Irritable bowel syndrome, spasmodic colon, irritable bowel syndrome, or nervous colitis are a series of terms that describe the same thing: a serious gastrointestinal disorder that afflicts millions throughout the world.
It is not uncommon for us to have come across someone with this condition. It is chronic and debilitating, for some even totally life changing.
If you want to find out about this disease, how to identify a similar symptom (for your own good or that of your loved ones), what causes it and how to treat it, we will provide you with the following article.
What is nervous colitis?
Irritable bowel syndrome (IBS) is a term used to encompass a series of gastrointestinal signs and symptoms (such as diarrhea, constipation, abdominal pain, and many more) that are not caused by any underlying disease. It can occur at any age and generally affects women more.
In general terms, it is a disorder of both sensitivity (because the patient experiences pain or an unpleasant sensation in the abdomen), and motor (intestinal transit is altered, leading to diarrhea or constipation).
IBS is a globally prevalent disease and although statistics vary from region to region, its prevalence remains high in a large number of countries. In 2009, the World Gastroenterology Organization announced that 9% to 13% of the world population is affected by this disease.
Due to the non-specific nature of the symptoms, it is not uncommon for physicians to mistakenly attribute the symptoms to other conditions before considering IBS.
The American College of Gastroenterology defines IBS as “abdominal discomfort or pain that occurs in association with altered bowel habits over a three-month period . “
IBS can present with a number of comorbidities, such as gastroesophageal reflux, genitourinary symptoms, fibromyalgia, headache and back pain, as well as other psychological symptoms.
Causes of nervous colitis
The exact cause behind this syndrome is unknown. A number of theories have been proposed, but most likely it is a multifactorial disorder, that is, all of these possible explanations occur synergistically.
Below, we will briefly mention some of the most frequently discussed theories.
abnormal immune response
The role played by the immune system in the genesis of the disease is a theory that has been suggested over and over again in different studies, but the exact mechanism by which this occurs is unknown.
An inflammatory stimulus (as we will see later) seems to trigger a prolonged immune response, generating an increase in the number of circulating proinflammatory cytokines and an exaggerated response of the innate immune system.
These abnormal responses generate a chronic low-grade inflammatory response that is perpetuated over time, wreaking havoc on the structure of the intestinal walls, possibly causing symptoms of discomfort and diarrhea.
Alterations of digestive sensitivity
Gastric electrical activity has been shown to be altered in patients with IBS, compared to the healthy individual. Among these alterations, we find increased contractions of the small intestine and alterations of the migratory motor complex (MMC).
The MMC are the cyclical electrical activities that are detected in the gastrointestinal tract during fasting and stop when we eat food, they are responsible for peristaltic movements and the transport of certain substances.
Among said substances, are the indigestible (eg bone, fiber, and foreign bodies that pass from the stomach and end up in the colon). In patients with IBS, the different phases of MBC are altered.
It has also been found that patients with IBS have an abnormal perception of pain when faced with a visceral stimulus that is not painful for a normal patient, this is called visceral hypersensitivity (VH).
Stomach flu
Gastroenteritis, infectious or not, seems to play an important role. This seems to be corroborated by the fact that one in ten IBS patients report that the symptoms started after an infectious disease.
In this sense, prospective studies affirm that around 3 to 36% of enteric infections lead to persistent IBS symptoms. The duration of these effects depends on the microorganism affected.
Viral infections are short-lived, whereas bacterial (eg Escherichia coli ) and parasitic infections last longer. This type of IBS has been termed post-infectious IBS (PI-IBS).
There are certain risk factors that increase the risk of developing IBS-PI after an infection, such as the duration of the disease, the toxicity of the pathogen, smoking, inflammation, being female, depression, and much more.
Hormonal changes
Enterochromaffin cells, located in the walls of the intestines, act like endocrine cells, releasing all kinds of substances that have an effect on gastric motility, sensitivity, and much more.
Serotonin, a neurotransmitter with powerful effects, is capable of stimulating the nerve fibers that are projected in the direction of the gastrointestinal tract, to facilitate its motility.
