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DESCRIPTION
Irritable bowel syndrome (IBS) is the most common digestive disorder seen by health care providers. It is estimated that about 1 in 5 adult Americans has symptoms of IBS, although fewer than half of them seek help for it. Twice as many women suffer from the condition as men. This disorders is also sometimes called intestinal neurosis, Mucous colitis, spastic colitis, spastic colon.
Irritable bowel syndrome is a functional bowel disorder. In IBS, the normally rhythmic muscular contractions of the digestive tract becomes irregular and uncoordinated. This means that the movement of the digestive tract is impaired but health care providers can find no change in physical structure, such as inflammation or tumors. The irregular and uncoordinated movement interferes with the normal movement of food and waste material, and leads to the accumulation of mucus and toxins in the intestine. This accumulated material sets up a partial obstruction of the digestive tract, trapping gas and stools, which in turn causes bloating, distention, and constipation/diarrhea. IBS may affect the entire gastrointestinal tract, from the mouth through the colon.
Many people with IBS have alternating periods of constipation and diarrhea, but often one problem is more common than the other. A given episode may be milder or more severe than the one before it, but the disorder itself does not become worse over time. IBS does not lead to more serious diseases, such as inflammatory bowel disease or cancer.
Inflammatory bowel disease (IBD) is not the same thing as Irritable Bowel Syndrome (IBS). IBD is a condition that causes chronic inflammation of the intestines. There are two major types of IBD:
- Ulcerative colitis affects only the large intestine (colon).
- Crohn's disease can affect any part of the entire digestive tract (from the mouth to the anus).
Symptoms of inflammatory bowel disease may include abdominal pain, frequent diarrhea that may contain blood or pus, fever, chills, weight loss, and fatigue. The condition may be mild or severe. The inflammation can also affect other parts of the body, such as the eyes or joints, and may cause a form of arthritis.
Inflammatory bowel disease may recur many times in a person's life. It is treated with medications and sometimes with diet changes. If the disease is in remission (not causing symptoms), treatment may not be needed, although medications may help keep the disease in remission. A severe attack may require that the person be hospitalized for treatment. In some cases, surgery may be needed.
Long-standing inflammatory bowel disease increases a person's risk of colon cancer, although the risk is higher with ulcerative colitis than with Crohn's disease.
SYMPTOMS
Symptoms of IBS may include:
- Constipation and/or diarrhea (often alternating).
- Abdominal pain. Pain is often triggered by eating and relieved by a bowel movement.
- Bloating.
- Intolerances to certain foods causing irritation of the intestinal tract. Lactose (milk sugar is a common culprit, as are all dairy products.
- Mucus in the stools.
- A sense that you have not completely emptied your bowels.
- Nausea.
- Severe headaches (sometimes).
- Vomiting.
- Anorexia. Because of the pain, a person may dread eating.
- Malnutrition may result regardless of whether a person eats normally or not, as nutrients often are not absorbed properly. As a result, people with IBS require as much as 30 percent more protein than normal, as well as an increased intake of minerals and trace elements, which can quickly be depleted by diarrhea.
IBS should not be confused with the more serious bowel disorders, such as Crohn's disease and ulcerative colitis. These are inflammatory bowel diseases, but, unlike IBS, they result in demonstrable lesions in the digestive tract. Crohn's disease affects the entire length and thickness of the wall of the large and/or small intestine, the last five or seven feet of the digestive tract.
MoonDragon's Health & Wellness: Crohn's Disease
Symptoms of irritable bowel syndrome (IBS) may persist for a long time, but IBS does not cause cancer or shorten life expectancy.
- Some people may have symptoms off and on for many years.
- The pattern of IBS varies from one person to the next and from one bout to the next. You may go months or years without having any symptoms. However, most people have recurrent episodes of symptoms.
- Symptoms may improve over time in some people.
- It is rare for a person to have symptoms constantly.
Although IBS does not cause more serious conditions, such as cancer or inflammatory bowel disease, a person who has IBS may also have one of these illnesses.
