Irritable Bowel Syndrome, or IBS, is often regarded as a functional disorder and not as a disease. The symptoms are very real and yet no identifiable cause is seen. Many experts attribute to stress, diet and other lifestyle factors as causes of IBS. One thing is for certain, though. GERD and IBS are connected and in ways we are still trying to find out. The majority of individuals suffering from GERD have IBS and vice versa. Let’s find out how these two are connected.
What Are The Symptoms of IBS?
IBS is a condition affecting the colon (large intestines) and is characterized by symptoms such as:
- Abdominal pain
- Diarrhea or constipation (in some cases, alternating bouts of diarrhea and constipation.)
Since IBS sufferers can also have GERD, they also experience symptoms like heartburn. More serious symptoms include rectal bleeding, weight loss and pain in the abdomen that usually occurs, or becomes more severe, at night.
Types of IBS
The Rome III criteria suggest that for diagnosing IBS, the person should be suffering from symptoms at least 6 months before diagnosis. The person should have a recurrent abdominal pain or discomfort for more than 3 days per month during the past three months. Finally, the person must have at least two of the following three symptoms:
- symptoms should improve following a bowel movement
- there should be a change in the stool frequency, and
- there should be change in the stool form
According to the Rome III criteria for diagnosing IBS, there are three subtypes of IBS:
- IBS with constipation (IBS-C)
- IBS with diarrhea (IB-D)
- IBS with alternating constipation and diarrhea (IBS-M, or IBS-A, for alternating type of bowel movement)
All three subtypes of IBS have more or less equal number of patients. A patient may also transition from one subtype to the other.
During digestion, food moves ahead through the gastrointestinal tract. This movement is made easy by rhythmic contractions of the muscles that line the walls of the intestines. If there is a problem with the muscles, it can impact the movement of food during digestion and impair the digestion process itself.
If the contractions are strong, food moves quicker than normal and may lead to diarrhea. If the muscles are weak, the movement is slower or sluggish and can lead to constipation. Improper muscle movement also causes pain and abdominal discomfort.
The nervous system plays an important role in digestion (as it does in all processes of the body). If there is a problem with the signaling between the nervous system and the digestive system, the digestion process is impaired. Problems in signaling can occur due to many triggers like foods against which the body shows intolerance or enhanced sensitivity (like lactose and gluten), psychological stress, hormonal changes, etc.
Research has shown that GERD and IBS are two conditions that overlap in a significant number of patients. In one of the largest studies done so far, consisting of more than 6000 patients with gastrointestinal problems, researchers found that more than 63% of IBS patients had GERD and close to 34% of GERD patients had IBS. One study found that if you have GERD, you are at a 3.5 times greater relative risk of developing IBS.
In a 1998 study involving over 4400 adults, researchers reported the overlapping of IBS and GERD in almost 50% of patients. In the same study, it was also found that women are at a greater risk than men of getting IBS if they also have GERD. One explanation could be the interplay of sex hormones as most of the cases worsened during the monthly cycle.
Complications of IBS: Why You Don’t Want Your GERD to lead to IBS
Alternating diarrhea and constipation can cause hemorrhoids (piles), or existing hemorrhoids to worsen. The piles can bleed and cause severe localized pain making passing stools an uncomfortable and painful process. Rectal fissures (cuts in the anal opening) may open up due to straining while passing stools.
The most discomforting complication is the effect on a person’s quality of life. The constant pain causes stress and anxiety, which only aggravate the existing condition. This has a serious impact on a person’s daily life. Constant pain and discomfort may lead to a feeling of discouragement and depression. If you are eliminating too many types of foods due to the anxiety that they may worsen your problem, you might be denying yourself essential nutrients from those foods.
Treatment of IBS linked to GERD depends upon a holistic approach that looks at eliminating the root cause of the problem. Most chronic diseases are indeed an imbalance in the normal bodily functions. It is necessary to bring back the lost balance to cure a chronic condition.
Treating GERD depends upon eliminating H. pylori infections (which is the causative agent in the majority of the cases), small intestinal bacterial overgrowth (SIBO) and regulating acid production. All of these can be done using a combination of dietary and lifestyle modifications, along with dietary supplements.
Dietary changes and lifestyle modifications are essential for reducing the frequency of IBS while your GERD is being treated at its root. You need to limit the consumption of foods and beverages that stimulate the intestines and cause diarrhea. These include:
- Fatty foods
- Dairy products (since lactose sensitivity is associated with IBS)
- Sugary foods
- Alternative sweeteners (xylitol and sorbitol)
Some vegetables like cauliflower, broccoli, cabbage and beans may cause gassiness and bloating. Carbonated drinks should be avoided for the same reason.
A diet that is low in FODMAPs (Fermentable Oligo-saccharides, Disaccharides, Monosaccharides And Polyols) may help relieve IBS. FODMAPs are short chain (relatively easy to break and process biochemically) carbohydrates. Check out this excellent resource for details on FODMAP foods.
Probiotics help in correcting the imbalance in the gut microflora. An imbalanced gut microflora makes it easy for bacteria like H. pylori and SIBO to colonize the gut and cause GERD. Probiotics have also been found to reduce symptoms of GERD-related IBS. Probiotic-rich foods or a high quality probiotic supplement can be consumed. A balance of the gut microflora does wonders to the health of the digestive system.
You should practice mindful eating – eating slowly, chewing every mouthful a sufficient number of times and without thinking about anything else. You should enjoy “eating the food,” enjoying every flavor and aroma of the food. You should also consume smaller meals as well as adequate amounts of water between meals to reduce the likelihood of cramping, constipation and diarrhea. Add fibers (flax seeds or psyllium supplementation can help) to your diet to regulate bowel movement and avoid constipation. But, of course, too much fiber is bad and can itself cause gas and bloating.
Supplementation with vitamin B1 and fish oil has been found to be immensely helpful in GERD-related IBS. B1 is necessary to eliminate fatigue as chronic IBS may lead to chronic fatigue. Fish oil helps lubricate the gut and reduces inflammation. A well-lubricated gut makes it easy for the food to move along easily. Chances of fermentation of food and resultant gas formation are greatly reduced. This eases GERD as well as IBS.
Alternative methods like acupuncture and hypnosis have also been found to be effective in treating IBS.
IBS is a complex chronic disease. It is a disease that has a similar spectrum of symptoms and possibly underlying causes as that of GERD. While the exact cause(s) isn’t known, it is clear that a bad diet and unhealthy lifestyle factors contribute greatly to IBS and indeed many other gastrointestinal distresses. A functional medicinal approach is required to look at the problem through a broader, more holistic, perspective.
A balanced combination of dietary changes, lifestyle modifications, stress management techniques and natural dietary supplements can help treat this disorder.