Irritable Bowel Syndrome And Haemorrhoids

Introduction

Overview of irritable bowel syndrome (IBS) and haemorrhoids

Irritable bowel syndrome (IBS) is one of the most common disorders of the digestive system that is frequently seen in gastroenterological practice. IBS affects the social life and performance of regular daily activities. IBS is associated with altered stool habits, abdominal pain, and bloating and imposes a heavy burden on the affected individual. On the other hand, haemorrhoids or piles are cushions of specialised, largely vascular tissue which constitute the anal canal in the submucosal space, in other words, formed from swollen blood vessels.¹

Understanding irritable bowel syndrome (IBS)

Definition and prevalence

Irritable bowel syndrome (IBS) is a gastrointestinal disorder marked by persistent abdominal discomfort and changes in bowel patterns without any identifiable organic causes. Almost 20% of people suffer from IBS with females assigned at birth at a slightly higher risk of being affected than males assigned at birth.

The commonness of IBS varies among countries, as it can be common in both East and West without a significant difference.¹

Causes and risk factors of IBS

IBS is associated with the use of analgesics like acetaminophen, aspirin, or nonsteroidal anti-inflammatory drugs (NSAIDs). However, many risk factors are associated with the development of irritable bowel syndrome including:¹

• Malnutrition
• Depression 
• Various infectious epidemics that trigger gastroenteritis episodes 
• Intake of certain food and irregular eating habits 
• Higher consumption of canned food and processed meat

Common symptoms

Although abdominal pain is the most frustrating symptom and it is found in all people with IBS, a variety of other symptoms occur with irritable bowel syndrome including:¹

• Bloating
• Nausea
• Diarrhea
• Constipation
• An irregular but more frequent urge to defecate 
• A change in stool consistency (sometimes fluctuating between softer and firmer stool)
• A sensation of not fully emptying the bowels even after having a bowel movement

Diagnosis of IBS

The signs of IBS can resemble those linked to physical illnesses, making diagnosis difficult. Some of the diagnosis methods for IBS include:^2,3

• Lab test: Most lab tests eliminate other conditions causing your symptoms, like an infection, food intolerance, or a different digestive condition, like inflammatory bowel disease (IBD)
• Blood test: To check for a digestive condition or any other condition that may bring about your symptoms
• Stool test: To assess for any infections or indications of inflammation in your intestines resulting from a digestive issue
• Hydrogen breath test: To see if you have an overgrowth of bacteria in your gut or a food intolerance
• Imaging tests: Imaging is sometimes needed to rule out conditions including inflammation or abnormal growth in your gastrointestinal (GI) tract. The imaging tests may include colonoscopy, flexible sigmoidoscopy, and upper endoscopy

Understanding haemorrhoids 

Definition and types

Hemorrhoids are enlarged vessels in the anal canal and they can consist of 2 types:⁴

• External haemorrhoids: can be itchy and painful. They are located in the distal one-third of the anal canal
• Internal haemorrhoids: swollen veins form inside your rectum. They are located in the upper section of the anal canal. Internal haemorrhoids may bleed, but they usually are not painful

Causes and risk factors 

The exact causes of haemorrhoids are unknown. However, some factors are believed to increase the risk including:⁴

• Sitting in an upright position for a prolonged period regularly
• Irregular bowel habits (constipation or diarrhoea)
• A low-fibre diet
• Increased intra-abdominal pressure
• Prolonged straining on the toilet
• Having anal intercourse
• Pelvic pressure from weight gain
• Pregnancy
• Straining to lift heavy objects
• A sedentary lifestyle

Common symptoms

• Itchy anus
• Firm bumps around your anus that are painful or sensitive
• Pain in your anus, especially when you sit
• Rectal bleeding
• Swelling and prolapse
• Irritation of the anus

Diagnosis of haemorrhoids

Physical exam

Your doctor will check the area around your anus for swelling, leakage of stool or mucus, skin irritation, and skin tags. In the case of external haemorrhoids, there may be a clot in the vein and prolapse in the case of internal haemorrhoids.⁵

Anoscopy

The physician will use an anoscope to view the lining of the anus and lower rectum. Your physician will thoroughly inspect the tissues that line your anus and lower rectum to identify indications of issues in the lower digestive tract and bowel diseases.