CAUSES
There are no physical signs of disease in bowel tissue with this disorder, and its cause or causes are not well understood or is not known. Some scientists believe a virus or bacterium may play a role. Lifestyle factors such as stress and diet are probably common causes. The overuse of antibiotics, antacids, or laxatives, which disturb the bacterial microflora of the bowel, may also be a factor.
Some health experts believe faulty communication between the brain and the intestinal tract cause IBS. A complex combination of elements, including psychological stress, hormones, the immune system, and chemicals called neurotransmitters, appears to interfere with messages between the brain and the bowel. The miscommunication causes abnormal muscle contractions or spasms, which often cause cramping pain. The spasms may either speed the passage of stool, causing diarrhea, or slow it down, causing constipation or bloating.
People with IBS seen to have unusually sensitive intestines. It is not know why their intestines are more likely to react strongly to these elements. People who have IBS may develop pain in response to one or more factors, including:
- Eating (though no particular foods have been associated with IBS).
- Stress. Stress may affect the movements of the intestines and also may affect the way a person feels pain. Stress may also have the same effect on people who do not have IBS.
- Bloating caused by trapped gas.
- Hormonal changes, such as during the menstrual cycle.
- Certain medications.
- Genetics. IBS may be more likely to occur in people who have a family history of the disorder.
RISK FACTORS
Many other diseases can be related to IBS, including candidiasis, colon cancer, diabetes mellitus, gallbladder disease, malabsorption disorders, pancreatic insufficiency, ulcers, and the parasitic infections amebiasis and giardiasis. Over 100 different disorders may be linked to the systemic effects of IBS. One disorder that is linked in about 25 percent of adults with IBS is arthritis, usually peripheral arthritis, which affects the ankles, knees, and wrists. Less frequently, the spine is affected. IBS can also be related to skin disorders, but this is unusual. Some people with IBS have abnormalities in the levels of liver enzymes in their blood.
Irritable bowel syndrome (IBS) tends to be more common in:
- People younger than age 35. At least half of the people who have IBS developed symptoms before age 35. If the first attack occurs after age 40, it is more likely than not that symptoms are caused by something other than IBS. IBS is less likely to develop for the first time in people over 60 than it is in younger people.
- Women. In the United States, most people who are seen by health care providers for IBS are women. However, in some other countries, most people who are seen by health care providers for IBS are men. This difference may have more to do with cultural variations in willingness to report IBS symptoms than with any real difference in the numbers of men and women who have the condition.
- People who have panic disorder or other psychological conditions.
- People who have a family history of IBS.
- People who have a history of physical or sexual abuse or other psychological trauma. Several studies have found a link between a past history of abuse and gastrointestinal disorders.
PREVENTION
You cannot prevent irritable bowel syndrome (IBS). However, proper self-care may help minimize symptoms and perhaps extend the time between episodes.
TREATMENT
Medical Treatment of IBS
DIAGNOSIS
No specific test can be used to diagnose irritable bowel syndrome (IBS), so health care providers use symptoms to help diagnose the condition. In most cases, only minimal tests are needed. A health care professional diagnoses IBS when a person has the typical symptoms of the disorder and routine tests, if needed, have ruled out other possible causes.
An expert panel has outlined a list of symptoms common in IBS. Health care providers often use these symptoms, known as the Rome criteria, to tell IBS apart from other intestinal problems. However, people who don't have all of these symptoms may still have IBS.
You are believed to have IBS if abdominal pain or discomfort is continuous or comes and goes for at least 12 weeks (need not be consecutive) during the past year, and two of the three following conditions occur:
- Pain is relieved by having a bowel movement.
- The frequency of bowel movements changes.
- The stools' appearance or form changes.
Bowel movement patterns. In IBS, your pattern of bowel movements varies at least 25 percent of the time. Two or more of the following may happen:
- Bowel movements may occur either more often (diarrhea) or less often (constipation) than usual, such as having more than 3 bowel movements a day or less than 3 per week.
