Introduction:

Irritable bowel syndrome (IBS) occurs when muscles in your large intestine contract faster or slower than normal. This causes pain, cramping, gassiness, sudden bouts of diarrhea, and constipation.

People may have alternating bouts of constipation and diarrhea, or diarrhea-predominant IBS or constipation-predominant IBS. Although the symptoms can be hard to live with, IBS doesn' t cause permanent damage to your intestine.

Between 10 - 20% of the population has IBS at some time. IBS also makes up 20 - 50% of visits to gastroenterologists, or doctors dealing with digestive system problems. IBS often starts in teens or young adults. It affects almost twice as many women as men, and is often associated with stress.

Signs and Symptoms:

Symptoms of IBS may include:

• Cramping pain in your lower abdomen
• Bloating and gas
• Diarrhea or constipation, or bouts of both
• Immediate need to move your bowels when you wake up or during or after meals
• Relief of pain after bowel movements
• Feeling of incomplete emptying after bowel movements
• Mucus in your stool

What Causes It?:

Researchers don' t know what causes IBS, and the intestines of people with IBS appear normal when examined. It may be caused by a disturbance in the muscle movement of the intestine or a lower tolerance for stretching and movement of the intestine.

IBS can occur at any age, but often begins in teens or young adults. It is more common in women. More than 80% of IBS patients in the United States are women, according to the American College of Gastroenterology. Risk factors may include a low-fiber diet, emotional stress, use of laxatives, a bout of infectious diarrhea, or other temporary bowel inflammation.

Up to 60% of people with IBS have psychological symptoms, such as anxiety and depression. Some people with BS have low levels of the brain chemical serotonin.

Diet is also plays a major role in IBS. Some doctors believe that food allergies cause some cases of IBS, although studies have been mixed. Fatty foods, artificial sweeteners (sucralose or Splenda and saccharine or Sweet'N Low), chemical additives (dyes and preservatives), red meat, dairy products (milk, cheese, sour cream), chocolate, alcohol, and carbonated beverages (sodas) may trigger or aggravate episodes in some people. Gluten contained in wheat and barley can also be a problem for some people with IBS. IBS may affect how the body is able to absorb nutrients, so that some people may not be getting all the nutrients they need.

What to Expect at Your Provider's Office:

Your doctor will feel your abdomen to check for signs of pain. Other tests may include a rectal exam, pelvic exam (for women), sigmoidoscopy, stool sample testing, blood and urine tests, ultrasound, and x-rays to rule out other conditions.

Doctors may also check to see if you are lactose intolerant. Lactase is an enzyme the body needs to digest sugars found in dairy products. If a person lacks this enzyme, they may have problems digesting dairy products that cause symptoms similar to IBS. Removing milk and dairy products from the diet for several weeks may help determine if the person is lactose intolerant.

Treatment:

The goal of treatment is to relieve symptoms. For some people, changing their diet may reduce symptoms. Adding more fiber and avoiding stimulants such as caffeine may help. Reducing anxiety by getting regular exercise and seeking counseling for severe anxiety or depression may also be helpful. Alternative and complementary therapies, including herbs, supplements, and lifestyle changes, may help relieve symptoms as well.

Drug Therapies

Anticholinergic medications -- help relax the muscles in the intestine and relive pain from bowel spasm. Anticholinergic drugs include hyoscyamine (Levsin and Levsinex) and dicyclomine (Bentyl).

Antiflatulents -- reduce gas. Antiflatulents include simethicone (Phazyme or Mylicon).

Antidiarrheal medications -- help decrease and stop diarrhea. Antidiarrheal drugs include loperamide (Imodium) and a combination of diphenoxylate & atropine (Lomotil).

Fiber supplements -- such as psyllium (Metamucil) may help with diarrhea or constipation.

Antidepressants -- may be prescribed to treat pain or depression.

Currently two drugs are approved specifically to treat IBS. They are used cautiously and only when other treatments have failed.

Lubiprostone (Amitiza) -- increases fluid in the intestine to help speed the passage of stool. It is approved only for women with IBS who predominantly have severe constipation and have failed all other treatments.

Alosetron (Lotronex) -- helps relax the intestine and slow passage of stool. This drug was removed from the market for a while because it was associated with serious side effects. Currently it is only allowed to be sold with restrictions. Your doctor must be enrolled in a special program to prescribe the drug, and it is approved only for women with IBS who predominantly have diarrhea and have failed all other treatments. Alosetron should not be prescribed for men.

