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 IBS - Irritable Bowel Syndrome

 

 

Irritable bowel syndrome (IBS) is a common disorder that affects your large intestine (colon). Irritable bowel syndrome commonly causes cramping, abdominal pain, bloating gas, diarrhea and constipation. Despite these uncomfortable signs and symptoms, IBS doesn't cause permanent damage to your colon.

Most people with IBS find that symptoms improve as they learn to control their condition. Only a small number of people with irritable bowel syndrome have disabling signs and symptoms.

Fortunately, unlike more-serious intestinal diseases such as ulcerative colitis and Crohn's disease, irritable bowel syndrome doesn't cause inflammation or changes in bowel tissue or increase your risk of colorectal cancer. In many cases, you can control irritable bowel syndrome by managing your diet, lifestyle and stress.

Symptoms

The signs and symptoms of irritable bowel syndrome can vary widely from person to person and often resemble those of other diseases. Among the most common are:

  • Abdominal pain or cramping
  • A bloated feeling
  • Gas (flatulence)
  • Diarrhea or constipation — sometimes even alternating bouts of constipation and diarrhea
  • Mucus in the stool

You may have only mild signs and symptoms of irritable bowel syndrome. However, sometimes these problems can be disabling. In some cases, you may have severe signs and symptoms that don't respond well to medical treatment. Because symptoms of irritable bowel syndrome can occur with other more serious diseases, it's best to discuss these symptoms with your doctor.

IBS is a chronic condition, although there will likely be times when the signs and symptoms are worse and times when they improve or even disappear completely.

When to see a doctor

It's important to see your doctor if you have a persistent change in bowel habits or if you have any other signs or symptoms of IBS. These may indicate a more serious condition, such as an infection or colon cancer.

Your doctor may be able to help you find ways to relieve symptoms as well as rule out other more-serious colon conditions, such as ulcerative colitis and Crohn's disease, which are forms of inflammatory bowel disease.

Causes

It's not known exactly what causes irritable bowel syndrome. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food from your stomach through your intestinal tract to your rectum. If you have irritable bowel syndrome, the contractions may be stronger and last longer than normal. Food is forced through your intestines more quickly, causing gas, bloating and diarrhea.

In some cases, the opposite occurs. Food passage slows, and stools become hard and dry. Abnormalities in your nervous system or colon also may play a role, causing you to experience greater than normal discomfort when your intestinal wall stretches from gas.

There are a number of other factors that may play a role in IBS. For example, people with IBS may have abnormal serotonin levels. Serotonin is a chemical messenger that's normally associated with brain function, but it also plays a role in normal digestive system function. It's also possible that people with IBS don't have the right balance of good bacteria in the intestine.


For reasons that still aren't clear, if you have IBS you probably react strongly to stimuli that don't bother other people. Triggers for IBS can range from gas or pressure on your intestines to certain foods, medications or emotions. For example:

  • Foods. Many people find that their signs and symptoms worsen when they eat certain foods. For instance, chocolate, milk and alcohol might cause constipation or diarrhea. Carbonated beverages and some fruits and vegetables may lead to bloating and discomfort in some people with IBS. The role of food allergy or intolerance in irritable bowel syndrome has yet to be clearly understood.

    If you experience cramping and bloating mainly after eating dairy products, food with caffeine, or sugar-free gum or candies, the problem may not be irritable bowel syndrome. Instead, your body may not be able to tolerate the sugar (lactose) in dairy products, caffeine or the artificial sweetener sorbitol.

  • Stress. If you're like most people with IBS, you probably find that your signs and symptoms are worse or more frequent during stressful events, such as a change in your daily routine. But while stress may aggravate symptoms, it doesn't cause them.
  • Hormones. Because women are more likely to have IBS, researchers believe that hormonal changes play a role in this condition. Many women find that signs and symptoms are worse during or around their menstrual periods.

Risk factors

Many people have occasional signs and symptoms of irritable bowel syndrome. However, you're more likely to have IBS if you:

  • Are young. IBS symptoms first appear before the age of 35 for about half of those with the disorder.
  • Are female. More women than men are diagnosed with this condition.
  • Have a family history of IBS. Studies have shown that people who have a first-degree relative — such as a parent or sibling — with IBS are at increased risk of the condition. It's not clear whether the influence of family history on IBS risk is related to genes, to shared factors in a family's environment, or both.

Tests and diagnosis

A diagnosis of irritable bowel syndrome depends largely on a complete medical history and physical exam.

Criteria for making a diagnosis
Because there are usually no physical signs to definitively diagnose irritable bowel syndrome, diagnosis is often a process of elimination. To help in this process, researchers have developed diagnostic criteria, known as Rome criteria, for IBS and other functional gastrointestinal disorders. These are conditions in which the bowel appears normal, but doesn't function normally. According to these criteria, you must have certain signs and symptoms before a doctor diagnoses irritable bowel syndrome.

The most important symptom is:

  • Abdominal pain and discomfort lasting at least 12 weeks, though the weeks don't have to occur consecutively

You also must have at least two of the following:

  • A change in the frequency or consistency of your stool — for example, you may change from having one normal, formed stool every day to three or more loose stools daily, or you may have only one hard stool every few days
  • Straining, urgency or a feeling that you can't empty your bowels completely
  • Mucus in your stool
  • Bloating or abdominal distension

Your doctor will likely assess how you fit these criteria, as well as whether you have any other signs or symptoms that might suggest another, more-serious condition. Some red flag signs and symptoms that might prompt your doctor to do additional testing include:

  • New onset after age 50
  • Weight loss
  • Rectal bleeding
  • Fever
  • Nausea or recurrent vomiting
  • Abdominal pain, especially if it's not completely relieved by a bowel movement
  • Diarrhea that is persistent or awakens you from sleep

If you have these red flag signs or symptoms, you'll need additional testing to further assess your condition.