- Bowel movements may differ in size or consistency (may be hard and pelletlike, pencil-thin, or loose and watery).
- The way stools pass changes. You may strain, feel an urgent need to have a bowel movement, or feel that you haven't completely passed a stool.
- You may have bloating or a feeling of gas in the intestines.
The amount of testing that may be done depends on several factors: age, how the symptoms come on and how severe they are, and how the person responds to the initial treatment. For example:
- For a 22-year-old woman who has all the typical symptoms of IBS, sigmoidoscopy may be the only test needed. Irritable bowel syndrome is more common in young women, and so if symptoms are typical of IBS, extensive testing is probably not needed.
- For a 56-year-old man whose symptoms started recently, more extensive testing is probably needed. People over age 50 are less likely than younger people to develop IBS symptoms for the first time, so it is more likely that symptoms may be caused by another problem.
- If you get better after some initial treatment for symptoms the health care provider suspects are caused by IBS, no further tests are needed.
TREATMENT
Irritable bowel syndrome is a long-term (chronic) but manageable condition. Active involvement in treatment is important to successfully manage the condition. Treatment is adapted to fit individual needs. Medication may be used in addition to changes in diet and lifestyle.
It is important that you work closely with your health care provider to create a treatment plan that will meet your needs. Learn all you can about your condition so you can effectively communicate concerns and questions to your health care provider.
No single type of treatment works best for everyone. Let your health care provider know if parts of your treatment are not helping your symptoms.
You and your health care provider will need to work together to determine what may be triggering your symptoms, such as constipation or diarrhea. For some people who have IBS, certain foods may trigger symptoms. Eliminating certain foods or adding more fiber to your diet may help relieve or prevent your symptoms. See dietary suggestions below.
If stress is a trigger for you, some form of psychological therapy or stress management may help you deal more positively with stress and help prevent or reduce stress-related IBS episodes. See STRESS for more information.
Getting regular, vigorous exercise (such as swimming, jogging, or brisk walking) may help reduce tension and make your bowels more regular.
Medications may be used along with lifestyle changes to manage symptoms of IBS.
MEDICATIONS
The goal of drug treatment is to relieve your symptoms enough to prevent them from interfering with your daily activities, because it may not be possible to eliminate symptoms. Medications may be prescribed to treat moderate to severe pain, diarrhea, or constipation that does not respond to home treatment.
- Antidepressant medications may improve IBS symptoms even in people who do not have depression, especially the medication class known as tricyclic antidepressants.
- Antianxiety medications may help people whose anxiety contributes to their IBS symptoms.
- Tegaserod, a medication that increases movement of the intestines, is now approved to treat IBS in women whose main symptom is constipation. While studies have shown a trend toward symptom improvement in men, the studies were not able statistically to show effectiveness in men.
No single medication has been shown to be effective in relieving IBS over the long term.
SURGERY
Surgery is not done for irritable bowel syndrome.
OTHER TREATMENT OPTIONS
A wide range of other therapies has been used to treat irritable bowel syndrome (IBS). Treatment methods that help improve responses to stressful situations can be helpful. However, no one treatment works best for everyone. Other treatment choices may include:
Psychological treatment: The following psychological treatment options may help relieve symptoms of irritable bowel syndrome (IBS) in some people. Psychological treatment methods are usually more effective if they are used along with other treatment methods, such as diet changes, stress reduction and sometimes medication.
- Stress Reduction. Research and testing have found not only that breathing exercises can control IBS, but that people who practice stress management have fewer and less severe attacks. Stress management also relieves symptoms. See STRESS for more information.
- Therapy. Psychotherapy and behavioral therapy may be effective if you have pain caused by IBS. Some people who use these treatment methods may have long-term relief.
- Hypnosis. Hypnosis may be an effective way to treat IBS that does not respond to other treatment methods. Hypnosis can help some people relax, which may relieve abdominal pain. Hypnosis has been especially successful in people younger than age 50.
