Irritable Bowel Syndrome

_____________________________________________________________________

KEY POINTS

• Irritable bowel syndrome (IBS) is a long term disorder in which your large intestine does not always work normally.
• There is no cure for IBS. However, controlling your diet and managing stress usually helps relieve the symptoms. Some medicines may also help.
• Follow the full course of treatment prescribed by your healthcare provider. Contact your healthcare provider if you have new or worsening symptoms.

________________________________________________________________________

What is irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a disorder in which your large intestine does not always work normally. The large intestine is also called the colon or large bowel. Although IBS can cause much distress, it does not damage your intestines and does not lead to life-threatening illness.

IBS is not the same as inflammatory bowel disease (IBD). IBD includes ulcerative colitis and Crohn’s disease, which cause swelling, redness, sores, or holes in the wall of the intestine.

IBS is the most common intestinal disorder. It affects more women than men and usually starts in early adulthood. In the past, it was also called IBS colitis, mucous colitis, spastic colon, nervous colon, and spastic bowel. The name was changed to reflect that the syndrome has both physical and mental causes.

You may have flare-ups of symptoms throughout your life. Although a cure hasn't been found yet, the disorder can usually be controlled.

What is the cause?

The exact cause of IBS is not known. It may be related to changes in the way nerves and muscles in the intestines work together. For example, the nerves in your intestines sometimes may make the muscles squeeze too much when you eat. This can make food move too fast through your intestines, causing gas, bloating, cramping, and diarrhea. Other times, the muscles may not squeeze enough, which slows the passage of food and causes cramps and constipation.

You may have a greater risk for IBS if someone in your family has the disorder. Some foods may trigger attacks. Other risk factors are depression, anxiety, personality disorder, and for women, a history of childhood sexual abuse or and domestic violence.

What are the symptoms?

Although the symptoms of IBS are different from person to person, you may find that your symptoms follow a predictable pattern. The most common symptoms include:

• Cramping and pain in the belly that comes and goes. The pain may be mild or severe. It often starts after eating a meal or when you are under stress and gets better after having a bowel movement.
• Constipation, diarrhea, or both. You may have constipation one week and diarrhea the next. There may be a lot of mucus in your bowel movements.

Other symptoms include:

• Bloating, increased gas and belching, or a feeling of fullness in the rectum
• Heartburn
• Nausea and vomiting
• Urinating frequently
• Backache
• Headache

Women may have more symptoms during their menstrual periods.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. There is no specific test for IBS. The diagnosis is usually based on the symptoms. You may have tests or scans to check for other possible causes of your symptoms.

To find foods that may be causing symptoms, your healthcare provider may tell you to record:

• All the foods that you eat
• How much (serving sizes) you eat of each food
• The times of day when you eat
• Any symptoms you have after eating a food
• When the symptoms started and how long they lasted

If your symptoms are not severe, your provider may suggest that you try to find which foods cause your symptoms by not eating certain foods for a while. For example, you might stop eating milk and dairy products or wheat products for a time. Then you can carefully try eating these foods again, one at a time, to see if your symptoms come back. Ask your provider which foods you should avoid at first.

How is it treated?

There is no cure for IBS. However, controlling the diet and managing stress usually helps relieve the symptoms. Sometimes, medicines may also help.

• Diet

  Ask your provider about the benefits of talking to a dietitian to learn what you need in a healthy diet. Talk to your healthcare provider about whether you should eat more or less high-fiber food or take a fiber supplement. Try eating smaller meals more often each day rather than just 2 or 3 larger meals. You may need to avoid certain foods such as foods high in fat, some milk products, drinks with alcohol, caffeine, artificial sweeteners, beans, cabbage, cauliflower, broccoli, and raw fruit. Other foods that may cause symptoms are:

  • Chocolate
  • Caffeine such as in coffee, energy drinks, and some sodas
  • Foods with wheat, barley, or rye
  • Sugar-free sweeteners such as sorbitol and mannitol
• Stress

  Your provider will help you identify things that cause stress in your life and will suggest ways to help you control them. Talk therapy, relaxation, or biofeedback techniques may help you manage stress.

• Medicines

  Examples of medicines your provider may prescribe are:

  • Bulk-forming agents, such as bran or methylcellulose
  • Antispasmodic drugs to slow the amount of muscle squeezing in the intestines and help with diarrhea and pain
  • Antidepressants, which can help control chronic pain
  • Medicines to help with constipation or diarrhea
  • Probiotic medicine to help with good bacteria in the intestines

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. Ask your healthcare provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example, talk to family and friends, take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• Stay fit with the right kind of exercise for you. Exercise helps keep bowel movements regular. It may also help lessen depression and stress.
• Drink enough liquids to keep your urine light yellow in color.
• Don’t drink alcohol, which can make symptoms of IBS worse.
• Contact your healthcare provider if you have new or worsening symptoms.