosa

In tissue samples of the intestinal mucosa of those affected, increased immune activity can be established. An increased number of immune cells and their messenger substances (inflammation mediators such as interleukin) can be detected in the mucosa. Where this increased reactions come from in IBS and what they are possibly good for is still being intensively researched. 

Increased permeability of the bowel mucosa (leaky gut)

In the intestinal mucosa, neighbouring cells are connected by so-called tight junctions. They seal the cells in relation to others so that no foreign substances or pathogens can move between the cells. As long as this barrier is intact, the totality of the intestinal mucosa cells form a protective shield preventing the intrusion of external substances from the bowels into the body. In IBS, this barrier is leaky or ‘holey’, i.e. the cells are no longer so tightly connected, pathogens and toxins can penetrate the mucosa more easily, leading to an immune reaction – inflammation.

How can irritable bowel syndrome be diagnosed?

The diagnosis of irritable bowel is made on the basis of a pattern of typical symptoms and after other conditions have been excluded.

Every diagnosis begins with a thorough interview with a doctor about the patient’s medical history. 

  • Where is the pain and in which situations does it appear?
  • Do you have diarrhoea or constipation?
  • Have you noticed a connection between the pain and certain foods or drinks?
  • Do you have other symptoms such as vomiting, muscle and joint pain, heartburn and a temperature? Have you noticed blood in your stools? Do you get tired quickly? Have you lost weight? This would be atypical for irritable bowel and would be an alarm bell to look at serious diseases.
  • Do you have a stressful life at the moment?
  • Do you have any other illnesses? Question about triggers and circumstances (e.g. stress, problems) which intensify the symptoms
  • Do you take medication regularly or have you done so in the last few weeks (including antibiotics, painkillers and heart drugs, thyroid gland medication, laxatives)?
  • Questions about your family history (presence of conditions running in the family)
  • The presence of organic bowel diseases (e.g. chronic inflammatory bowel disease (IBD)) which are accompanied by severe diarrhoea

After this interview a physical examination takes place during which the doctor examines the rectum and palpates and listens to the abdomen. A stool sample can provide information about digestive problems and malfunctions of the bowels. In addition, the stools are examined for hidden traces of blood. Alongside the intestinal tract the doctor also examines the bladder, the kidneys, and in the case of women, the ovaries. Further important information is provided by an analysis of the blood and stools (blood in the stools, parasites (worms)), the urine and functional tests of the organs.  As in the case of flatulence, food intolerances such as fructose, lactose and sorbitol intolerance need to be excluded. If the symptoms are acute and are accompanied by loss of weight, fever, tiredness, anaemia,  vomiting, joint pains and/or blood in the stools, they can be caused by serious diseases, and a more detailed medical investigation of the underlying condition needs to take place. Indications of liver, gall bladder or pancreatic diseases must be followed up.

A subsequent examination of the rectum and the large intestine (colonoscopy) may be carried out. During a colonoscopy, a flexible tube is inserted via the anus in order to examine the large intestine and the end of the small intestine. The bowels can also be viewed on an X-ray image by using a contrast medium. If an organic disease, food intolerance or inflammatory bowel disease have been excluded, the doctor will diagnose irritable bowel syndrome. IBS is a diagnosis of exclusion which can only be made when all other possible causes are definitely not present.

Other possible diagnostic measures:

  • Ultrasound examination of the entire abdomen (sonography)
  • X-ray examination of the bowels and abdominal area, now usually carried out as a computer tomography scan (CT)

How can irritable bowel syndrome be treated?

Irritable bowel syndrome is an unpleasant disorder which reduces the quality of life significantly. (Mainstream) medical treatment is only possible to a limited extent and is oriented towards combating symptoms. The most important thing initially is for you to recognise the symptoms as IBS and not to worry that it might be a serious disease. As the side effects of conventional medicines are frequently severe, it must be considered whether the risks of medicinal treatment are not worse than the symptoms themselves.

A change of diet and the avoidance of foods which are hard to digest and cause flatulence can often relieve symptoms. Natural treatments can suffice as the sole therapy in the case of slight symptoms, but they can also be used to support mainstream medical treatment.