- Relaxation or meditation. Relaxation training and meditation involves concentrating on a word, image, or phrase for a given length of time to reach a state of deep relaxation. It may be helpful in reducing generalized muscle tension and abdominal pain. Used regularly, these techniques can be helpful in dealing with stressful situations. With practice, you can learn to relax easily in almost any setting.
- Biofeedback. Biofeedback training may help relieve pain from intestinal spasms. It also may help improve bowel movement control in people who have severe diarrhea.
HOLISTIC & NUTRITIONAL RECOMMENDATIONS
For most people who have irritable bowel syndrome (IBS), home treatment may be the best way to manage the symptoms. It is also helpful to learn all you can about IBS so you can effectively communicate concerns and questions to your health care provider.
Although there is no cure for IBS yet, careful attention to diet and stress management should help keep your symptoms under control and perhaps even prevent them from coming back.
DIET MODIFICATION SUGGESTIONS
In many people who have IBS, eating may trigger symptoms. However, for most people, there is not a particular type of food that triggers symptoms. You can take steps to reduce the possibility that certain foods will cause symptoms.
Avoid or limit gas-producing foods (including beans and cabbage), sugarless chewing gum and candy, caffeine, and alcohol.
Limit or eliminate foods that may make diarrhea worse. These include caffeine, alcohol, fatty foods, gas-producing foods (such as beans, cabbage, and broccoli), and the artificial sweetener sorbitol, often used in sugarless gum and sugarless candy.
Avoid animal fats, butter, all carbonated beverages, coffee and all other substances containing caffeine, candy, chocolate, all dairy products, fried foods, ice cream, all junk foods, the additives mannitol and sorbitol, margarine, nuts, orange and grapefruit juices, pastries, all processed foods, seeds, spicy foods, sugar, sugar-free chewing gum, wheat bran and wheat products. These foods encourage the secretion of mucus by the membranes and prevent the uptake of nutrients.
Avoid alcohol and tobacco; these irritate the linings of the stomach and colon.
When an intestinal upset occurs, switch to a bland diet. Put vegetables and nonacidic fruits through a food processor or blender. Organic baby food is good. If you are on a soft diet, take some type of fiber and a protein supplement.
To relieve occasional gas and bloating, use charcoal tablets (available in health food stores). Take 5 tablets as soon as this problem arises. Do not use charcoal daily, however, because it also absorbs needed nutrients, and do not take it at the same time as other supplements or medications. Check to see if you have food allergies; they are important factors in this disorder. Eliminating allergenic foods from the diet relieves symptoms in many cases. See ALLERGIES for more information.
Keep a daily diary of what you eat and whether you experience symptoms after eating.
Eating slowly, chewing your food well, and having meals in a quiet, relaxing environment without being in a hurry. Do not overeat.
Practice deep breathing exercises. Shallow breathing reduces the oxygen available for proper bowel function.
Do not eat right before going to bed. Wait one or two hours after eating before lying down.
Eat a high-fiber diet including plenty of fruits and vegetables, plus whole grains (especially brown rice) and legumes.
Eating the correct diet, using supplemental fiber, and drinking plenty of water are very important in controlling IBS. Use supplemental fiber such as psyllium powder. This regulates bowel movements and should be used daily. Also use oat bran and ground flaxseeds daily, on an alternating basis. Early recognition of the disease, good nutrition, and a positive outlook help minimize complications.
Certain foods irritate the wall of the intestinal tract. Lactose (milk sugar) is a common irritant and if you are lactose intolerant, all dairy products should be avoided.
For excessive gas and bloating that lingers, see ENEMAS and L.BIFIDUS RETENTION ENEMA for details and instructions. This will replace the " friendly" bacteria very quickly and resolve the problem. Exercise, such as stretching exercises, swimming, or walking, is also important.
Enteric-coated peppermint capsules are used successfully in Europe for IBS.
If IBS causes chronic diarrhea, electrolyte and trace mineral deficiencies are likely. See DIARRHEA for suggested mineral supplementation. Also see MALABSORPTION SYNDROME.
