What is ‘spastic colon’?
The colon is the part of the large intestine responsible for storing and excreting feces. ‘Spastic colon’ describes an increase in muscle contractions of the large intestine. These contractions are also known as spasms and lead to more frequent bowel movements and diarrhea. However, not all people with IBS have increase muscle spasms, and some experience a decrease in spasms, so the term is inaccurate. Therefore, ‘IBS’ is used in modern medicine. (1, 2, 3)
What are the symptoms of spastic colon?
The experience of a spasming colon may differ from one person to another. Generally, the following symptoms are experienced:
- Pain: This is usually experienced in the abdomen, and pain may vary with the intensity of the spams
- Sudden urge to defecate: The contractions of colon muscles may induce a need to suddenly use a restroom.
- Loose stools: Colon spasms may prevent stools from forming correctly, causing loose and watery stools (diarrhea).
- Alternating bowel movements: Patterns of diarrhea and constipation may be caused by a spasming colon. (4, 5)
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Irritable bowel syndrome
Irritable bowel syndrome (IBS) is generally an interchangeable term for spastic colon. IBS is a functional disorder of the gastrointestinal system affecting 11% of the population globally. It is ‘functional’, as symptoms occur even though there is no damage to the GI tract. Not all IBS patients will experience colon spasms, as some may have constipation-predominant IBS which is due to slower, less frequent contractions of the intestines. (6, 7)
Symptoms of IBS
IBS is characterized by a range of gastrointestinal symptoms equivalent to that of spastic colon. These are related to the function and sensitivity of the large intestine and include:
- Abdominal pain, which may worsen after consuming a meal
- Change in bowel habits (e.g. constipation or diarrhea)
- Bloating and gas
- Mucous in stools
- Nausea (8, 9)
Diagnosis of IBS
IBS is a ‘syndrome’, a collection of symptoms that commonly occur together, and is diagnosed based on certain GI symptoms. These are ongoing abdominal pain for at least 3 months and two or more of the following:
- Improvement with defecation
- Change of frequency of stools
- Change in appearance of stools.
If you believe you have experienced the above, it is best to consult a doctor to confirm diagnosis. (10, 11)
Are there different types of IBS?
IBS is grouped into three subtypes, based on whether symptoms of diarrhea or constipation predominate. These are:
- IBS with diarrhea (IBS-D): Stools are loose and watery, and bowel movements that occur more frequently.
- IBS with constipation (IBS-C): Stools are hard and lumpy, and rarely loose or watery. Stools may be infrequent and hard to pass.
- IBS with mixed bowel habits (IBS-M): Alternating patterns of diarrhea and constipation occur, and stools may hard or watery.
Spasming of the colon is most commonly associated with IBS-D. (12)
Who is most likely to get IBS?
Those with the following risk factors are most likely to develop IBS:
- Less than 50 years in age
- Being female
- History of trauma or abuse
- Past severe infection of the digestive system
- Having a family member with IBS (13, 14, 15)
Other gastrointestinal symptoms
If you experience any of the following symptoms, you should see a doctor immediately. These symptoms suggest underlying damage to the intestines and a more serious illness:
- Bloody stools
- Severe stomach or abdominal pain
- Inability to pass a stool
- Weight loss
- Black, dark-coloured stools
These symptoms may be associated with colon cancer, inflammatory bowel disease (IBD) or other life-threatening conditions. (16, 17)
Causes of colon spasms
IBS is the most common health condition causing colon spasms. However, other conditions may also cause these contractions and include:
- Ulcerative colitis
- Crohn’s disease
- Trapped gas
- Bowel obstruction
- Bacteria infection of the gut (gastroenteritis)
Spasming of the colon shares many similarities with IBS and therefore it is important to see a doctor to confirm a proper diagnosis. (18, 19, 20)
To rule out other gastrointestinal conditions producing similar symptoms to IBS, your GP may refer you to the following tests:
- Stool sample: To check for signs of infection and inflammatory bowel disease.
- Blood test: To check for problems such as coeliac disease.
- Colonoscopy: To examine the inner lining of the colon for signs of inflammation. This can be used to diagnose inflammatory bowel diseases.
- X-ray or CT scan: A scan of the abdomen and pelvis can rule out physical causes of abdominal pain, such as twisted bowel.
- Breath tests: To test for lactose intolerance, which may cause abdominal pain, gas, and diarrhea. Bacterial overgrowth can also be assessed with a breath test. (21, 22)
Treatment of IBS
1) Dietary treatment for IBS
Spastic colon/IBS is often worsened by ‘trigger foods’ that may differ from person to person. However, the low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet eliminates short-chain carbohydrates that generally worsen IBS symptoms. These FODMAPs are not absorbed well by the small intestine, and eliminating them has been demonstrated to improve IBS symptoms in approximately 70% of patients. Common foods eliminated on the low FODMAP diet include:
- Lactose: milk, ice-cream, cheese, yogurt, and other dairy products.
