Irritable bowel syndrome

Answer 1

Definition

Irritable bowel syndrome (IBS) refers to a disorder of the lower intestinal tract. It involves abdominal pain and abnormal bowel movements. Emotional stress often makes the symptoms worse.

It is not the same as inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis.

Alternative Names

Nervous indigestion; Spastic colon; Intestinal neurosis; Functional colitis; Irritable colon; Mucous colitis; Laxative colitis; IBS

Causes, incidence, and risk factors

IBS involves a combination of abdominal pain and constipation, diarrhea, or an alternating pattern of these problems.

There are many possible causes. For example, there may be a problem with muscle movement in the intestine or a lower tolerance for stretching and movement of the intestine. There is no problem with the structure of the intestine.

It is not clear why patients develop IBS, but in some instances, it occurs after an intestinal infection. This is called postinfectious IBS. There may also be other triggers.

IBS can occur at any age, but it often begins in adolescence or early adulthood. It is more common in women. The condition is the most common intestinal complaint for which patients are referred to a gastroenterologist.

Symptoms

Symptoms range from mild to severe. Most people have mild symptoms. IBS symptoms may be worse in patients who also have stress or mood disorders, such as anxiety and depression. However, it is important to understand that these conditions do not cause IBS.

Symptoms may include:

• Abdominal distention
• Abdominal fullness, gas, bloating
• Abdominal pain that:
  • Comes and goes
  • Is reduced or goes away after a bowel movement
  • Occurs after meals
• Chronic and frequent constipation, usually accompanied by pain
• Chronic and frequent diarrhea, usually accompanied by pain
• Emotional distress
• Depression
• Loss of appetite

Signs and tests

Most of the time, your doctor can diagnose IBS with few or no tests. Tests usually reveal no problems. Some experts recommend a lactose-free diet for 2 weeks to evaluate for possible lactase deficiency.

Some patients may need an endoscopy, especially if symptoms begin later in life. Younger patients with persistent diarrhea may need this test to look for inflammatory bowel diseases that can cause similiar symptoms, such as Crohn's disease or ulcerative colitis. You may need additional tests if you have blood in your stool, weight loss, signs of anemia, or you have recently traveled.

Patients over age 50 should be screened for colon cancer.

Treatment

The goal of treatment is to relieve symptoms.

Lifestyle changes can be helpful in some cases of IBS. For example, regular exercise and improved sleep habits may reduce anxiety and help relieve bowel symptoms.

Dietary changes can be helpful. However, no specific diet can be recommended for IBS in general, because the condition differs from one person to another. Increasing dietary fiber and avoiding foods and drinks that stimulate the intestines (such as caffeine) may help.

Other possible treatments may include:

• Counseling in cases of severe anxiety or depression
• Antidiarrheal medications for those whose main symptom is diarrhea
• Low-dose antidepressants to help relieve intestinal pain
• Medications to stimulate bowel movements for those with constipation

Expectations (prognosis)

Irritable bowel syndrome may be a lifelong condition, but symptoms can often be improved or relieved through treatment.

Calling your health care provider

Call your health care provider if you have symptoms of irritable bowel syndrome or if you notice a persistent change in your bowel habits.

References

Talley NJ. Functional gastrointestinal disorders: irritable bowel syndrome, dyspepsia, and noncardiac chest pain. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 139.

Answer 2

Irritable bowel syndrome affects the large intestine. It will cause cramping, bloating, gas, abdominal pain, constipation and diarrhea. While it doesn't cause permanent damage to your body, it can leave you feeling embarrassed and miserable. There is no quick cure, so patients must learn how to live with and control the condition.

A Chronic Condition

The pain and symptoms of irritable bowel syndrome will be chronic. While the symptoms may fade for a time, they can return suddenly and without any warning. The condition can be managed by making dietary changes and some lifestyle changes.