Certain drugs can aggravate the malabsorption problems often present with IBS. These include antibiotics, corticosteriods, cholestyramine (Questran), and sulfasalazine (Azulfidine), among others. These drugs increase the need for nutritional supplements.
Wear loose-fitting clothing that does not bind or is tight around the waist or abdomen.
Significant acidosis may occur with IBS. See ACIDOSIS for more information and take the self-test.
Avoid sugar and other refined carbohydrates. Both bacteria and fungi (yeast) thrive on sugar.
The symptoms of IBS are similar to those of many other disorders, including cancer. If dietary modification and natural remedies yield no relief, it is wise to consult with a health care provider to rule out some other underlying problem. We recommend this only after natural remedies and nutritional changes have been tried, however.
See HEARTBURN, INDIGESTION (Dyspepsia), and/or DIVERTICULITIS for more information.
HERBS
If you have IBS, it is wise to treat your liver as well as your digestive tract, preferably with silymarin (milk thistle extract). Licorice can also be used. Other beneficial herbs are burdock root and red clover, which are good for cleansing the bloodstream, and thereby the liver. Caution: If overused, licorice can elevate blood pressure. Do not use this herb on a daily basis for more than 7 days in a row. Avoid it completely if you have high blood pressure.
Aloe vera is healing to the digestive tract. Used in combination with Aerobic Bulk Cleanse (ABC) from Aerobic Life Industries, it helps to keep the colon walls clean of excess mucus and slow down food reactions. Take 1/2 cup of aloe vera juice 3 times daily, on an empty stomach.
Alfalfa contains vitamin K, needed to build intestinal flora for proper digestion, and chlorophyll for healing and cleansing of the bloodstream. It can be taken in liquid or tablet form.
Peppermint aids in healing and digestion, and also relieves upset stomach and gas or that "too-full" feeling. It must be taken in enteric-coated capsule form to prevent the oil from being released before it reaches the colon. Do not take any other form, or heartburn may result.
Skullcap and valerian root are helpful for the nerves that regulate intestinal muscle function. These are good taken at bedtime or when an upset occurs.
Other herbs that can be beneficial for irritable bowel syndrome include balm, chamomile, fenugreek, ginger, goldenseal, lobelia, marshmallow, pau d'arco, rose hips, and slippery elm. Caution: Do not use chamomile or lobelia on an ongoing basis. Avoid chamomile completely if your allergic to ragweed. Do not take goldenseal internally on a daily basis for more than one week at a time, do not use it in large quantities during pregnancy, and use it with caution if you are allergic to ragweed.
NUTRITIONAL RECOMMENDATIONS
Nutrients Supplement Suggested Dosage Comments Very Important Alfalfa As directed on label. For healing and cleansing the bloodstream. Take in liquid or tablet form. Vitamin B complex 50-100 mg 3 times daily, with meals. Needed for proper muscle tone in the gastrointestinal tract. Vitamin B12 200 mcg twice daily. Needed for proper absorption of foods, protein synthesis, and metabolism of carbohydrates and fats, and to prevent anemia. Use a lozenge or sublingual form. Important Acidophilus
Or
Bio-Bifidus from American Biologics
Or
Kyo-Dophilus from WakunagaAs directed on label for all brands. To replenish the "friendly" bacteria. Needed for digestion and for the manufacture of the B vitamins. Use a nondairy formula. Aloe vera Juice 1/2 cup 3 times daily, on an empty stomach. Helps keep the colon walls clean of excess mucus and slow down food reactions. Garlic (Kyolic) As directed on label. Aids in digestion and destruction of toxins in the colon. Liquid form is best. Fiber (oat bran, flaxseeds, psyllium seeds, and Aerobic Bulk Cleanse (ABC) from Aerobic Life Industries are good sources) As directed on label. Take separately from other supplements and medications. Has both a healing and cleansing effect. Avoid wheat bran, as it may be too irritating. Free-form amino acid complex As directed on label. Necessary for repair of mucous membranes of the intestines. L-Glutamine 500 mg twice daily, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg vitamin B6 and 100 mg vitamin C for better absorption. A major metabolic fuel for the intestinal cells; maintains the villi, the absorption surfaces of the gut. See AMINO ACID INDEX. Multivitamin and mineral complex As directed on label. Supplies those nutrients lost or not absorbed. Use a hypoallergenic formula. N-Acetylglucosamine (N-A-G from Source Naturals) As directed on label. A major constituent of the intestinal lining and of the barrier layer that protects the intestinal lining from digestive enzymes and other potentially damaging intestinal contents. Primrose oil
Or
Flaxseed oilAs directed on label.
