Irritable Bowel Syndrome

Definition

Irritable bowel syndrome (IBS) is a combination of intermittent abdominal pain and irregular bowel habits (i.e. constipation, diarrhea or a combination) that occur in the absence of a diagnosable disease.

IBS is also called irritable colon, mucous colitis, spastic colon, colitis, spastic bowel, and functional bowel disease. Most of these terms are somewhat inaccurate, however. Colitis, for instance, means inflammation of the colon. IBS, on the other hand, is associated with no inflammation

Description

The colon (large intestine) is responsible for packaging and eliminating stool. As food moves through the colon it absorbs water while forming stool. Muscle contractions (squeezing motions) in the colon push the stool toward the rectum (the lower 8 to 10" of the large intestine). These contractions are controlled by nerves, hormones and by electrical activity in the colon muscle and is called defecation or bowel movement.

Normal bowel function varies widely from person to person, but doctors generally agree that normal bowel function ranges from three stools a day to three each week. A normal movement is one that is formed but not hard, contains no blood, and is passed without cramps or pain. However, when the nerves become "irritated" the muscle contractions may become too hard (causing abdominal pain), may stop (causing constipation and bloating), may accelerate (causing diarrhea and an urgency to have a bowel movement) or be a combination of all, causing the major symptoms of IBS.

Though IBS can cause a great deal of discomfort, it can almost always be managed and does not lead to any other serious diseases. With attention to proper diet, stress management, and sometimes medication prescribed by their physician, most people with IBS can keep their symptoms under control.

Symptoms

The symptoms of IBS are:

• abdominal pain

• constipation

• diarrhea

• alternating constipation and diarrhea

• bloating and gas

• feeling the need for a bowel movement after just having one

• feeling a strong urge to have a bowel movement

• pain and cramping

• mucus-covered stools

Symptoms such as anemia, anal bleeding, weight loss and fever are not symptoms of IBS. Contact the doctor immediately if you are experiencing these symptoms.

The symptoms of IBS can be aggravated by a number of factors such as emotional conflict, stress, food, alcohol, caffeine, change in daily routine or a women's menstrual period.

Diagnosis

The diagnosis of IBS is determined by a complete medical history with emphasis on symptoms and symptom frequency, a physical examination, laboratory tests such as a CBC (complete blood count) and fecal test, as well as a diagnostic procedure called a sigmoidoscopy (examination of the rectum and sigmoid colon through a viewing instrument inserted into the rectum).

Treatment

Depending on the severity of IBS will determine the method of treatment. There are three (3) treatment options: conservative, pharmaceutical and psychological/behavioral.

Conservative Treatment for Mild IBS

The first line of treatment of mild IBS is changing the person's diet and alleviating stress. A high-fiber, low fat diet is recommended. Foods such as whole grain breads and cereals, beans, fruits and vegetables are good sources of fiber. Avoid alcohol and caffeine as much as possible and try eating six (6) small meals a day rather than three (3) large meals.

Some doctors may suggest using an over-the-counter fiber supplement. Lifestyle changes consist of exercising, alleviating stress, getting a good night's sleep, reserving enough time to have a bowel movement and having a bowel movement when needed.

Pharmaceutical Approach for Moderate to Severe IBS

When these conservative measures fail, the doctor may recommend a pharmaceutical approach to ease the symptoms of IBS. For moderate symptoms such as cramping and pain doctors may prescribe an antispasmodic medicine (such as hyoscyamine (Anaspaz, Cystospaz, Levsin) or dicyclomine (Bemote, Bentyl, Di-Spaz)). For diarrhea, the doctor may recommend loperamide (Imodium) or cholestyramine (Questran) and for constipation, osmotic laxatives such as lactulose (Chronulac) or sorbitol are helpful.

For patients suffering from severe, continuous pain that impairs their daily functioning, doctor may prescribe an antidepressant such as amitriptyline (Elavil) or nortriptyline (Pamelor). These drugs work by increasing the release of neurotransmitters in the brain to "close the gate" and prevent the transmission of pain.

Psychological/Behavioral Treatments

Psychological and behavioral treatments are supplemental therapy for patients with IBS, regardless of the severity of the condition. Simple forms of relaxation or exercise (e.g., baths, golf, tennis, and rest periods) may reduce tension and enable the patient to feel more in control. This is important, because many patients with IBS come to the physician already feeling a loss of control over their lives.

In selected patients, insight or cognitive psychotherapy can lead to emotional and symptomatic improvement. Finally, hypnotherapy, biofeedback or other structured relaxation techniques can be considered.

Questions to Ask Your Doctor

Are there any signs of disease that may indicate another disorder?

Have all tests been performed to rule out other disorders?

Are you going to prescribe any medications? What are the side effects?

Could this disorder result from the ingestion of certain foods or food irritants?

Should a psychological profile be done and will it help?

Are biofeedback techniques or hypnotherapy successful in treating irritable bowel syndrome? Can you recommend someone in this field?

Are there any other measures, such as heat to the abdomen, to help relieve discomfort?

Can this increase the chances of developing colon cancer?