Rigid proctosigmoidoscopy

This is similar to anoscopy, except that the doctor uses an instrument called a proctoscope to view the lining of the rectum and lower colon. The doctor will carefully examine the tissues lining your rectum and lower colon to look for signs of lower digestive tract problems and bowel disease.⁵

Relationship between irritable bowel syndrome and haemorrhoids

Shared risk factors

Excessive straining, feelings of incomplete evacuation, repeated toilet visits, and periods of constipation are also found among the possible causes of haemorrhoids in irritable bowel syndrome cases.⁷

Managing both conditions simultaneously

It is important to look at the parallels between the symptoms of both problems. If IBS is the reason you are suffering from piles, it is important to treat your IBS first. To avoid piles and IBS simultaneously, taking the following steps will help:

• Avoid spicy and oily food
• Exercise regularly
• Eat a well-balanced diet
• Avoid caffeine and alcohol

Management and treatment options

Lifestyle changes and dietary modifications

Although fibre supplements may take 6 weeks for a significant improvement, it is safe and useful and represents the first-line treatment of haemorrhoids in comparison with other treatment modalities. Patients with any degree of haemorrhoids should be advised to adopt lifestyle modifications such as adequate fluid intake, regular exercise, improved hygiene, and avoiding straining at stool. 

A first-line approach to IBS is dietetic education and the identification of foods potentially responsible for the onset or worsening of symptoms. Dietary approaches may include the reduction of gas-producing foods, lactose, and gluten.^6,7

Medication for symptom relief

The combination of steroids, anaesthetics, antiseptics, and barrier creams has proven to be effective in temporarily relieving the acute symptoms of haemorrhoidal disease. The application of ice packs to the anal region also may reduce symptoms and is acceptable provided that contact is minimal.⁸

Fibre supplements are effective for several IBS symptoms. Antispasmodics such as peppermint oil, dicyclomine, and hyoscyamine are also used to treat IBS. Chloride Channel activators like lubiprostone and antibiotics like Rifaximin are also effective against the symptoms of IBS.

Surgical and procedural interventions for severe cases

IBS is treated medically and surgery is not an option for this condition. Contrarily, the degree of prolapse and the intensity of symptoms determine how haemorrhoids are managed. A variety of procedural and surgical interventions are available including:⁸

• Rubber band ligation: It is the best outpatient treatment for haemorrhoids. In rubber band ligation, a small rubber band is placed around the base of a haemorrhoid to cut off the blood supply to the vein. About 80% of patients are satisfied with the short-term outcome
• Cryotherapy: It is based on the principle that freezing the haemorrhoid (internal) at low temperatures can lead to tissue necrosis. However, the procedure is not commonly used nowadays because it is associated with foul smelling profuse discharge, irritation, and pain after the procedure
• Infrared coagulation (IRC): To remove the haemorrhoid, a little probe is placed into the rectum and heat is transmitted
• Sclerotherapy: A chemical is injected into the swollen vein to destroy hemorrhoidal tissue

On the other hand surgical treatments for haemorrhoids may include:

• Hemorrhoidectomy: a type of surgery which removes large external haemorrhoids or prolapsed internal ones
• Haemorrhoid stapling: a technique that uses a circular stapler to remove an internal haemorrhoid or pull a prolapsed internal haemorrhoid back inside of your anus and holds it there

Prevention strategies

Since there is no known cause for IBS, there is no way to prevent or avoid it. You can only prevent the symptoms from flaring up by avoiding triggers like gluten food once you have recognised what food is your trigger. Although haemorrhoids become more common as you get older, there are still some steps that can be taken to prevent their occurrence including:^6,7

• Limiting the intensity you push on the toilet
• Using the restroom as soon as the need arises
• Consume plenty of water during the day
• Eating more high-fibre foods like fresh fruits, vegetables, and whole grains
• Staying physically active

Summary

Irritable bowel syndrome (IBS) and haemorrhoids are common digestive issues that can impact daily life. IBS causes abdominal pain, bloating, and changes in bowel habits without any identifiable organic cause. About 20% of people experience IBS, especially females at birth. Factors like malnutrition, depression, certain infections, and unhealthy eating habits can contribute to IBS symptoms.

Symptoms can include abdominal pain, bloating, nausea, diarrhoea, constipation, and a feeling of incomplete bowel evacuation. Diagnosing IBS can be challenging because its symptoms overlap with other conditions, and doctors may use lab tests, blood tests, stool tests, breath tests, and imaging procedures to rule out other issues.

Haemorrhoids, or piles, are swollen blood vessels in the anal canal. They can be either external, causing itching and pain, or internal, which may bleed but are usually not painful. Risk factors for haemorrhoids include prolonged sitting, irregular bowel habits, a low-fibre diet, pregnancy, and heavy lifting. Diagnosis involves a physical exam and procedures like anoscopy and proctosigmoidoscopy to view the anal area and look for issues.

IBS and haemorrhoids share some risk factors, such as straining and constipation. Managing these conditions involves dietary changes, regular exercise, and medications for relief. In severe cases, various surgical options are available for haemorrhoids but not for IBS. Prevention for IBS focuses on avoiding known triggers, while strategies for preventing haemorrhoids include maintaining a high-fibre diet and staying active.