What is Irritable Bowel Syndrome?

Irritable bowel syndrome, or IBS, is a common condition and affects up to 15% of people over a lifetime. IBS is second only to the common cold as a cause of work absenteeism. IBS is more common in women and tends to be more active during the reproductive years (after menstruation begins and before menopause). Many women report that IBS symptoms get worse during or just before menstruation. Although we see IBS more commonly in women, many men also suffer from IBS.

IBS is a disturbance of gut function. The bowel looks normal when visualized during a colonoscopy, CT scan or x-ray. The problem is in the way the bowel works. IBS is characterized by abdominal discomfort/pain, bloating, and abnormal bowel movements. Diarrhea may alternate with constipation. Discomfort, pain and bloating are often relieved by having a bowel movement or passing gas. Bowel movements may be "urgent", making it difficult to make it to the bathroom in time. Or, some feel like the bowels do not empty completely. Symptoms often get worse with stress.

Anemia (low blood counts), blood in the stool, weight loss or fever cannot be explained by IBS and may indicate a more serious medical problem. These symptoms should be immediately reported to your physician.

What tests are appropriate in the evaluation of IBS?

The evaluation of IBS symptoms varies from patient to patient. A complete history should be taken by a health professional. A physical exam should be performed. Further testing may include bloodwork/labs, stool studies or imaging (ultrasound, x-ray, etc.). You may need a colonoscopy, especially if you are over 50 years old or having worrisome symptoms like blood in the stool.

What does "irritable" mean?

Irritable means that the nerve endings in the lining of the bowel are extremely sensitive, and that the nerves that control the muscles of the bowel are unusually active. The result is that the bowel is too sensitive to "normal" events such as the passage of gas, fluid or stool. This leads to inappropriate muscular activity that can cause cramping, diarrhea or constipation.

Will I ever recover from IBS?

It has been established that each year, approximately 10% of IBS patients get better. Others tend to have waxing and waning disease. That is, symptoms may be severe for a month or two, then improve for a while, and then recur. In cases where life stress is an important factor, a change in lifestyle or job or personal relationships may lead to complete recovery.

Is IBS "colitis"?

No. IBS was called "spastic colon" or "spastic colitis" in the past, and this has led to much confusion. "Colitis" refers to inflammation of the colon. Infections or disease such as Crohn's or Ulcerative Colitis can produce such inflammation. In IBS there is no inflammation of the colon wall.

What causes bloating and gas?

The mechanism of bloating is not well understood. Many factors may be involved, such as poor abdominal muscle tone or unusual sensitivity to sensations arising in the gut. The smooth muscle that lines the intestine and colon may be overly relaxed. When tested, people with IBS do not actually produce more gas than others. However, IBS patients experience discomfort from normal amounts of gas. They also may be less able to pass gas that is present.

What is the effect of diet on irritable bowel?

Diet is almost always a contributing factor in IBS. Your doctor will probably ask you to keep a food and symptom diary to help identify certain foods that aggravate your IBS. This diary should be kept for a minimum of one week. Common offending foods are those that contain high fat (greasy foods), dairy, wheat, MSG (monosodium glutamate, a food additive), artificial sweeteners or gassy vegetables such as beans, broccoli and cauliflower. But, just about every food has been implicated in the production of IBS symptoms, so it is important to identify which particular foods increase your symptoms.

About 17% of Caucasians have lactose intolerance. This condition is even more common in Native Americans and those of Asian decent. Lactose intolerance refers to the inability to digest milk products. The enzyme that breaks down milk sugar (lactose) is missing or reduced in the digestive tract. It has also been suggested that the milk protein, in addition to the milk sugar, can cause problems. People with lactose intolerance experience gas, bloating or diarrhea when they eat milk products. Since the symptoms can be the same, many folks diagnosed with IBS may actually have lactose intolerance. This is why your physician may ask you to try a dairy-free diet for 2-4 weeks to see if your symptoms improve.

What is the relationship of stress to IBS?

Emotional distress can significantly influence IBS. That is why IBS may flare during times of emotional upset such as family or job problems. That does not mean that IBS is "all in your head". It does not mean that all IBS patients are "crazy" or "anxious". As stated previously, IBS results from a complex interaction between the mind and the gut. In many IBS patients the mind is much too aware of what is going on in the gut and the gut is much too aware of what is going on in the mind. So, if you are under increased stress, some of that stress may be transmitted to your gut. When this happens, the gut may become under-active (constipation), over-active (diarrhea) or ultra-sensitive (pain, bloating).

If you have been diagnosed with depression or anxiety, IBS may become worse when these conditions are not under good control.

How is IBS treated?

There is no easy cure for IBS. There is no "magic pill" that can make IBS symptoms go away. IBS treatment is difficult as it almost always involves lifestyle change.

The first step in the treatment of IBS is a personal evaluation of your overall well-being. Do you eat a healthy diet? Do you eat a lot of processed food or fast food? Are there certain foods which tend to aggravate your IBS? Do you exercise regularly? How do you deal with the stress in your life? (Sources of stress may include overwork, unhealthy relationships, poor sleep habits, and overuse of caffeine, alcohol or tobacco.) Do you have untreated depression, anxiety or post traumatic stress disorder? You cannot expect to "recover" from IBS if any of these issues are neglected.

Proper rest and exercise can help to reduce stress levels. Your doctor may recommend that you speak to a therapist about coping mechanisms and stress reduction techniques.

Of course, foods which make your symptoms worse should be avoided. A high fiber diet and/or fiber supplements are often helpful. Not only is fiber used in the treatment of constipation, but it is also useful in the treatment in IBS marked by pain, diarrhea or alternating constipation and diarrhea. Laxatives such as Miralax or Milk of Magnesia may be used for constipation. The chronic use of stimulant laxatives should be avoided. Stimulant laxatives are those that contain ingredients such as bisacodyl, senna or cascara.

When these measures fail, medications can be prescribed that target specific symptoms of IBS. Some of these include a class of medications called "antispasmodics" to treat pain or cramping. Other medications treat discomfort by interfering with the overly sensitive connections between brain and gut. Low dose antidepressants are commonly used to reduce the pain associated with IBS. Other medications treat constipation or diarrhea.

The key to achieving relief from IBS is for patients to realize that IBS is a complex disorder with physical and stress-related dimensions. A strong partnership between an empathetic physician and a knowledgeable, motivated patient can produce significant improvement.

5 tips to help you deal with Irritable Bowel Syndrome:

  • If your physician has diagnosed you with IBS, then stop worrying about whether it is "something else" (like cancer).
  • Avoid foods that you know will make your symptoms worse.
  • Use medications wisely. For instance, take an anti-diarrheal before leaving home if you are worried about having loose stool when no bathroom facilities are readily available.
  • Look for sources of stress in your life and do something about them.
  • Above all, decide who is running your life... YOU or your GUT. Life is easier if you've made up your mind that you are in charge!


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