If you fit the IBS criteria and don't have any red flag signs or symptoms, your doctor may suggest a course of treatment without doing additional testing. But if you don't respond to that treatment, you'll likely require more tests.

Additional tests
Your doctor may recommend several tests, including stool studies to check for infection or malabsorption problems. Among the tests that you may undergo to rule out other causes for your symptoms are the following:

  • Flexible sigmoidoscopy. This test examines the lower part of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope).
  • Colonoscopy. In some cases, your doctor may perform this diagnostic test, in which a small, flexible tube is used to examine the entire length of the colon.
  • Computerized tomography (CT) scan. CT scans produce cross-sectional X-ray images of internal organs. CT scans of your abdomen and pelvis may help your doctor rule out other causes of your symptoms.
  • Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar (lactose) found in dairy products. If you don't produce this enzyme, you may have problems similar to those caused by irritable bowel syndrome, including abdominal pain, gas and diarrhea. To find out if this is the cause of your symptoms, your doctor may order a breath test or ask you to exclude milk and milk products from your diet for several weeks.
  • Blood tests. Celiac disease (nontropical sprue) is sensitivity to wheat protein that also may cause signs and symptoms like those of irritable bowel syndrome. Blood tests may help rule out that disorder.

Treatments and drugs

Because it's not clear what causes irritable bowel syndrome, treatment focuses on the relief of symptoms so that you can live as normally as possible. In most cases, you can successfully control mild signs and symptoms of irritable bowel syndrome by learning to manage stress and making changes in your diet and lifestyle. But if your problems are moderate or severe, you may need to do more. Your doctor may suggest:

  • Fiber supplements. Taking fiber supplements, such as psyllium (Metamucil) or methylcellulose (Citrucel), with fluids may help control constipation.
  • Anti-diarrheal medications. Over-the-counter medications, such as loperamide (Imodium), can help control diarrhea.
  • Eliminating high-gas foods. If you have bothersome bloating or are passing considerable amounts of gas, your doctor may suggest that you avoid such items as carbonated beverages, salads, raw fruits and vegetables — especially cabbage, broccoli and cauliflower.
  • Anticholinergic medications. Some people need medications that affect certain activities of the autonomic nervous system (anticholinergics) to relieve painful bowel spasms. These may be helpful for people who have bouts of diarrhea, but can worsen constipation.
  • Antidepressant medications. If your symptoms include pain or depression, your doctor may recommend a tricyclic antidepressant or a selective serotonin reuptake inhibitor (SSRI). These medications help relieve depression as well as inhibit the activity of neurons that control the intestines. If you have diarrhea and abdominal pain without depression, your doctor may suggest a lower than usual dose of tricyclic antidepressants, such as imipramine (Tofranil) and amitriptyline. Side effects of these drugs include drowsiness and constipation. SSRIs, such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil), may be helpful if you're depressed and have pain and constipation. These medications can worsen diarrhea, however.
  • Antibiotics. It's unclear what role, if any, antibiotics might play in treating IBS. Some people whose symptoms are due to an overgrowth of bacteria in their intestines may benefit from antibiotic treatment. But more research is needed.
  • Counseling. If antidepressant medications don't work, you may have better results from counseling if stress tends to worsen your symptoms.

Medication specifically for IBS
Two medications are currently approved for specific cases of IBS:

  • Alosetron (Lotronex). Alosetron is a nerve receptor antagonist that's designed to relax the colon and slow the movement of waste through the lower bowel. The drug was removed from the market soon after its original approval because it was linked to serious complications. The Food and Drug Administration (FDA) has since allowed alosetron to be used again — with restrictions. The drug can be prescribed only by doctors enrolled in a special program and is intended for severe cases of diarrhea-predominant IBS in women who haven't responded to other treatments. Alosetron is not approved for use by men.

    Generally, alosetron should only be used if usual therapy for IBS has failed. Additionally, it should only be prescribed by a gastroenterologist with expertise in IBS because of the potential side effects.

  • Lubiprostone (Amitiza). Lubiprostone is approved for adult women and men who have IBS with constipation. Lubiprostone is a chloride channel activator that you take twice a day. It works by increasing fluid secretion in your small intestine to help with the passage of stool. Common side effects include nausea, diarrhea and abdominal pain. More research is needed to fully understand the effectiveness and safety of lubiprostone. Currently, the drug is generally prescribed only for those with IBS and severe constipation for whom other treatments have failed.

Coping and support

Living with irritable bowel syndrome presents daily challenges. IBS may be painful or embarrassing and can seriously affect the quality of your life. These suggestions may help you cope more easily:

  • Learn as much about IBS as you can. Talk to your doctor, look for information on the Internet from reputable sources such as the National Institutes of Health, and read books and pamphlets. Being informed about your condition can help you take better charge of it.
  • Identify the factors that trigger IBS. This is a key step both in managing your condition and in helping you feel you have control of your life.
  • Seek out others with IBS. Talking to people who know what you're going through can be reassuring. Try IBS support groups on the Internet or in your community.

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