Complementary and Alternative Therapies

Irritable bowel syndrome (IBS) is often treated with alternative therapies. Stress reduction techniques, such as biofeedback, hypnosis, dietary changes, or counseling, may help.

Nutrition and Supplements

Some doctors believe food allergies may be a trigger of IBS, at least for some people. The most common food allergens are dairy products, wheat, corn, peanuts, citrus, soy, eggs, fish, and tomatoes. Your health care provider may recommend an elimination diet, where foods that are suspected of causing an allergic reaction are eliminated from your diet, then gradually added back in to see which food trigger symptoms.

Eating a healthy diet that includes mainly fruits, vegetables, and whole grains may help. If gas is a problem, you may want to avoid beans, cabbage, broccoli, and cauliflower, along with apple juice, grape juice, bananas, nuts, and raisins. These tips may also help:

• Avoid refined foods such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine
• Fiber supplements can help reduce pain, cramping, and gas.
• Avoid caffeine, alcohol, chocolate, and tobacco.
• Sugar substitutes (such as sorbitol and mannitol) trigger symptoms in some people.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise 30 minutes daily, 5 days a week.

These supplements may also help relieve IBS symptoms:

• Probiotic supplement (containing Lactobacillus acidophilus and Bifidobacterium), 5 - 10 billion CFUs (colony forming units) a day. Probiotics, or “friendly” bacteria, help your digestive system function properly. A number of studies – though not all – have found that probiotics may help relieve symptoms of IBS, including abdominal pain and gas, and constipation. Some probiotic supplements may need refrigeration for best results. Check the label carefully.
• Flaxseed, ground, 6 - 24 grams per day -- to relieve constipation. One study of 55 people with constipation caused by IBS found that those who took used flaxseed reduced constipation, boating, and abdominal discomfort more than those who used psyllium.
• Melatonin, 2 - 5 mg one hour before bedtime. A few small studies have suggested melatonin may improve IBS symptoms. Ask your health care provider about potential drug interactions before taking melatonin.

Herbs

You can use herbs in the form of dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink two to four cups per day.

• Peppermint oil (Mentha piperita), enteric-coated, 0.2 - 0.4 ml, 3 times daily. Peppermint oil is used traditionally for digestive problems, and some (though not all) studies show it may help relieve symptoms of IBS including gas and cramping. In one study, peppermint oil combined with 50 mg of caraway oil in enteric-coated capsules taken three times daily reduced IBS symptoms.
• Chinese herbal medicine -- In one study, a standardized Chinese herbal extract containing 20 herbs including dan shen (Salvia miltiorrhiza), ginger (Zingiber officinale), wormwood (Artemesia absinthium), and bupleurum helped reduce symptoms of IBS. If you are interested in using Chinese herbal medicine for IBS, consult with a knowledgeable practitioner to make sure you get the safest and most effective formula for you.

Homeopathy

There have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend treatments for IBS based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person' s constitutional type -- your physical, emotional, and intellectual makeup.

Acupuncture

Several small studies suggest that acupuncture may help people who have IBS by improving general well-being and reducing bloating. Large-scale trials are still needed.

Acupuncturists treat people with IBS based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of IBS, an acupuncturist usually detects a qi deficiency in the spleen and lung meridians. Acupuncturists frequently use moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) for treatment of IBS because they believe its effects reach deeper into the body. Because acupuncture is considered safe, and IBS is not easily treated by currently available conventional methods, people with IBS may wish to try acupuncture therapy to improve symptoms.

Chiropractic

There have been no well-designed studies of chiropractic for IBS. However, chiropractors report that spinal manipulation may improve symptoms of IBS in some people. In these cases, spinal manipulation may have a balancing effect on the nerves that supply impulses to the intestinal tract.

Other Treatments

• Electric heating pads, hot water bottles, and long hot baths can relieve painful spasms and cramping in the abdomen.
• Regular exercise, such as walking, can reduce stress and encourage bowel movements if you are constipated.
• Castor oil pack. Apply oil directly to skin, cover with a clean soft cloth and plastic wrap. Place a heat source over the pack, and let it sit for 30 - 60 minutes.
• Deep breathing is a way to reduce stress and may also help with digestion.
• Therapeutic massage may help reduce stress.
• Some small studies have suggested that yoga may help relieve pain and other symptoms of IBS.
• Hypnotherapy may be helpful for some people with IBS.

Following Up:

Irritable bowel syndrome itself may cause stress. Following a diet recommended by your doctor is very important.

Alternative Names:

Spastic colon; Mucous colitis; Spastic colitis; Nervous stomach; Irritable colon