7 Answers About Irritable Bowel Syndrome

Two gastroenterologists explain what irritable bowel syndrome is, also known as “nervous colitis” or “irritable colon”, who is most affected, the causes, symptoms and how to treat it. And they leave a warning to patients: “Beware of misinformation campaigns with commercial intentions.”

1. What is irritable bowel syndrome and at what age does it occur?

Irritable bowel syndrome, also known as “nervous colitis”, “spastic colitis”, “irritable colon” or “functional bowel disease”, occurs when the muscular tissue of the intestine is more sensitive and reacts intensely to two everyday stimuli: food and stress. This dysfunction leads to a delay (constipation) or an acceleration (diarrhoea) of bowel movements, resulting in changes in the shape, frequency and consistency of stools.

As Paulo Ribeiro, a gastroenterologist at Hospital Lusíadas Lisboa and Clínica Longeva, says, it is “a disease of adulthood”, with onset over the age of 30 and “usually affecting more women than men worldwide”. It is estimated that 10% of the Portuguese population has it, reaching 20% in some countries.

Because of this high number, the doctor issues a warning: “These patients must be careful as they are often the target of disinformation campaigns with commercial intentions.”

2. What are the causes?

There is no single cause and it is still not known why it occurs. “It is one of the most common disorders of the digestive tract”, notes Ana Catarina Carvalho, gastroenterologist at Hospital CUF Viseu, and the causes are multifactorial. “It involves environmental, genetic and psychosocial factors”, she says, and is quite common in people with “anxiety and depression” or after a gastrointestinal infection (gastroenteritis).

The mechanisms involved in “its genesis”, continues the doctor, include increased intestinal sensitivity to pain (visceral hypersensitivity), “disruption” of the proper functioning of the brain-intestinal axis, changes in “intestinal motility”, chronic inflammation of the “intestinal mucosa” and changes in the microbiota.

3. What are the symptoms?

The most common symptom is abdominal pain or discomfort, associated with changes in bowel habits, such as diarrhea and/or constipation. Abdominal distension and flatulence are also common symptoms. According to Paulo Ribeiro, there are patients in whom the disease is “associated with diarrhea, in others with constipation, and in another group, there is an alternation between periods of constipation and diarrhea”.

4. How is it treated?

In his consultations, doctor Paulo Ribeiro always begins by explaining to patients how “the intestine works” and how everything we “do and eat” can have consequences. “It is important to demystify the disease, which is something completely different from downplaying it.” It is not fatal, but clinicians know that “it does cause immense discomfort.”

For patients who suffer from more frequent constipation, the “prescription” is to increase water and fiber intake. In cases where diarrhea is more frequent, the patient should avoid stimulant foods, which “the patient usually already knows what they are,” adds the doctor.

Adopting a healthy lifestyle that “fosters physical and psychological well-being”, adds Ana Catarina Carvalho, is essential, as stress and diet can aggravate symptoms.

In cases where changing habits does not work, medication may be necessary, such as antispasmodics, antidiarrheals, laxatives, probiotics or pain modulators.

5. What foods should be avoided?

“Nutritional counseling” for this disease, says Ana Catarina Carvalho, is a “challenge,” since many patients associate the onset of symptoms with the ingestion of certain foods. “There is no list of foods to avoid and the nutritional strategy to adopt is individual.” According to the doctor, “increasing fiber intake and reducing consumption of easily fermentable carbohydrates” seem to be associated with an improvement in symptoms. Furthermore, and although it is not clear whether gluten worsens symptoms, some patients, she says, report that they improved after “reducing the intake of foods rich in gluten.”

Paulo Ribeiro advises “good food hygiene”: eating at regular intervals, avoiding large meals, avoiding stimulants (caffeine, alcohol, spicy foods and fats), drinking 1.5 liters of water a day, avoiding soft drinks with sweeteners and gas and encouraging physical exercise (as simple as walking).

6. How is irritable bowel syndrome diagnosed?

There are standardized standards based on symptoms for making a diagnosis, called the Rome Criteria. The clinical history is essential for drawing conclusions and is related to the presence of “recurrent abdominal pain (equal to or greater than once a week)”, notes the gastroenterologist at CUF Viseu, associated with at least two of these characteristics: pain when defecating and pain due to changes in the frequency of bowel movements (diarrhea, constipation or alternation between the two); or pain due to changes in the consistency of the stool (solid or liquid).

The doctor emphasizes that, in patients over 50 years of age or with “warning signs”, such as significant weight loss, nocturnal diarrhea or blood loss, tests should be carried out to rule out other diseases.

7. Does this disease cause anorectal bleeding?

No. “This is in fact very important, as some of the symptoms can be confused with other serious diseases of the digestive tract,” explains Paulo Ribeiro.