IBS symptoms male/females and treatment
IBS symptoms male/females and treatment
Irritable bowel syndrome (IBS) is a chronic disease that plagues the lives of patients. Let’s talk about it !
The irritable bowel syndrome (IBS), better known under the name of functional colopathy, is a chronic disease that associates abdominal pain and transit disorders.
- WHAT ARE THE SYMPTOMS? WHAT IS IRRITABLE INTESTIN SYNDROME?
Abdominal pain, bloating and transit problems are the main symptoms of IBS. Concerning transit disorders, it can be constipation, diarrhea, or alternation of the two, even forms difficult to classify when the transit changes too often.
Although not currently part of the definition of functional colopathy, bloating is almost constant and their intensity is taken into account in the “severity score” used to evaluate colopathy. They were present in 92% of patients in the Irritable Bowel Syndrome Patient Association (APSSII) who participated in an online survey of the disease in 2013.
HOW DO THE DIAGNOSIS?/IBS symptoms male/females
There is no diagnostic test unlike other digestive diseases. No abnormal blood test, colonoscopy, or radiological examination can confirm the disease. As a result, always having a doubt, doctors when they do different exams that are all normal, sometimes conclude their consultation with the following sentence “you have nothing”. This normality of exams is sometimes followed by words or attitudes that may suggest to the patient that “it is in his head”. To make the diagnosis we use clinical criteria (criteria of Rome) which group together a set of symptoms which when present make evoke the diagnosis.
- WHO IS CONCERNED AND WHAT ARE THE CONSEQUENCES OF IBS?
The disease affects between 5 and 10% of the general population. This disease is predominantly female (2 to 3 women for every 1 man) in Europe and the United States. Patients are often young at the time of diagnosis (most often before age 45 in studies) but the disease can exist at any age. Some forms can even begin in childhood or adolescence. The distribution of IBS forms by transit subtype is relatively balanced between forms. It should be noted that a significant proportion of patients no longer consult (disappointed with their previous care) or never consulted (not aware of this disease due to the banality of symptoms).
Although IBS is a mild chronic disease, it is often taboo despite the significant impact it has on the quality of life of patients. The disease can thus have a significant repercussion, be responsible for a feeling of isolation, and an alteration of the quality of life that can affect all areas (work, relationship with others, sleep, diet, sexuality …) .
- WHAT ARE THE RISKS AND POSSIBLE CHANGES IN THIS DISEASE?
Most often the disease begins gradually and without triggering factor. In 20% of cases, however, the disease follows an acute event, it can appear after a strong gastroenteritis or after a psychological shock or even after surgery on the digestive tract.
There is no risk of death related to the disease or risk of transformation into inflammatory bowel disease (Crohn’s) or cancer, however colopathy does not protect, and randomly other diseases can occur after his diagnosis without have a relationship with her. This should lead to a reconsideration of the need for new examinations in the event of a change in symptoms.
- WHAT ARE MECHANISMS?
The mechanisms are currently better known. These mechanisms are multiple, none is present in all patients but many can coexist in the same patient. Some mechanisms concern the digestive tract itself (micro-inflammation and increased permeability of the intestinal wall, intestinal flora, motility disorder of the digestive tract). Other factors concern nerve pathways (hypersensitivity of the digestive tract corresponding to exacerbated digestive sensations) and abnormalities in the integration of messages from the digestive tract in the spinal cord and brain. Psychological factors such as stress, anxiety, primary or secondary depressive illness may also play a role. The “second brain” that has been talked about a lot lately refers to the very richness of neurons (nerve cells that transmit information and nerve impulses) in the wall of the digestive tract and which constitutes the Enteric Nervous System (= of the tube digestive) with more than 100 million neurons.
Genetics and education can also play a role.
The mechanisms causing bloating can be related to various factors such as gas transit abnormality, increased gas production by small intestine or colon bacteria, or visceral hypersensitivity.
Regarding diet two-thirds of patients consider that meals can trigger or aggravate their symptoms. In a French study conducted in 2001, 57% of patients had stopped consuming foods they liked, 46% could not eat as much as they wanted, and a third of patients had changed their diet. Diets that are followed by patients can also impact quality of life by limiting available foods and isolating patients and making it more difficult to go out to restaurants or friends.
The diet can play a role by various mechanisms, including an action on motor skills or sensitivity of the digestive tract in relation to fats that slow down the emptying of the stomach and increase hypersensitivity. There may also be food intolerances such as lactose intolerance. Abnormal sensitivity to gluten may exist even outside of celiac disease. Some foods containing carbohydrates (FODMAPs) can cause symptoms of IBS such as diarrhea due to an osmotic effect (= water effect) or bloating, gas, flatulence and abdominal pain due to malabsorption. fermentations of these sugars by bacteria located in particular in the right colon.
- WHAT CARE?
There is no indisputable reference treatment during IBS. No treatment cures the disease. The goal of treatment is to reduce the frequency and intensity of symptoms (complete disappearance of symptoms is rare). The available treatments target the symptoms and for some of the mechanisms. The effectiveness of a treatment in a given patient can not be predicted. The treatment must be adapted to the patient during a consultation with the analysis of his symptoms and treatments already tried. Effective treatment at a time may lose its effect transiently or durably. In practice, it is common to try different treatments successively in the same patient. The inefficiency of a treatment should not make the diagnosis reconsider. There are first-line treatments such as antispasmodics and transit modifiers. Other treatments (antidepressants, hypnosis) are second-line treatments. Patients often make themselves or advised by health professionals lactose-free diets, gluten-free diets, low in FODMAPs (= decrease in foods rich in carbohydrates that promote fermentations) with sometimes an improvement. A regime that is not effective should not be pursued.