Irritable Bowel Syndrome

What is irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a chronic (long-lasting) disorder of the large intestine. (The large intestine is also called the colon or bowel.) IBS is not a disease. It's a condition in which the bowel does not always work normally. Although IBS can cause much distress, it does not damage the bowel and does not lead to life-threatening illness.

IBS is the most common intestinal disorder. It affects more women than men and usually begins in early adult life. Sometimes it is referred to as spastic colon.

How does it occur?

The cause of IBS is not well understood. Changes in the nerves and muscles in the bowel or in the central nervous system may be a cause. For example, the nerves in the bowel may make the muscles contract too much when you eat. These contractions can make food move too fast through the intestines, causing gas, bloating, cramping, and diarrhea. In other cases abnormal contractions may slow the passage of food and delay bowel movements, causing cramps and constipation.

Some foods may trigger attacks. Sometimes the symptoms of IBS may be caused by gas or an illness such as stomach flu. Other possible triggers of attacks are hormonal changes, emotional stress, or depression.

What are the symptoms?

The most common symptoms include:

• cramping and pain in the abdomen, which may be mild or severe
• constipation or diarrhea
• a lot of gas.

Other symptoms include:

• bloating
• a feeling of fullness in the rectum.

Symptoms often occur after you have eaten a big meal or when you are under stress. Women may have more symptoms during their menstrual periods. You may feel better after you have a bowel movement.

How is it diagnosed?

After asking about your symptoms and medical history, your healthcare provider will examine your abdomen and may do a rectal exam.

There is no specific test for IBS. The diagnosis is usually based on your symptoms. But your provider may do one or more of these simple tests:

• blood tests
• tests of bowel movement samples to check for blood and infection.

Depending on your medical and family history, physical exam, and age, your provider may do the following tests to look for other possible causes of your symptoms:

• colonoscopy or sigmoidoscopy, which are procedures that allow your provider to see the inside of your colon with a thin, flexible, lighted tube
• barium enema, which is a procedure that uses X-rays and a liquid dye passed into the colon through the rectum to check the colon.

Your healthcare provider may ask you to try a milk-free diet to see if lactose intolerance (trouble digesting milk products) may be causing your symptoms. Or your provider may suggest not eating foods with gluten for a certain amount of time to see if the symptoms then go away. This is a way to check for gluten intolerance (called celiac disease), which can cause symptoms similar to the symptoms of IBS. Common gluten-containing foods are wheat products. There is also a blood test that can help check for celiac disease.

How is it treated?

Doctors have not yet found a cure for IBS. However, a combination of careful food selection and stress management usually relieves the symptoms. Some medicines may also help.

• Diet

  Talk to your healthcare provider about whether you should eat more or less high-fiber food. Try eating smaller meals more often each day rather than just 2 or 3 larger meals. Avoid foods that cause gas, such as carbonated drinks, cabbage, and beans. Other foods that may cause symptoms are:

  • fatty foods, such as French fries
  • milk products, such as cheese or ice cream
  • chocolate
  • caffeine (found in coffee and some sodas)
• Food diary

  Your healthcare provider may ask you to keep a food diary to see if eating a particular food, for example, milk, worsens your symptoms.

• Stress

  Your provider will help you identify things that cause stress in your life and will suggest ways to help you control them. Relaxation or biofeedback techniques may help you manage stress.

• Medicines

  Your provider may prescribe:

  • Bulk-forming agents, such as bran or methylcellulose.
  • Antispasmodic drugs to slow contractions in the bowel and help with diarrhea and pain.
  • Antidepressants, which can help control chronic pain.
  • Medicines to help with constipation or diarrhea: For example, alosetron may be prescribed for treatment of IBS when diarrhea is the main symptom and other medicines have not helped. A medicine called Zelnorm (tegaserod) was previously available for the treatment of severe side effects of IBS. Due to complications in a few people, the drug was recalled by the manufacturer. It is currently available from the manufacturer by special referral from your healthcare provider.

How long will the effects last?

Because IBS is a chronic disorder, you may have flare-ups of symptoms throughout your life. Although a cure hasn't been found yet, the disorder can usually be controlled. IBS will not progress to something worse.

How can I take care of myself?

• Follow your healthcare provider's recommendations.
• Learn stress-management techniques to reduce stress and anxiety in your life. Professional counseling may be helpful.
• Exercise regularly, according to your provider's recommendations. Exercise helps keep bowel movements regular. It may also help maintain serotonin levels in the brain, which can help lessen depression and stress symptoms.
• Drink plenty of water.
• Do not drink alcohol, which can make symptoms of IBS worse.
• Select your foods carefully. If a food appears to bring on your symptoms, avoid it. However, don't eliminate a food just because it appears to cause symptoms one time. Be sure that a food produces symptoms several times before you give it up. You should try to keep many different foods in your diet because a varied diet provides better nutrition.
• Ask your healthcare provider if you should have a high-fiber diet, especially if you tend to be constipated. High-fiber foods may cause gas and bloating, but usually these symptoms lessen as the digestive tract gets used to the increased fiber. Some high-fiber foods include:
  • whole-grain breads and cereals, such as shredded wheat or bran flakes
  • fruits, especially apricots, blackberries, coconut, dates, figs, kiwi, peaches, pears, pineapple, prunes, raspberries, and strawberries
  • nuts, especially almonds, pistachios, and walnuts
  • vegetables, particularly Brussels sprouts, corn and popcorn, broccoli, and parsley
  • beans and lentils.
• Ask your healthcare provider if you should use a nonprescription fiber supplement.
• Eat smaller meals more often. For example, eat 4 to 6 small meals a day rather than 3 large ones.
• See your healthcare provider if your symptoms are getting worse or you are having them more often.

How can I help prevent irritable bowel syndrome (IBS)?

There is no way to prevent IBS, since its cause is still unknown. However, having a healthy lifestyle may help to prevent symptoms:

• Eat a healthy diet
• Eat regular meals, keeping on a schedule as much as possible and not skipping meals.
• Get enough sleep each night, usually 7 to 9 hours a night
• Do what you can to reduce and manage the stress in your life.