insoluble fibre

Irritable bowel syndrome (IBS) is one of the most common functional bowel disorders.
Between 1 in 11 people and 1 in 26 people globally experience irritable bowel syndrome (IBS) symptoms.

The condition affects more women than men. Some people with IBS have minor symptoms. However, for others the symptoms are significant and disrupt daily life.

Irritable bowel syndrome (IBS) is a common condition that affects the digestive system.
It causes symptoms like stomach cramps, bloating, diarrhoea and constipation. These tend to come and go over time, and can last for days, weeks or months at a time.It’s usually a lifelong problem

IBS could also be termed as a disorder of gut-brain interaction, meaning it falls within the realm of the growing field of neurogastroenterology and can be understood through an interdisciplinary biopsychosocial model, which looks at the interconnection between biology, psychology, and socio-environmental factors

In simple terms, there is a relationship between mental stress and the digestive system.
It is mostly associated with a change in stool frequency, stool form, and/or relief or worsening of abdominal pain related to defecation.

Unlike other GI disorders, there are no scarring or lesions in the tract of someone with IBS.

WHAT ARE THE SYMPTOMS TO LOOK OUT FOR?

Symptoms are almost same with other GI diseases and they include:
– Cramping
– abdominal pain
– bloating and gas
– constipation
– Diarrhea

You might be wondering how one can be constipated and still have issues with diarrhea. It is very common for people with IBS to have episodes of both constipation and diarrhea.

Symptoms such as bloating and gas typically go away after you have a bowel movement.
Symptoms of IBS aren’t always persistent. They can resolve, only to come back. However, some people do have continuous symptoms.

Women tend to have symptoms around their periods but reduced symptoms in men. Men have same symptoms as women but tend to report it less.

DIAGNOSIS
Your doctor may be able to diagnose IBS based on your symptoms. They may also take one or more of the following steps to rule out other possible causes of your symptoms:
– Suggest that you adopt a certain diet or cut out specific food groups for a period to rule out any food allergies
– Suggest a stool sample examined to rule out infection
– Suggest blood tests to check for anemia and rule out celiac disease
– Perform a colonoscopy

WHAT COULD BE THE CAUSE(S)
Although there are many ways to treat IBS, the exact cause of IBS is unknown
The varied possible causes make IBS difficult to prevent.

The physical processes involved in IBS can also vary, but may consist of:
– slowed or spastic movements of the colon, causing painful cramping
– abnormal serotonin levels in the colon, affecting motility and bowel movements
– mild celiac disease that damages the intestines, causing IBS symptoms

IS THERE ANY TREATMENT OPTION?
There is no cure for IBS. Treatment is aimed at symptom relief. Initially, your doctor may have you make certain lifestyle changes. These “home remedies” are typically suggested before the use of medication.

HOME REMEDY
Certain home remedies or lifestyle changes may help to relieve your IBS symptoms without the use of medication. Examples of these lifestyle changes include:

– regular physical exercise
– cutting back on caffeinated beverages that stimulate the intestines
– eating smaller meals
– minimizing stress (talk therapy may help)
– taking probiotics (“good” bacteria normally found in the intestines) to help relieve gas and bloating
– avoiding deep-fried or spicy foods

MEDICAL TREATMENT OPTION
– Alosetron (LOTRONEX) is intended for use only in women with severe cases of IBS-D who haven’t responded to other treatments
– Tricyclic antidepressants (TCAs) (eg, amitriptyline [Elavil]) and selective serotonin reuptake inhibitors (SSRIs)
– Antibiotics such as rifaximin (Xifaxan), which stays in the gut without being reabsorbed, may benefit patients with IBS symptoms caused by SIBO(small intestine bacterial overgrowth.

DIETARY INTERVENTIONS
Just as there is no single therapy for treating IBS, it’s important to remember there’s no single dietary strategy either.
– Avoid or minimize high-gas foods such as broccoli, cauliflower, cabbage, and beans as well as carbonated beverages.
– Avoid chewing gum or drinking liquids through a straw, both of which can lead to swallowing air, which causes more gas.
– Minimize consumption of fried or other high-fat foods.
– Avoid consuming large meals, which may promote cramping and/or diarrhea, and consume smaller, more frequent meals instead.
– Minimize consumption of foods high in lactose, such as milk, ice cream, and soft cheeses, especially if lactose intolerance is suspected. Hard cheeses, lactose-free milk, lactose-free ice cream, and low-lactose or lactose-free yogurt or kefir, which either have no lactose or tend to be lower in lactose than other dairy products, may be more easily tolerated.
– Drink adequate amounts of fluid to help alleviate constipation.
– Avoid or minimize alcohol and caffeine intake, especially with IBS-D, as both substances can stimulate the intestines and lead to diarrhea.
– Avoid artificial sweeteners that contain sugar alcohols, such as sorbitol, mannitol, and xylitol, which may cause diarrhea.
– Consume foods rich in soluble fiber, such as oatmeal, oat bran, oranges, strawberries, nuts, and carrots.

