Irritable bowel syndrome

Irritable bowel syndrome (IBS) is the one of the most common “functional” conditions of the intestines.  A functional disorder is a disease in which there is no physical cause detectable by currently available diagnostic techniques (lab tests, x-rays, etc.).  This makes it a difficult disease to diagnose.  

It is a non life-threatening ailment characterized by changes in bowel habits and abdominal pain.  Another name for the condition is “spastic colon”.  It’s estimated that between 5 to 10 percent of the population suffers from IBS.  It is more common in women and usually begins around age 20.  It is not an inflammatory disease such as Crohn’s disease or ulcerative colitis.

The problem is that the intestines “act” irritated.  The intestinal muscles may squeeze too hard or not hard enough, causing food to move too quickly or too slowly through the bowels.  This dysfunction gives symptoms of diarrhea or constipation; bloating and gas; pain and cramping; and strong feelings of having to have a bowel movement.  
The cause of IBS is unclear.  There seem to be many factors involved including the bowel itself, the nerves supplying the intestines, and psychological stressors.  The bowel tends to be “hypersensitive” in IBS.  Some find that certain foods will cause symptoms.  Others will notice more symptoms during times of emotional stress or with a change in normal routine, such as with traveling.  

Diagnosing IBS can be difficult since there are no specific tests or studies that can be done to determine if IBS is causing the symptoms.  Usually, testing to rule out more serious conditions (inflammatory bowel disease, colon cancer) is done initially.  These may include blood tests, X-rays or CT scans, and colonoscopy.  

Once it is determined that irritable bowel syndrome is the cause, treatment can then be recommended.  Strategies for controlling IBS incorporate diet modification, regular exercise, and stress reduction.  If certain foods seem to aggravate the condition, avoiding these foods is a good first step.  Keeping a diary of your food intake and symptoms may help to determine what foods incite certain symptoms.

Increasing fiber in the diet will help most IBS sufferers.  There are two types of fiber: soluble and insoluble.  Soluble fiber dissolves in liquid.  An example is psyllium (Fiberall, Metamucil).  Higher intake of soluble fiber usually helps both diarrhea and constipation.  Insoluble fiber is present in fruits, vegetables, whole grains and cereals.  Insoluble fiber can make diarrhea worse in some individuals.   

Switching to a high-fiber diet can cause a temporary worsening of some symptoms, such as bloating or gas.  The key is to increase fiber in your diet slowly.  This will allow your gastrointestinal system to get used to the fiber.  

Avoid foods that are high in fat or items containing caffeine, as these can cause cramping.  Alcohol and chocolate may also worsen symptoms.  Gas-producing foods such as beans and cabbage should be eliminated.  Drink plenty of water each day.  Try eating smaller, more frequent meals.  Dairy products should only be avoided by those who are lactose intolerant.  

Prescription medicines for IBS are primarily aimed at relaxing intestinal spasms.  Some medicines work on the muscles of the bowel while others affect the nerves to the bowel.  Since stress can play a big part in IBS exacerbations, medicines traditionally used for anxiety and depression are often considered for the treatment of this condition.

The content in this column is for informational purposes only.  Consult your physician for appropriate individual treatment.  Dr. Reynolds practices Family Medicine in Chesterfield.

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