Triggers

One of the keys to managing IBS is learning what your triggers are. It's important to know what can prompt the condition to flare up. Possible triggers include chocolate, milk and alcohol. Other people find that avoiding Carbonated Beverages or some vegetables will help them find relief. Stress is a common trigger of IBS, and hormonal changes can also play a role. One way to pinpoint the triggers is by keeping a log of flare-up, what was consumed before and anything that was going on to cause stress or hormonal changes around that time.

Treatments

Increasing fiber levels will help you avoid diarrhea or constipation, so the first line of defense is typically to increase fiber levels. Ideally, the fiber levels should be increased naturally by consuming more beans and high-fiber fruits and vegetables. However, you can also increase fiber intake by taking special fiber pills. Your water intake should also be increased.

Doctors have not been able to pinpoint the link, but there seems to be a connection between some antibiotics and IBS. Certain SSRI antidepressants may also trigger problems with IBS. If you are currently taking these medications and suffering from irritable bowel syndrome, you should talk to your doctor about different treatment methods.

There are also medications that are designed specifically for IBS. Alosetron and Lubiprostone are both used for treatment of this painful bowel disorder. The treatments are usually only prescribed after you have attempted other treatments without success.

IBS is not a condition that should be ignored. Without taking steps to counteract the disorder, the problems will persist. Start by making dietary changes and looking for any triggers that cause flare-ups. If other treatments are not successful, you should talk to your doctor about prescribing medication to help with the condition.

Answer 3

Irritable bowel syndrome is a collection of nonspecific symptoms that point to a disorder of the lower gastrointestinal track. The symptoms are called nonspecific because they can be indicative of all sorts of disorders. This is why a person who suffers from inflammatory bowel syndrome should go to their doctor to make sure that more serious diseases are ruled out.

Symptoms

The symptoms of irritable bowel syndrome can include but aren't limited to:

• Abdominal pain or bloating that's relieved through bowel movements
• Constipation or diarrhea
• Dyspepsia, which includes nausea, gas and loss of appetite
• Anxiety and depression

Some people also suffer from backaches, generalized aches and pains and even chest pains that radiate to the left arms or into the jaw. In other words, for some people irritable bowel syndrome feels like a heart attack. Still, even a thorough examination of the patient will find nothing structurally wrong with the GI track.

Causes

Many patients who suffer from irritable bowel syndrome have food Allergies. Indeed, doctors have understood that food allergies contribute to IBS since the early part of the 20th century. About two thirds of IBS sufferers have at least one food allergy and many have multiple allergies. These people not only have the abdominal symptoms of IBS, but can have heart palpitations, headaches and fatigue.

People with IBS also have too much refined sugar in their diet. When people eat too much sugar, the contractions in the GI track slow down and can even stop.

Psychological stress also seems to play a part in IBS. Many sufferers report depression and anxiety. Some medical professionals believe that psychological stress causes IBS and IBS in turn causes psychological stress. Women with IBS often have flare ups before the start of their menstrual cycle.

Treatment

Many IBS patients can be helped through relaxation therapy, biofeedback, counseling and being taught ways to help deal with stress. Regular exercise, the increase of fiber rich foods and the elimination of allergens and refined sugar also can help ease irritable bowel syndrome. Some people also find that .2 to .4 ml of enteric coated peppermint oil taken twice a day between meals also helps with the syndrome.

Answer 4

Definition

Irritable bowel syndrome (IBS) is a disorder that leads to abdominal pain and cramping, changes in bowel movements, and other symptoms.

IBS is not the same as inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis. In IBS, the structure of the bowel is not abnormal.

Alternative Names

Spastic colon; Irritable colon; Mucous colitis; Spastic colitis

Causes, incidence, and risk factors

It is not clear why patients develop IBS. Sometimes it occurs after an infection of the intestines. This is called postinfectious IBS. There may also be other triggers.

The intestine is connected to the brain. Signals go back and forth between the bowel and brain. These signals affect bowel function and symptoms. The nerves can become more active during stress, causing the intestines to be more sensitive and squeeze (contract) more.