As directed on label.To supply essential fatty acids needed to protect the intestinal lining. Proteolytic enzymes
With
PancreatinAs directed on label. To aid in protein digestion and prevention of "leaky gut syndrome. " Also aids in reducing inflammation. Use a formula that is low in HCl and high in pancreatin. Ultra Clear Sustain from Metagenics As directed on label. A complex that provides nutritional support for gastrointestinal mucosa. Available only through health care professionals. Helpful Or
Dioxychlor from American BiologicsAs directed on label. For tissue oxygenation and destroys foreign bacteria in the digestive tract. Calcium
And
Magnesium2,000 mg daily.
1,000 mg daily.Helps the "nervous stomach" and the central nervous system.
Aids in preventing colon cancer. Use chelate forms.Shark cartilage (Benefin) As directed on label. If you cannot tolerate taking it orally, it can be administered rectally in a retention enema. Fights growth and metastasis of cancerous tumors. IBS is associated with an increased risk of colon cancer.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
Call your health professional if:
- You have been diagnosed with irritable bowel syndrome and your symptoms become worse, begin to disrupt your activities, or do not respond as usual to your home treatment.
- You are becoming more tired than usual.
- Your symptoms wake you from sleep.
- You have unexplained weight loss.
- You have decreased appetite.
- You have abdominal pain that is not associated with changes in bowel function or that is not relieved when you pass gas or a stool.
- You have abdominal pain that is now in one area (localized) more than any other area. You see blood in your stool.
If none of the symptoms listed above is present, try to rule out other causes of abdominal problems (such as eating a new food; eating sugar-rich foods, especially milk products; eating foods containing sorbitol, an artificial sweetener; nervousness; or stomach flu). Try home treatment for 1 or 2 weeks. If your symptoms don't get better or if they get worse, call your health care provider.
An occasional case of upset stomach, diarrhea, or constipation is common, especially during stressful times. Symptoms of stomach pain, nausea, vomiting, and diarrhea that come on quickly and that go away on their own are more likely to be caused by stomach flu or food poisoning, especially if other people around you are also sick.
For More Information: Organizations
American College of Gastroenterology
P.O. Box 3099
Alexandria, VA 22302
Web Address: www.acg.gi.org
This is an organization of digestive disease specialists. At the Web site, you can view information about common gastrointestinal problems.
International Foundation for Functional Gastrointestinal Disorders
P.O. Box 170864
Milwaukee, WI 53217-8076
Phone: 1-888-964-2001
Fax: (414) 964-7176
E-mail: iffgd@iffgd.org
Web Address: www.iffgd.org
The International Foundation for Functional Gastrointestinal Disorders is a nonprofit educational and research organization that provides information and support to physicians and people who have gastrointestinal disorders. It provides information about irritable bowel syndrome and other conditions such as gastroesophageal reflux disease (GERD).
National Digestive Diseases Information Clearinghouse (NDDIC)
2 Information Way
Bethesda, MD 20892-3570
Phone: (301) 654-3810
1-800-891-5389
Fax: (301) 907-8906
E-mail: ndic@info.niddk.nih.gov
Web Address: digestive.niddk.nih.gov/index.htm
This clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The clearinghouse answers questions; develops, reviews, and sends out publications; and coordinates information resources about digestive diseases. Publications produced by the clearinghouse are reviewed carefully for scientific accuracy, content, and readability.
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