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WHAT IS IRRITABLE BOWEL SYNDROME (IBS)?

IBS is a chronic condition of the digestive system. Its primary symptoms are abdominal pain and altered bowel habits such as constipation and/or diarrhea, with no identifiable cause. Other symptoms of IBS may include bloating, belching, and gas. IBS is very common and symptoms may come and go. Several treatments and therapies are available for IBS. These measures help alleviate symptoms, but do not cure the condition. However, symptoms can be managed so you feel better.

IBS is NOT a risk for cancer. The symptoms of IBS are not life threatening and are not imaginary.

CAUSES OF IBS:

One theory suggests that IBS is caused by abnormal contractions of the colon and intestines which can cause severe cramps. Antispasmodics, prescribed by your health care provider, and fiber can help regulate the contractions of the colon. However, it is unclear whether the contractions are a symptom or cause of the disorder.

Some people develop IBS after a severe gastrointestinal infection (e.g. Salmonella or Campylobacter or viruses), although this is not common.

Stress or anxiety is probably not the cause of IBS, however, stress and anxiety are known to affect the intestine; thus, it is likely that anxiety and stress worsen symptoms. This is why relaxation, aerobic exercise, and adequate sleep are so important.

One theory suggests that IBS may be caused by a food sensitivity or allergy because food intolerances are common in people with IBS. However, this theory has been difficult to prove.

A number of foods are known to cause symptoms that mimic or aggravate IBS, including dairy products (which contain lactose), legumes (such as beans), and cruciferous vegetables (such as broccoli, cauliflower, brussel sprouts, and cabbage). These foods increase intestinal gas, which can cause cramps.

Many researchers believe that IBS is caused by heightened sensitivity of the intestines to normal sensations. This theory proposes that nerves in the bowels are overactive in people with IBS, so that normal amounts of gas or movement are perceived as excessive and painful. Some people with IBS feel better when treated with medications that decrease pain perception in the intestine such as antidepressant medications.

SYMPTOMS OF IBS:

IBS often begins in young adulthood. Women are twice as likely as men to be diagnosed with IBS in the United States and other western countries. In other countries, an equal number of men and women are diagnosed with IBS. The most common symptom of IBS is abdominal pain in association with changes in bowel habits (diarrhea and/or constipation).

Abdominal pain-Abdominal pain is typically crampy and varies in intensity. Some people notice that emotional stress and eating worsen the pain, and that having a bowel movement relieves the pain. Some women with IBS notice an association between pain episodes and their menstrual cycle.

Changes in bowel habits-Altered bowel habits are a second symptom of IBS. This can include diarrhea, constipation, or alternating diarrhea and constipation.

Diarrhea-A person with IBS may have frequent loose stools often in the morning or after meals. Diarrhea is often preceded by a sense of extreme urgency and followed by a feeling of incomplete emptying. About one-half of people with IBS also notice mucous in their stool.

Constipation-The constipation of IBS can be intermittent and last for days. Stools are often hard and pellet-shaped. You may not feel empty after a bowel movement, even when the rectum is empty. This faulty sensation can lead to straining and sitting on the toilet for prolonged periods of time.

Other symptoms-Other symptoms of IBS include bloating, gas, and belching.

DIAGNOSIS OF IBS:

There is no single diagnostic test for IBS. Many health care providers compare your symptoms to formal sets of diagnostic criteria to aid in the diagnosis. Many clinicians order routine blood tests in people with suspected IBS; these tests are usually normal, but they can help rule out other medical conditions.

IBS TREATMENT:

There are a number of different treatments and therapies for IBS. Treatments are often given to reduce the pain and other symptoms of IBS, and it may be necessary to try more than one combination of treatments to find the one that is most helpful to you.

Monitor symptoms- The first step in treating IBS is to monitor symptoms, daily bowel habits, and any other factors that may affect your bowels. This can help to identify factors that worsen your symptoms, such as lactose or other food intolerances and stress. A daily diary can be helpful.

Diet changes- Eliminating foods that aggravate your symptoms can be helpful which may include milk products with lactose. The greatest concentration of lactose is found in milk and ice cream and, less so, in yogurt, cheeses and cottage cheese. Eliminating foods that cause gas (cruciferous vegetables) may be helpful as well. Coffee, caffeine, carbonated beverages and alcohol  all affect the gut and may worsen IBS symptoms. Having a routine with regular meals and a set time to have a bowel movement can be helpful.

Increasing dietary fiber-Increasing the dietary fiber may relieve symptoms of IBS. By reading the product information panel on the side of the package, you can determine the number of grams of fiber per serving. However, insoluble fiber (bran cereals and whole grains) can be hard to digest.

A bulk forming soluble fiber supplement (such as psyllium in Metamucil capsules) may also be recommended to increase fiber intake since it is difficult to consume enough fiber in the diet. Fiber supplements should be started at a low dose and increased slowly over several weeks to reduce the symptoms of excessive intestinal gas, which can occur in some people when beginning fiber therapy.

Psychosocial therapies-Stress and anxiety can worsen IBS in some people. Some people benefit from counseling and/or cognitive behavior therapy, which helps you to focus on a particular problem in a limited time period. You learn how your thoughts contribute to anxiety or stress and learn how to change these thoughts. Participation in a support group can also be valuable. Many patients find that daily exercise is helpful in maintaining a sense of well-being. Exercise can also have favorable effects on the bowels. Getting enough sleep can be very helpful.

IBS medications-  Although there are medications available to treat the symptoms of IBS, these drugs do not cure the condition. The choice among these medications depends in part upon whether you have diarrhea, constipation, or pain-predominant IBS.

Many herbal and natural therapies have been advertised for the treatment of IBS; however, these therapies have not been proven effective and they are not recommended. There is increasing interest in the possible beneficial effects of “healthy” bacteria (probiotics) in a variety of intestinal diseases including IBS. Whether supplements containing these bacteria are of any benefit is unproven. There is some evidence supporting the use of peppermint oil for symptoms but not conclusively.

IBS PROGNOSIS

Although IBS can cause pain and stress, the majority of patients are able to control symptoms and live a normal life without developing serious health problems.

OTHER INFORMATION

International Foundation for Functional GI Disorders: www.iamibs.org

Health and Wellness Education Department of IU Health Center, 3rd floor; 812-855-7388. Services include Registered Dieticians, Fitness Consultants, Massage Therapists and education in relaxation techniques.

Counseling and Psychological Services (CAPS) of IU Health Center, 4th floor; 812-855-5711. For counseling, group or individual therapy to manage stress, anxiety or develop coping skills.