- Fructose: fruits such as apples, pears, and mangoes and products containing high fructose corn syrup.
- Galacto-oligosaccharides: lentils, chickpeas, soy products, and broccoli
- Fructans: vegetables such asgarlic, onion and broccoli, and grains such as wheat and rye
- Polyols: fruits such as peaches, watermelon, and blackberries, and artificial sweeteners such as mannitol, maltitol, and sorbitol.
Typically, the low FODMAP diet involves two phases: the elimination phase, in which FODMAPs are fully removed from the diet, and the reintroduction phase in which foods are reintroduced, one by one and symptoms monitored. The goal of dietary therapy for IBS is to remove ‘trigger’ foods whilst maintaining adequate nutrition. It is therefore recommended that a nutritionist be consulted to ensure adequate nutrition whilst on the low FODMAP diet. (23, 24, 25)
2) Psychological therapies for IBS
The cause of IBS is not fully understood. However, there appears to be a susceptibility for the bowel to overreact to certain triggers such as stress and emotional trauma. For this reason, psychological therapies have been tested and found highly effective in treating patients with IBS. (26) These include:
- Gut-directed hypnotherapy: involves relaxation and suggestions to help IBS patients feel more positively about the sensations in the body. Working on the gut-brain connection, this therapy reduces pain signals and desensitizes the gut to digestive processes. (27)
- Cognitive-behavioral therapy (CBT): is a form of psychotherapy in which patients are taught to challenge negative thoughts associated with IBS, and adopt a more positive outlook. By reducing the stress response and negative mood, symptoms of IBS have been shown to improve. (28)
- Mindfulness meditation: is a form of Buddhist training in which patients are taught to accept the sensations in their bodies and appraise them without judgment.By bringing the patient’s awareness to the present moment, this form of therapy helps to reduce negative thoughts associated with IBS that may worsen symptoms (29)
3) Medication treatments for IBS
Several medications are commonly prescribed for spastic colon/IBS. These include:
- Fiber supplements: such as psyllium (Metamucil) to improve symptoms of constipation in constipation-predominant IBS.
- Laxatives: such as polyethylene glycol and lactulose can improve motility in IBS with constipation.
- Anti-diarrheal medications: such as loperamide (Imodium) can improve symptoms of diarrhea-predominant IBS.
- Pain medications: such asPregabalin (Lyrica) can reduce abdominal pain in IBS.
- Antidepressants: such as tricyclic antidepressants, imipramine and desipramine, and SSRI medications, fluoxetine and paroxetine may reduce abdominal pain in IBS. These medicines work by lessening the pain signals from the intestines to the brain.
- IBS-specific medications: such as alosetron work by relaxing the colon to slow the movement of digested material in IBS with diarrhea. Other drugs such as linaclotide work by relaxing the colon and increasing fluid secretion in the small intestines, to improve motility in IBS with constipation.
- Probiotics: by improving the constituency of microbes in the gut, probiotics containing live bacterial species such as Bifidobacterium may improve IBS symptoms with limited side effects. However, this research is preliminary.
- Antispasmodic medications: such as dicyclomine (Bentyl) may relieve stomach cramps and abdominal pain in IBS by relaxing the smooth muscles of the gut. (30, 31, 32)
What’s the outlook?
Spasming of the colon is common and usually associated with IBS but can also occur without any reason. Although uncomfortable, they are rarely a cause of concern. IBS is generally a long-term condition and many people experience symptoms for life. However, there are several treatment options that improve symptoms in most people and improve quality of life.
A Word from Mindset Health
Spastic colon or irritable bowel syndrome (IBS) is a common condition of the digestive tract. Unlike celiac disease, IBD or other digestive diseases in which physical damage to the GI tract can be observed, IBS may involve dysfunction of the nervous system and immune system. Fortunately, this functional gastrointestinal disorder can be treated by lifestyle changes such as adopting the low FODMAP diet, which involves identifying food intolerances, and food allergies, typically using a food diary and eliminating 'trigger foods' such as gluten found in whole grains. Eating smaller meals may also help. Alternatively, treatment may involve stress management and relaxation techniques such as hypnotherapy, mindfulness meditation and cognitive-behavioral testing (CBT). Finally, symptoms of irritable bowel syndrome may be targeted by medications targeting specific health problems associated with IBS, and probiotics. Although the exact causes of IBS are not fully understood, the health information provided in this article should help you to find appropriate treatment.