Peppermint oil in enteric-coated form to resist stomach acid has a relaxing effect on the small intestine. Camomile, lavender oil, coriander, lemon balm and calamus also have a calming influence on the stomach and bowels. These plants can be obtained as teas and ready-made products in your pharmacy. Special organically manufactured products made from papayas counteract symptoms such as flatulence, pain during bowel movements or constipation, and calm a digestive system which is in a state of alarm.

If you have very hard stools, you can carefully try foods which you tolerate well and are rich in fibre. Care is needed because fibre can also cause wind. Plant products containing mucilage, a thick gluey substance, such as linseed, Indian psyllium and wheat bran, take up a lot of water and also reduce diarrhoea.  Other foods such as rice, potatoes and oats tend to promote constipation. In the case of wind, products or teas containing caraway seeds, fennel or aniseed can be soothing.


Recent research has shown that irritable bowel syndrome is accompanied by mild (chronic) inflammation and a less diverse and functional gut flora. Irritable bowel syndrome often occurs after bowel infections, particularly when they have been treated with antibiotics, as the latter also destroy the natural healthy gut flora and harmful bacteria can continued to spread uninhibited. The result is an increasingly permeable bowel because its protective barrier has been damaged. Myrrh, camomile and coffee charcoal can help to seal the intestines again.

However, in order to effectively counteract the diverse reasons behind irritable bowel syndrome, there are gentle methods which combat the root cause of IBS symptoms. Natural intestinal bacteria – probiotic bacteria products which are recommended by medical councils and associations for all symptoms of irritable bowel syndrome. These probiotic gut bacteria not only eliminate the symptoms of irritable bowel syndrome, but also the causes, and restore the equilibrium in the bowels in three different respects:

  1. These intestinal bacteria are completely natural micro-organismswhich are present in a healthy bowel and improve digestion and well-being in various ways
  2. Intestinal bacteria have no undesired effects – there can occasionally be slight flatulence and stool changes at the beginning of the treatment. This is temporary, however, only lasting until the beneficial effects begin.
  3. With intestinal bacteria (including bifidobacteria, lactobacillus, lactococcus and streptococcus) – which are combined in special compositions again the range of causes – inflammation, leaky gut, harmful bacteria (often after treatment with antibiotics or bowel infections), motility disorders – the root causes of the symptoms are combated and eliminated.

How can irritable bowel syndrome be treated?

Symptoms such as diarrhoea or constipation can be treated with medication in the short term. You can find detailed information below for the respective clinical symptoms.

Which specific measures can be taken against IBS? Which tips are there for IBS?

Tip 1 – Schedule some time for relaxation If you are relaxed, so are your bowels! Stress intensifies the symptoms of IBS.  Sufficient relaxation and regular exercise restore equilibrium to the bowels. Going to a sauna, exercise in natural surroundings and water treatments are meaningful. Practising relaxation methods (e.g. autogenic training, yoga) can help to keep the symptoms under control during periods of stress, nervousness and anxiety. Patients with severe psychological problems and depression should consult a psychotherapist or counsellor.

Tip 2 – Remove foods which cause flatulence and are hard to digest from your diet This requires keeping a food diary and finding out which foods, drinks and situations influence the symptoms and cause complaints. Prevention is better than cure. You should try and avoid thing which trigger irritable bowel syndrome. If fibre is taken to stimulate bowel movements, those which are soluble in water should be used (carob powder, pectin).

A larger number of small portions are better than a small number of large portions. Eat slowly and chew well. Drink enough (e.g. mineral water without carbon dioxide). Avoid foods which are greasy and cause flatulence as well as very cold and very hot drinks. Fizzy drinks and fruit also frequently cause symptoms.

Eat regularly and always at the same time.

Tip 3 – Give up smoking if possible and consume alcohol only in moderation.

Tip 4 – The (also long-term) consumption of specially developed probiotic multi-species synbiotics which protect the intestinal mucosa and balance digestive function is ideal to prevent the disease and as a supporting treatment for irritable bowel syndrome. 

Last updated: Friday, 02. June 2017

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