STUDENT HEALTH CENTRE

Irritable Bowel Syndrome

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What is the Irritable Bowel Syndrome? We speak of Irritable Bowel Syndrome (IBS) or spastic colon when a person feels abdominal discomfort during at least 12 weeks in one given year, experiencing difficult stool passing and pain in various parts of the abdomen. The IBS diagnosis can be given upon elimination of any other possible – and eventually serious – conditions. A syndrome represents a set of symptoms that often occur together.

What are the symptoms? The following symptoms may recur for many years on a regular basis: • An uncomfortable or bloated feeling in the abdomen, persistent pain in parts of the abdomen or severe cramps; • Abdominal pain felt throughout the entire area or localized pain felt alternately in different parts of the abdomen; • Symptoms which improve after a bowel movement; • Irregular bowel movement in the form of blockage, diarrhoea or an alternation of the two; Additional symptoms may include: tiredness, nausea, flatulence or a tense feeling in the abdomen. The symptoms may either improve or worsen after eating or after a bowel movement, and will likely differ slightly from person to person. Some people have few symptoms and do not feel much discomfort. For others, however, the symptoms can be more severe and might even hamper one’s daily activities. In addition, it is difficult to predict how the symptoms will develop. At times one can experience little or no discomfort, but at other times the symptoms can suddenly become very intense.

What are the causes of IBS? The exact causes of IBS are not known. It is possible that in cases of IBS the line of communication between the brain and the intestinal tract is faulty, leading the brain to pay increased attention to the activity of the intestines. Any stimuli within the intestines are thus picked up immediately by the brain, making the intestines feel more sensitive and mobile. The symptoms can worsen after an intestinal infection (ex. stomach flu). In some cases the intestines also seem to react strongly under negative stimuli such as increased pressure or stress. When IBS-symptoms worsen it could be sign that a certain situation is causing you increased stress. 1

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If you are concerned about your symptoms it is advisable to consult with your physician. A set of simple tests can help rule out other physical conditions and provide understanding of the situation. Worrying about certain symptoms might actually make them worse, creating a vicious circle of mutually reinforcing effects. Your physician can help you seek out the root of the problem and address it in a constructive way, avoiding the anxiety of not knowing what is wrong. Try not to avoid social situations because of the discomfort you feel. While you might be inclined to skip a social activity because you are not sure if a proper toilet will be available, by doing so you could miss out on an occasion to release some pressure. However, feeling stressed about being in an unknown environment might make some of the IBS-symptoms worse. Try to participate more in activities, but if necessary begin by gradually easing into the new situation by meeting a friend half an hour before the event and walking there together. Then on the next occasion you might consider staying longer at the party than the first time. Don’t hesitate to ask the organisers where you might find a proper toilet nearby, which you may use if you need to. Try to minimize stress. As with many other illnesses stress makes many symptoms worse. Stop and think where the stress you feel comes from and talk about it with your physician. You can eventually decide to keep a diary beforehand: write about the moments when you feel stressed or tense, and keep track of what you do to remedy the situation. Also important for IBS-patients is to pay attention to your dietary habits. Many IBS patients avoid certain foodstuffs such as cabbage, bell peppers, legumes, onions, carbonic acid, dairy products, coffee, sugar, sweeteners, fat or citrus fruit as they find that they sometimes make certain symptoms worse. However this connection has not been scientifically proven. If you do decide to limit your consumption of certain foodstuffs (for ex. dairy products) it is strongly recommended to seek the advice of a dietician in order to find out how to compensate for the absence of certain nutrients from your diet. Moreover, a balanced diet with at least three meals a day is also strongly encouraged for IBS-patients. Make sure you include enough fibres (found primarily in fruit and veg) in your meals and to drink enough water. Six on ten people who suffer of IBS symptoms report that regular light physical activity reduces the discomfort and symptoms. Think about your own pattern of physical activity at home, at school or at work. If you don’t move enough, try to go out for a walk every now and then and see if this has any positive impact on your symptoms. Don’t give up after feeling the first cramp, but try to carefully build up your effort.

Medication Several types of medication may be used in order to temporarily relieve the symptoms. Fibre supplements, peppermint oil and antispasmodics are established remedies for patients with IBS. •

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Fibre supplements (especially soluble fibres such as psyllium) raise the intestinal peristalsis and can therefore relieve symptoms of constipation. At the same time they can also add more volume to an inconsistent stool, which minimizes the effects of diarrhoea. However if taken in large doses fibres may cause flatulence. Antispasmodics have an effect on the muscles in the intestinal wall, helping to relieve cramps. They should best be taken around 20 minutes before each meal. Peppermint oil has strong anti-microbial characteristics and includes menthol as main active ingredient, a substance which also has a positive effect on relieving cramps. It is taken in the form of capsules which may be directly ingested without chewing, around 1 hour before each meal. A treatment with peppermint oil usually lasts around 1 month and may be repeated in case of positive effect. Probiotics may also bring some relief to certain IBS patients’ symptoms, but there currently is insufficient proof that they are indeed of help. Loperamide reduces the intestinal peristalsis and may only be used in urgent cases to reduce the immediate effects of diarrhoea (ex. when there is no toilet nearby). Keep in mind that loperamide can also cause severe blockages and thus lead to a worsening of many symptoms. In case of recurring or long lasting symptoms, certain anti-depressants may be employed to relieve the discomfort.

What to do after the diagnosis? Being diagnosed with IBS provides some clarity and a sense of relief. Afterwards it is good to decide on a constructive course of action. Patients often require additional consultations and advice from a physician in order to learn how to best manage their condition. If you suffer from acute IBS symptoms it may be useful to also consult a dietician or even a therapist. If you notice radical changes in your bowel movement pattern or the composition of your stool, including bleeding or mucus, or if you unintentionally lose much weight in a short period of time it is best that you see a doctor. These symptoms are not indicative of IBS and could point to the existence of a different underlying condition.

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This flyer is printed on CyclusPrint, paper made entirely from 100% recycled fibers. Student Services KU Leuven works for the Student Health Centre together with the Social service associations for the students Luca – Campus Lemmens Institute and Vlerick Leuven Gent Management School.

v.u.: Jan De Vriendt, Naamsestraat 80, 3000 Leuven

STUDENT SERVICES Student health centre Naamsestraat 80 box 5415 3000 LEUVEN, Belgium tel. + 32 16 32 44 20 fax + 32 16 32 44 14 [email protected] www.kuleuven.be/studentservices/health