In patients with IBS where the predominant symptom is diarrhea, it has been found that the absorption of serotonin by transporters that allow its degradation is reduced.
food intolerances
One study found that high amounts of insoluble fiber appear to worsen IBS symptoms. Specifically, fermentable oligosaccharides, mono- and disaccharides, which can be found in legumes, lactose-containing foods, and artificial sweeteners.
However, the above study was published twenty years ago and only a specific subgroup occurred, research on the interaction of fiber, soluble and insoluble, is still ongoing and many questions remain.
On the other hand, in a control study , 45 IBS patients were assigned a gluten-rich or gluten-free diet. Those who were on the gluten-rich diet noted that there was an increase in mucosal permeability and symptoms worsened.
Stress and emotional disturbances
IBS is such a complex pathology that it even includes psychosocial factors, but precisely how they work or modify the course of the disease is unknown. For example, child abuse and IBS are closely related, although their importance in causing the disease is unknown.
Other psychiatric symptoms frequently found in patients with IBS are depression and anxiety. It is hypothesized that people with IBS may suffer from hyperalgesia (excessive response to sensation) disorders.
This disorder of somatization (sensitivity) can, perhaps, disturb the central axis constituted by the nervous system and the gastrointestinal system. Coupled with possible genetic predisposition and other factors, they may contribute to the disease.
hereditary factors
The genetic component is a possibility that cannot be left out. Research has reported that studies in dizygotic twins show greater concordance, that is, the same trait in both twins.
This suggests that there is a genetic component. Other genetic variations possibly play a role as factors that increase a person’s susceptibility to this disorder.
Symptoms of nervous colitis
People suffering from nervous colitis report a wide variety of symptoms, of which gastrointestinal symptoms stand out, most of which are related to each other, so the most frequent ones will be described below.
Abdominal pain
Abdominal pain can occur in many diseases, thus being classified as a non-specific symptom. In nervous colitis it can appear in 30% of patients, they can have a distended abdomen and also, painful on palpation.
rectal pain
Rectal pain may be due to irritation caused by constant liquid evacuations in diarrhea, or by passing hard stools in constipation, both frequent symptoms of nervous colitis due to altered intestinal rhythm.
Diarrhea
Diarrhea is the main symptom of nervous colitis, which manifests insidiously and in most cases with mucus, later as the disease progresses it is associated with lower digestive bleeding.
Constipation
The most common manifestations in nervous colitis are intestinal rhythm disturbances, including diarrhea and constipation. During the course of the disease, the patient may experience that both conditions alternate.
In constipation, the large intestine retains or absorbs water excessively, so that the stool hardens, the number of bowel movements per week decreases, and when they are expelled, they do so with great difficulty.
Blood or secretions in the stool
Bloody or mucoid stools are frequent in nervous colitis, 10% of patients have several bloody stools a day, which may be accompanied by abdominal pain.
It is considered a serious sign when stools with abundant blood are greater than 6 times a day.
Sensation of incomplete evacuation
The sensation of incomplete evacuation or tenesmus, occurs as a recurring symptom in nervous colitis, it is described as the urge to defecate, despite the fact that the intestines are already empty, this causes efforts to defecate, pain and colic.
Fatigue
Fatigue is described as the feeling of continuous tiredness, lack of energy, in which despite the fact that the person sleeps or rests, the feeling does not fade.
Regarding the appearance of fatigue in nervous colitis, this is due to the fact that the body tends to focus all its energies on the immune system’s response to the inflammation caused by the disease.
In addition, due to other symptoms such as abdominal pain or diarrhea, sleep disorders or anxiety may occur, or anemia may develop, thus contributing to fatigue.
Weightloss
Weight loss is caused by diarrhea (which is the main symptom of nervous colitis), in which most of the nutrients from the food we eat are excreted before they are properly absorbed in the intestine.
