Irritable Bowel Syndrome (IBS) is a relatively common disease in the United States, where it affects up to 10-15% of the population. IBS on its own is more of an annoying disease because of its unpredictable nature. However, it can become more than a nuisance and cause complications, such as hemorrhoids.
In this article, we will discuss Irritable Bowel Syndrome (IBS) and Hemorrhoids, and their relationship. Specifically, what is IBS and hemorrhoids, how IBS leads to hemorrhoids, symptoms of IBS, how to treat it, and what happens if you delay treatment.
What is Irritable Bowel Syndrome (IBS)?
IBS is a disease that affects the intestines. Unlike most gut diseases, it is a functional disease. This means there’s nothing physically wrong with the gut of IBS patients — the problem lies in how it functions. It is a diagnosis of exclusion which means other more serious ailments need to be ruled out such as cancer or inflammatory diseases. This is typically done through a variety of tests including colonoscopy.
The exact mechanism behind IBS is still unknown. But certain environmental and genetic factors might contribute to the disease.
The major symptom of IBS is long-term abdominal pain that comes and goes. It can be classified into three types:
- Constipation predominant IBS (IBS-C). This is when the condition is dominated by constipation.
- Diarrhea predominant IBS (IBS-D). In IBS-D, patients experience long-term diarrhea in addition to abdominal pain.
- Mixed IBS (IBS-M). This is where patients experience alternating diarrhea and constipation.
What are the symptoms of Irritable Bowel Syndrome?
IBS symptoms differ between individuals. Common symptoms include stomach pain, bloating, nausea, weight loss, feeling tired, and a change in sleeping habits.
However, your doctor will look for certain specific symptoms to diagnose you with IBS. These are known as the Rome Criteria, which consists of:
- A change in the frequency of stool
- A change in the consistency of stool
- Improvement in stomach pain after passing stool
If these symptoms persist for a specified period, you’re diagnosed with IBS.
What are hemorrhoids?
Hemorrhoids are blue-colored veins that are filled with blood located in or around the anal canal. They are also called ‘piles’, and can be divided into two types, depending on their location:
- Internal hemorrhoids are found inside the anal canal
- External hemorrhoids occur when engorged veins pop out of the anal canal
Veins normally carry blood away from your organs. When pressure inside the body increases, veins are engorged and blood does not flow normally. This causes blood to collect in these veins, making them engorged and causing hemorrhoids.
Situations where the pressure inside the body increases include pregnancy, coughing, lifting weights, obesity, and straining during bowel movements.
Hemorrhoids mainly show up as pain and bleeding when passing stool but might also cause itching and swelling around the anus.
Can IBS lead to hemorrhoids?
Yes, IBS can lead to hemorrhoids, especially if you have IBS-C or IBS-M. Both these forms of IBS can cause long-term constipation, which leads to excessive straining.
When you strain while passing stool, you have to contract the muscles around your belly. This increases the pressure inside your abdomen, which in turn, engorges blood vessels around the anal area. And this causes hemorrhoids. If you already have hemorrhoids, IBS can make them worse.
For people with IBS-D, prolonged sitting on the toilet and wiping the anus forcefully can sometimes also lead to hemorrhoids.
How to treat hemorrhoids due to IBS?
Most internal hemorrhoids symptoms can go away on their own, which is why simply observing them for some time is a good initial measure. But if your hemorrhoids start causing severe pain, pop out of your anal canal, or bleed significantly, then you must find a suitable surgeon for hemorrhoids and begin treatment.
Unfortunately, IBS is a long-term disease. This means if you focus on treating only hemorrhoids (and not IBS), hemorrhoids will develop again. In order to prevent hemorrhoids from returning, you must treat any risk factors that cause them (which is IBS in this case). Although researchers are trying to find a cure for IBS, current treatments are focused on reducing symptoms.
Lifestyle Changes for IBS
Before we look at definitive medical treatment for IBS, let us look at a few healthy lifestyle changes that can improve your condition. These include:
- Drinking plenty of water: Good hydration is one of the easier remedies for constipation seen in IBS-C and IBS-M.
- Exercising: Exercising isn’t just beneficial for a healthy heart, but it is also a great way to relieve the pain associated with IBS. It also relieves stress, which is thought to play a role in IBS development.
- Getting adequate sleep
Making changes to your diet can also help you fight IBS. This means excluding the following from your diet:
- Foods that cause bloating: These include carbonated drinks and alcoholic beverages.
- Gluten: Research has found that excluding gluten can help improve pain and bloating in IBS patients.
- FODMAPs: FODMAPs stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are carbohydrates (sugars) found in fruits, vegetables, and dairy. Some people with IBS are sensitive to FODMAPs as these lead to pain and bloating.
Whether or not you should consume fiber depends on the type of IBS you have. Consuming fiber is a great way to avoid constipation, and is therefore recommended if you have constipation predominant IBS.
However, if you have a diarrhea predominant form of IBS, you should balance fiber-containing foods. It’s important to NOT completely eliminate it from your diet because dietary fiber is required for healthy gut function. You should talk to your doctor about how much fiber is acceptable for IBS-D patients.
Medical Treatment for IBS
If lifestyle and dietary changes fail to improve your symptoms, your doctor will prescribe you medicines. Some examples include:
- Laxatives: If a fiber-based diet does not improve constipation, laxatives such as magnesium hydroxide are helpful alternatives.
- Antidiarrheals: These are used in diarrhea predominant IBS and should be avoided in patients with constipation. Loperamide is a popular antidiarrheal agent.
- Rifaximin: Excessive bacteria in the gut, especially in the small intestine, can influence IBS symptoms. Rifaximin is an antibiotic that may be prescribed to kill these bacteria and improve symptoms.
- Probiotics: Not all bacteria are harmful for the gut. Instead, good bacteria can help maintain a healthy gut. And probiotics are a good way to increase the number of good bacteria in your gut.
- Anticholinergics: These medications act on the part of the nervous system that controls bowel movement. By blocking the action of this component of the nervous system, anticholinergics reduce bowel contractions. This helps treat diarrhea and painful spasms.
- Tricyclic antidepressants (TCA): These medicines are mainly used to treat depression. But they also inhibit the neurons that control gut movement and are useful in treating diarrhea and abdominal pain.
- SSRIs: SSRI stands for selective serotonin reuptake inhibitors, which are another class of antidepressant drugs. Just like TCAs, they also act on the neurons that control gut movement and are useful for treating constipation and pain.
- Pain medications
What happens if irritable bowel syndrome goes untreated?
IBS is a functional disease that does not cause any structural damage to the gut. So it usually does not lead to any life threatening complications if it is left untreated.
But that doesn’t mean you should ignore IBS. That’s because long-term constipation associated with IBS can lead to complications like:
- Anal fissures: Straining while passing stools can cause small tears at the anal orifice. These are painful and can bleed, and might require a surgical procedure called sphincterotomy for treatment.
- Fecal impaction: Persistent constipation can cause your stool to dry up and turn into a large stool ball. If this happens, you may have to visit a doctor to have it manually removed.
- Rectal prolapse: Pressure inside your gut can sometimes increase so much that the last part of the gut — the rectum — is forced out of the anus.
Hemorrhoids: As discussed above, both forms of IBS can lead to hemorrhoids.