Irritable bowel syndrome (IBS) is one of the most common disorders that physicians see. Yet it’s also one that many people aren’t comfortable talking about. IBS is characterized by abdominal pain or cramping and changes in bowel function — including bloating, gas, diarrhea and constipation — problems most people don’t like to discuss. What’s more, for many years IBS was considered a psychological rather than a physical problem.
Up to one in five American adults has irritable bowel syndrome. The disorder accounts for more than one out of every 10 doctor visits. For most people, signs and symptoms of irritable bowel disease are mild. Only a small percentage of people with IBS have severe signs and symptoms.
Fortunately, unlike more serious intestinal diseases such as ulcerative colitis and Crohn’s disease, IBS doesn’t cause inflammation or changes in bowel tissue or increase your risk of colorectal cancer. In many cases, you can control IBS by managing your diet, lifestyle and stress.
Signs and symptoms of IBS vary widely from one person to another and often occur with many other diseases. Among the most common are:
Like many people, you may have only mild signs and symptoms of IBS. Sometimes these problems can be disabling, however. In some cases, you may have severe signs and symptoms that don’t respond well to medical treatment.
For most people, IBS is a chronic condition, although there will likely be times when signs and symptoms are worse and times when they improve or even disappear completely.
The walls of the intestines are lined with layers of muscle that contract and relax as they move food from your stomach through your intestinal tract to the rectum. Normally, these muscles contract and relax in a coordinated rhythm. But if you have IBS, the contractions are stronger and last longer than normal. Food is forced through your intestines more quickly, causing gas, bloating and diarrhea. In some cases, however, the opposite occurs. Food passage slows, and stools become hard and dry.
No one knows exactly what causes IBS. Some researchers believe IBS is caused by changes in the nerves that control sensation or muscle contractions in the bowel. Others believe the central nervous system may affect the colon. And because women are two to three times more likely than men to have IBS, researchers believe that hormonal changes also play a role. Also, many women find that signs and symptoms are worse during or around their menstrual periods.
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 instance, chocolate, milk and alcohol might cause constipation or diarrhea. And the least bit of stress might send your colon into spasms.
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 or family arguments. But while stress may aggravate symptoms, it doesn’t cause them.
Sometimes another illness, such as an acute episode of infectious diarrhea (gastroenteritis) can trigger IBS. Antibiotic use also may be a factor because antibiotics disrupt the normal bacterial flora living in your bowel. Excessive use of laxatives and even some antidiarrheal medications may contribute to the problem as well.
If you experience cramping and bloating mainly after eating dairy products 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 or the artificial sweetener sorbitol.
Many people have occasional symptoms of IBS, but you’re more likely to have IBS if you’re young and female. IBS typically begins around age 20. Overall, two to three times as many women as men have the condition.
A diagnosis of IBS depends largely on a complete medical history and physical exam. Your doctor may also recommend conducting several tests, including stool studies to check for infection or malabsorption problems. He or she may perform a flexible sigmoidoscopy — a test that examines the lower part of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope).
Both diarrhea and constipation can aggravate hemorrhoids. In addition, signs and symptoms of IBS can interfere with your work, your relationships with friends and family, and your ability to live your life to the fullest. At times, you may feel discouraged or depressed.
Because it’s still not clear what causes IBS, treatment focuses on the relief of symptoms so that you can live your life as fully and normally as possible.
In most cases, you can successfully control mild symptoms of IBS by learning to manage stress and making changes in your diet and lifestyle. But if your problems are moderate or severe, you may need more help than lifestyle changes alone can offer.
For moderate IBS, your doctor may suggest taking fiber supplements such as psyllium (Metamucil) or methylcellulose (Citrucel) with fluids, to help control constipation and over-the-counter medications such as loperamide (Imodium) to help control diarrhea. In some cases, you may need drugs that affect certain activities of the nervous system (anticholinergics) to relieve painful bowel spasms. If so, follow-up with your doctor is very important.
If your symptoms include pain and 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. For diarrhea and abdominal pain, your doctor may suggest tricyclic antidepressants such as imipramine (Tofranil) and amitriptyline (Elavil). Side effects of these drugs include drowsiness and constipation.
Selective serotonin reuptake inhibitors such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil) may be helpful if you’re depressed and have pain and constipation. If these medications don’t work, you may have better results from counseling. If you have severe IBS, it’s important to receive ongoing treatment and support from your physician.
In November 2000, the Food and Drug Administration (FDA) approved the first medication specifically for the treatment of moderate to severe symptoms of IBS in women. Alosetron (Lotronex) is a nerve receptor antagonist that’s supposed to relax the colon and slow the movement of waste through the lower bowel. But the drug was pulled from the market just nine months after its approval when it was linked to at least four deaths and severe side effects in 197 people.
In June 2002, the FDA took the unprecedented step of allowing Lotronex to be sold again — with a number of restrictions. The drug can be prescribed only by doctors enrolled in a special program and is intended for severe cases that haven’t responded to other treatments. Lotronex is not approved for use by men or for women who don’t have the diarrhea-predominant form of IBS.
For women who have IBS with constipation, the FDA approved the medication tegaserod (Zelnorm) in July 2002. It’s approved only for short-term use in women, and has not been approved for use in men. Tegaserod imitates the action of the neurotransmitter serotonin and helps to coordinate the nerves and muscles in the intestine.
Living with IBS presents daily challenges. It may be painful or embarrassing and can seriously affect the quality of your life. These suggestions may help you cope more easily:
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