Irritable Bowel Syndrome
Irritable Bowel Syndrome
What is Irritable Bowel Syndrome?
Irritable bowel syndrome (IBS), also known as "spastic colon," is a chronic disorder of the large intestine or colon. It is one of the most common disorders of the gastrointestinal tract. IBS is referred to as a "functional disorder," meaning there is no structural or chemical abnormality associated with this syndrome. IBS is characterized by abdominal pain, diarrhea, constipation, or diarrhea alternating with constipation.
The large intestine, or colon, is approximately six feet long. The primary function of the colon is to absorb water and nutrients from digested food (stool) as it passes from the stomach and small intestine through the colon to the anus. Normally, the muscles of the colon contract and relax in a regular, gentle fashion to move stool through the colon to the anus for elimination. Nerves, hormones and electrical impulses in the muscles control the alternating muscular contractions and relaxations. In people with IBS, the alternating periods of contraction and relaxation are not regular; they can be severe and irregular. This change in colonic motility is responsible for the symptoms of IBS.
While the symptoms of IBS can be quite distressing, they are not life-threatening, nor do they cause more serious medical complications.
What Causes Irritable Bowel Syndrome?
Unfortunately, the cause of IBS is not known. There are many theories as to the cause of IBS, such as changes in the nerves or hormones that regulate colonic motility. While many people feel that stress causes IBS, there is no proof that this is the case. It does appear that emotional stress can worsen the symptoms of IBS, but it does not cause them. The colons of people with IBS may be hypersensitive to the effects of stress, diet or medications.
Factors that may contribute to IBS include:
Genetics (family history of IBS)
Certain foods or beverages
Who Gets Irritable Bowel Syndrome?
It is estimated that approximately 35 million Americans have IBS. It affects twice as many women as men, and it typically occurs in late adolescence or early adulthood. IBS often occurs in adults who are otherwise healthy.
Signs and Symptoms
IBS can cause abdominal symptoms, alterations in bowel habits, and symptoms that appear to be unrelated to the gastrointestinal tract. Normal bowel habits vary from person to person. A normal frequency of bowel movements ranges from three times per day to three times per week. People with IBS often have an alteration in their normal bowel frequency as well as in stool consistency. The most common symptoms of IBS are abdominal pain and cramping; feelings of bloating, fullness or pressure; excessive gas; diarrhea; and constipation.
The type of symptoms and their severity vary greatly from person to person and even from time to time in a given individual. Many people report symptoms after eating, early in the morning or around times of emotional stress.
The typical symptoms associated with IBS are:
Abdominal pain and/or cramping (the pain is often relieved after a bowel movement)
Feelings of bloating, fullness or pressure
Sensation of stool remaining in the rectum after a bowel movement (incomplete evacuation)
Excessive gas or belching
Diarrhea, constipation or diarrhea alternating with constipation
Changes in stool form
Feelings of urgency (sensing an immediate need to have a bowel movement)
Other symptoms include:
Presence of mucus in the stool
Symptoms not generally associated with the abdomen:
Chest pain (not due to cardiac disease)
Pain upon swallowing (dysphagia)
Extreme tiredness (fatigue)
The Diagnosis of Irritable Bowel Syndrome
A physician should diagnose IBS. As there are many medical conditions that cause symptoms similar to IBS, the physician will conduct tests that rule out the presence of more serious problems. There is no specific test that can positively identify IBS; it is often diagnosed after the possibility of other conditions is excluded. The physician will typically conduct a complete medical and family history, perform a complete physical exam, and send blood, urine and stool samples for laboratory analysis. During the medical history, the physician will ask the person to describe the symptoms in detail. The physician may also recommend a three-week trial of a lactose-free diet to ensure that the symptoms are not caused by lactose intolerance.
The physician may perform other tests:
Sigmoidoscopy (a camera in a flexible tube is inserted into the colon to allow the physician to see inside the colon)
Tissue biopsy (during the sigmoidoscopy procedure)
How Serious is Irritable Bowel Syndrome?
Complications of Irritable Bowel Syndrome
IBS may be inconvenient for those with mild or moderate symptoms, but those affected are often able to maintain their current level of functioning. However, for those with severe symptoms, IBS can be severely disabling. Severe symptoms may interfere with normal daily activities such as going to work or traveling. Some people with severe symptoms may develop psychological distress, anxiety, panic attacks or even depression.
While IBS is certainly associated with bothersome symptoms and can be inconvenient, it is not life-threatening. It does not cause more serious problems, such as cancer, nor does it affect digestion or cause tissue damage. As there is no cure, it is a chronic condition, but for most people, the symptoms can be controlled when managed appropriately.
What are the Complementary and Alternative Treatments for Irritable Bowel Syndrome?
What are the Conventional Treatments for Irritable Bowel Syndrome?
As there is no cure as yet, the treatment for IBS is aimed at relief of symptoms. While most people will respond well to treatment, there are some people whose symptoms appear unresponsive to treatment. The initial approach is often a modification in diet. A health care provider will help to tailor a diet to the specific needs of each person in hopes of minimizing symptoms. A fiber supplement may be recommended in addition to dietary modifications. As stress may worsen the symptoms in many people with IBS, stress management will be recommended. Should these measures fail, there are medications that can be used to control the symptoms. The choice of medication is determined by the most common symptom that a person experiences:
Antispasmodics are used in people who primarily have abdominal pain or bloating. Examples include tincture of belladonna and dicyclomine (Bentyl).
Antidiarrheals are used in people who primarily suffer from diarrhea. Examples include diphenoxylate with atropine (Lomotil), loperamide (Imodium), and cholestyramine (Questran).
Fiber may be recommended. Examples include psyllium (Metamucil, Fiberall), polycarbophil (Fibercon) and methylcellulose (Citrucel).
Antidepressants may be used for those who primarily suffer from pain. The most common agents are amitriptyline (Elavil) and desipramine (Norpramin).
Benzodiazepines may be recommended for those experiencing worsening of symptoms due to stress or anxiety. Examples include alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), and chlordiazepoxide (Librium).
The goals of treatment are to:
Minimize interference with daily activities
Prevent psychological symptoms
Improve quality of life
Provide thorough education regarding IBS and its management
How Can Irritable Bowel Syndrome Be Managed?
There are a number of things that one can do to manage the symptoms of IBS.
Eat smaller meals or smaller portions more often.
Eat on a regular schedule.
Chew food slowly.
Avoid foods that worsen symptoms (commonly dairy products, chocolate, fatty foods, gas-forming foods, alcohol, and caffeine).
Increase dietary fiber (whole grain breads and cereals, beans, fruits and vegetables).
Drink adequate amounts of water.
Use a heating pad or hot water bottle or take a warm bath to relieve abdominal pain or spasm.
Learn to manage stress appropriately.
Join a support group.