Treatment and prevention of nervous colitis
Treatment and prevention of nervous colitis mostly go hand in hand. They are habits that we should adopt in our daily routine, to avoid any gastrointestinal disease, or improve the condition caused by nervous colitis.
As for its pharmacological treatment, it must be under constant medical surveillance, it depends on the stage of the disease and the needs of each patient.
Diet rich in fiber and protein
Earlier, we discussed that insoluble fiber intake may not be the best alternative for IBS patients. However, a series of recommendations published by Nature Reviews shows that there could be benefits.
However, the aforementioned benefits still require confirmation. Therefore, it is still recommended to avoid eating a diet that is high in fermentable fiber.
On the other hand, the consumption of fiber as a preventive method can be of great help, since fever contains anti-inflammatory and immunomodulatory components. Even introducing a small amount of fiber into your diet could be beneficial.
Avoid eating fat and large meals
Ingested fats are broken down by bile acids in the ileus, before they reach the colon. In the patient with IBS, it is recommended to avoid the consumption of fats. It has been shown experimentally that lipids promote gas and bloating.
However, other studies dispute this claim, as they have found a putative positive effect of consuming fat in moderation.
Avoid alcohol and cigarette
Although there is no extensive literature on the direct relationship between alcohol and IBS, it is known that the former affects mortality, absorption, and permeability of the gastrointestinal tract, which could worsen symptoms.
Currently, the recommendations indicate that if the consumption of alcohol worsens the symptoms, its intake should be reduced. Between the normal limits in the consumption of alcohol, one finds: 1 daily drink for the woman and two for the man.
Tobacco even contains hundreds of pro-inflammatory and pre-cancerous substances capable of increasing the inflammatory state of the body, generating the release of pro-inflammatory cytokines that could exacerbate intestinal inflammation.
Avoid stress and anxiety
Chronic stress is bad for every part of your body, not just your intestines. These increase oxidative stress, formation of pro-inflammatory substances, and alter the function of almost every system in the body.
Therefore, it is not surprising that it is a risk factor for multiple pathologies, such as hypertension, atherosclerosis or, in this case, IBS. Likewise, anxiety works synergistically with depression to worsen mental state.
Relaxation therapies (eg yoga), cognitive-dysfunctional therapies, psychodynamics and hypnotherapy are valid therapeutic strategies to treat psychological symptoms.
Perform physical exercises
Exercise is among the best remedies out there. There is a plethora of benefits from almost any angle of health, from skin, cardiovascular to neural and gastrointestinal.
It has psychobiological effects that act to reduce aging, oxidative stress, cell death, promotes circulation, improves intestinal transit, effectively regulates immune functions and favors brain function.
consume enough water
Many people underestimate the amount of water they ingest daily. In the young adult, this doesn’t mean much, but as we get older, dehydration can be deadly.
At the gastrointestinal level, water consumption helps to soften the stool and improves the permeability of the mucosa, reducing constipation in patients with IBS.
Medications prescribed by specialist
The most common medications for the treatment of nervous colitis are antispasmodics, antidiarrheals, laxatives, antibiotics, and probiotics. These are prescribed by specialist doctors and must be specific for each patient.
Psychological therapies
Many diseases bring with them problems that influence the mental health of the patient and nervous colitis is no exception. In general, drug treatment is effective for most symptoms, but not for those such as depression and anxiety.
That is why it is recommended to include psychological therapy within the treatment, in which the practice of relaxation exercises, yoga or meditation is promoted , since emotional stress can trigger the symptoms of nervous colitis.
Cognitive-behavioral therapy teaches the patient to identify those negative emotions, and to learn to respond correctly to certain situations, to reduce their psychological stress, and in turn gastrointestinal symptoms.
Psychodynamic therapy is also recommended, whose intention is to provide the patient with information about how stress is linked to emotions and, in turn, to digestive symptoms, so that they can improve their quality of life and symptoms.
University Professional in the area of Human Resources, Postgraduate in Occupational Health and Hygiene of the Work Environment, 14 years of experience in the area of health. Interested in topics of Psychology, Occupational Health, and General Medicine.