IBS can occur at any age, but it often begins in the teen years or early adulthood. It is twice as common in women as in men.

About 1 in 6 people in the U.S. have symptoms of IBS. It is the most common intestinal problem that causes patients to be referred to a bowel specialist (gastroenterologist).

Symptoms

Symptoms range from mild to severe. Most people have mild symptoms. Symptoms are different from person to person.

The main symptoms of IBS are abdominal pain, fullness, gas, and bloating that have been present for at least 3 days a month for the last 3 months. The pain and other symptoms will often:

• Be reduced or go away after a bowel movement
• Occur when there is a change in how often you have bowel movements

People with IBS may switch between constipation and diarrhea, or mostly have one or the other.

• People with diarrhea will have frequent, loose, watery stools. They will often have an urgent need to have a bowel movement, which may be hard to control.
• Those with constipation will have a hard time passing stool, as well as fewer bowel movements. They will often need to strain and will feel cramps with a bowel movement. Often, they do not release any stool, or only a small amount.

For some people, the symptoms may get worse for a few weeks or a month, and then decrease for a while. For other people, symptoms are present most of the time.

People with IBS may also lose their appetite.

Signs and tests

Most of the time, your doctor can diagnose IBS based on your symptoms, with few or no tests. Eating a lactose-free diet for 2 weeks may help the doctor check for a possible lactase deficiency.

There is no test to diagnose IBS. Tests may be done to rule out other problems:

• Blood tests to see if you have celiac disease or a low blood count (anemia)
• Stool cultures to check for an infection

Some patients will have colonoscopy. During this test, a flexible tube is inserted through the anus to examine the colon. You may need this test if:

• Symptoms began later in life (over age 50)
• You have symptoms such as weight loss or bloody stools
• You have abnormal blood tests (such as a low blood count)

Other disorders that can cause similar symptoms include:

• Celiac disease
• Colon cancer(cancer rarely causes typical IBS symptoms, unless symptoms such as weight loss, blood in the stools, or abnormal blood tests are also present)
• Crohn's diseaseor ulcerative colitis

Treatment

The goal of treatment is to relieve symptoms.

Lifestyle changes can help in some cases of IBS. For example, regular exercise and improved sleep habits may reduce anxiety and help relieve bowel symptoms.

Dietary changes can be helpful. However, no specific diet can be recommended for IBS, because the condition differs from one person to another.

The following changes may help:

• Avoid foods and drinks that stimulate the intestines (such as caffeine, tea, or colas)
• Avoid large meals
• Increase fiber in the diet (this may improve constipation but make bloating worse)

Talk with your doctor before taking over-the-counter medications.

No one medication will work for everyone. Medications your doctor might try include:

• Anticholinergic medications (dicyclomine, propantheline, belladonna, and hyoscyamine) taken about a half-hour before eating to control intestine muscle spasms
• Bisacodyl to treat constipation
• Loperamide to treat diarrhea
• Low doses of tricyclic antidepressants to help relieve intestinal pain
• Lubiprostone for constipation symptoms
• Rifaximin, an antibiotic

Therapy may help in cases of severe anxiety or depression.

Expectations (prognosis)

Irritable bowel syndrome may be a lifelong condition. For some people, symptoms are disabling and reduce the ability to work, travel, and attend social events.

Symptoms can often be improved or relieved through treatment.

IBS does not cause permanent harm to the intestines, and it does not lead to a serious disease, such as cancer.

Calling your health care provider

Call your health care provider if you have symptoms of irritable bowel syndrome or if you notice a change in your bowel habits that does not go away.

References

Irritable bowel syndrome. NIH Publication No. 07-693. September 2007. The National Digestive Diseases Information Clearinghouse (NDDIC).

Talley NJ. Irritable bowel syndrome. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 118.

Reviewed By

Review Date: 07/22/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.