It’s important to note that while foods with soluble fiber may be beneficial for IBS patients, foods high in insoluble fiber, such as whole wheat, wheat bran, raisins, and corn bran, may further aggravate IBS symptoms in certain individuals

In addition, some IBS patients may not be able to tolerate other sources of soluble fiber, such as lentils, apples, pears, and beans, because they’re sources of fermentable carbohydrates

THE LOW FODMAP DIET
The low-FODMAP elimination diet is based on limiting certain short-chain carbohydrate-containing foods, including sugars, starches, and fibers that some people can’t fully digest and absorb.

These dietary carbohydrates are lactose, fructose, fructans, polyols, and galactans/galacto-oligosaccharides and are found in certain grains, fruits, vegetables, dried peas and beans, milk products, and prepared foods and beverages.

HIGH FODMAP CARBS HIGH FODMAP FOODS
Lactose Dairy and its products
Fructose Apples, pear, mango, watermelon
Fructans Garlic, artichokes, wheat, beer
polyols Cherries, apricots, peaches, sorbitol, xylitol
Galacto-oligosaccharrides Beans, cabbage, lentils, soy products

SOURCES:
1. https://www.healthline.com/health/irritable-bowel-syndrome#ibs-with-stress
2. https://www.thelancet.com/journals/langas/article/PIIS2468-1253(20)30217-X/fulltext#:~:text=Our%20data%20therefore%20suggest%20that,criteria%20and%20methodology%20were%20pooled.
3. https://www.bcdietitians.ca/blog/what-is-irritable-bowel-syndrome-ibs-and-how-to-improve-your-gut-health

Constipation is broadly defined as an unsatisfactory defecation characterized by infrequent stools, difficult stool passage or both.

PHYSIOLOGY OF COLONIC FUNCTION
Water absorption
The colon receives approximately 1.5 L of liquid effluent daily from the small intestine, with 200 mL to 400 mL excreted in the stool. The functions of the colon are to absorb fluid from residual food and transport waste to the rectum, where it is expelled or stored until defecation is convenient.
The amount of fluid contained in a diet determines the state of one’s stool.
Removal of water from the fecal slurry is time dependent and actively regulated, and can be substantially increased in dehydration states. Sodium is actively reabsorbed from luminal content through several active transport channels, with water following passively in response to osmotic gradients. Conversely, colonic secretion is mediated through chloride channels (eg, cystic fibrosis transmembrane conductance regulator [CFTR]), which are generally quiescent, leading to a net reabsorption of electrolytes and fluid. Thus, stool that remains in the colon longer will become drier, which can lead to scybalation (pebble-like stools) and impaction if the stool becomes too large and hard to pass through the anal canal.

POOR DIET AND CONSTIPATION
If stool remains in the colon for too long, it could become dry and hard.
A diet that contains enough water and fiber would help moisten the faeces and make it easier to pass through the anorectal region.
Fiber-rich foods are generally made from plants. Fiber comes in soluble and insoluble forms. The soluble fiber can dissolve in water and creates a soft, gel-like material as it passes through the digestive system.
Insoluble fiber retains most of its structure as it goes through the digestive system. Both forms of fiber join with stool, increasing its weight and size while also softening it. This makes it easier to pass through the rectum.

Stress could also be a factor that would lead to constipation, other routines that would slow muscle contraction of the colon could also lead to hardening of stool.
Underlying medical problems
Possible medical conditions that could lead to constipation:
• certain diseases, such as stroke, Parkinson’s disease, and diabetes
• problems with the colon or rectum, including intestinal obstruction, irritable bowel syndrome (IBS), or diverticulosis
• overuse or misuse of laxatives (medications to loosen stools)
• hormonal problems, including an underactive thyroid gland

SIGNS OF CONSTIPATION
-An excruciating pain experienced while trying to defecate.
– bowel movements restricted to 3 per week.
-feeling of fullness after passing stool.
– passing hard dry stools.
– feeling like your rectal areas are blocked.

MANAGEMENT OF CONSTIPATION
– Drink more water. At least 3 litres per day.
– Add more fiber to your diet; either soluble or insoluble fibre. Examples include wheat, bran, dark green leafy vegetables, oats, seeds, some fruits with roughages.
– Do exercises.
– Eat probiotic and prebiotic containing foods or you can use their supplements. Examples of foods in this category include plain yoghurt, banana, onions and garlic.
– Over the counter drugs like bulking agents
– Try magnesium citrate
– Eat prunes: prunes contain the sugar alcohol sorbitol which has a laxative effect. About 7 pieces twice a day is recommended (50g).
Constipation could be uncomfortable for anyone, these home remedies suggested would really help get you relieved, but if symptoms persists, see your doctor (as every drug would indicate).