Irritable bowel syndrome (IBS).
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What is IBS?.
IBS is not a disease. It is a syndrome--a combination of signs and symptoms. But IBS has not been shown to lead to
any serious, organic diseases, including cancer. IBS causes a great deal of discomfort and distress, but it does not
permanently harm the intestines and does not lead to intestinal bleeding. IBS has also been called as colitis, mucous
colitis, spastic colon, or spastic bowel. But there has been no established link between IBS and IBD (Crohn's disease
or ulcerative colitis).
About 20% of Americans are believed to be suffering from IBS, making it one of the most common disorders
diagnosed by doctors. It occurs more often in women than in men, and it usually begins around age 20.
Though most people can control their symptoms with diet, stress management, and medications prescribed by their
physician, in some IBS can be disabling. They may be unable to work, go to social events, or travel even short
distances.
What are the symptoms of IBS?
Irritable bowel syndrome (IBS) is a disorder that interferes with the normal functions of the large intestine (colon). We
have seen that the large intestine receives 2.0 liters of liquidy mix from Small intestine and delivers 0.2 to 0.3 liters of
stool, after absorbing excessive water and certain nutrients. In a patient with IBS, either the food moves too slowly
(resulting in excessive water absorption resulting in constipation, pain and bloating)) or too fast (resulting in under
absorption of water resulting in diarrhea). In some it may cause alternating constipation and diarrhea.
When food remains in the large intestine for a long time, too much water is absorbed from it. Then it becomes hard
and difficult to pass. In addition, with spasms, gas may get trapped in one area or stool may collect in one place,
temporarily unable to move forward. Sometimes people with IBS have a crampy urge to move their bowels but cannot
do so or pass mucus with their bowel movements.
Bleeding, fever, weight loss, and persistent severe pain are not symptoms of IBS and may indicate other problems
such as inflammation or rarely cancer.
How is IBS diagnosed?
A doctor on the basis of a complete medical history that includes a careful description of symptoms and a physical
examination diagnoses IBS. No particular test is specific for IBS but diagnostic tests are performed to rule out other
diseases. These tests may include stool or blood tests, x rays, or endoscopy (viewing the colon through a flexible
tube inserted through the anus). If these tests are all negative, the doctor may diagnose IBS based on your
symptoms: frequency of abdominal pain or discomfort over a period of time, when the pain starts and stops in relation
to bowel function, and how your bowel frequency and stool consistency are altered.
Criteria for IBS Diagnosis
· Abdominal pain or discomfort with one week in a month frequency.
· The abdominal pain or discomfort has two of the following three features:
It is relieved by having a bowel movement.
When it starts, there is a change in how often you have a bowel movement.
When it starts, there is a change in the form of the stool or the way it looks.
Factors affecting IBS
1) Stress
The colon has a vast supply of nerves that control the normal rhythmic contractions of the colon. These nerves and
cause abdominal discomfort at stressful times. When people get scared/nervous or upset these nerves may make
them have an urge to go or stop the normal colon action. Stress, feeling mentally or emotionally tense, troubled,
angry, or overwhelmed, stimulates colon spasms in people with IBS. In people with IBS, the colon can be overly
responsive to even slight conflict or stress thus triggering off a vicious cycle. Hence stress management by
· stress reduction (relaxation) training and relaxation therapies, such as meditation
· counseling and support
· regular exercise such as walking or yoga
· changes to the stressful situations in your life
· adequate sleep
is important to treatment of IBS.
2) Food
For most carefull choice of proper diet goes a long way in controlling IBS. Before changing your diet, keep a journal
noting the foods that seem to cause distress. Then discuss your findings with your doctor/dietitian to help you make
changes to your diet.
In many cases of IBS constipation, use of dietary fiber may lessen the severity. Whole grain breads and cereals, fruits,
and vegetables are good sources of fiber. Some forms of fiber also keep water in the stool, to produce soft, painless
bowel movements. High-fiber diets may cause gas and bloating, but these symptoms often go away within a few
weeks as your body adjusts.
If suffering from IBS related diarrhea, it is important to drink six to eight glasses of plain water (not carbonated
beverages that may result in gas and cause discomfort) a day.
Chewing gum and eating too quickly can lead to swallowing air, which again leads to gas. Also, large meals can cause
cramping and diarrhea, so eating smaller meals more often or eating smaller portions should help. It may also help if
your meals are low in fat and high in carbohydrates, such as pasta, rice, whole-grain breads and cereals (unless you
have celiac disease), fruits, and vegetables.
For some people, fruits with tough rind/skin like apples makes the problem more severe due to difficulty in emptying
these out of stomach during Antral peristalsis, in such a case chewing food well and avoiding hard rind fruits is
advised.
What is the treatment for IBS?
No cure has been found for IBS, but many options are available to treat the symptoms. Medications are an important
part of relieving symptoms. Your doctor may suggest fiber supplements or occasional laxatives for constipation, as
well as medicines to decrease diarrhea, tranquilizers to calm you, or drugs that control colon muscle spasms to
reduce abdominal pain. Antidepressants are also used to relieve some symptoms. Medications available to treat IBS
specifically are the following:
Alosetron hydrochloride (Lotronex) used for women with severe IBS related diarrhea and have not responded to
conventional therapy. However, even in these patients, it should be used with caution because it can have serious
side effects, such as severe constipation or decreased blood flow to the colon.
Tegaserod maleate (Zelnorm) used for the short-term treatment (usually 4 weeks) of women with IBS related
constipation. This has been recalled by FDA in Feb-2007.
In some cases though use of Calcium salts reduces the intensity of IBS, caution must be used as long term use of it is
very likely to cause Kidney stones.
With any medication, even over-the-counter medications such as laxatives and fiber supplements, it is important to
follow your doctor's instructions. Laxatives can be habit forming if used too frequently. You need to work with your
doctor to find the best combination of medicine, diet, counseling, and support to control your symptoms.
