Irritable Bowel Syndrome

What is irritable bowel syndrome?
Irritable bowel syndrome (IBS) is a collection of symptoms that a person has had for at least 12 weeks in the previous 12 months. It always involves abdominal pain or discomfort. The pain must have two of these three characteristics to be diagnosed as IBS: 1) it is relieved by defecation; 2) the pain is associated with a change in frequency of stool; and 3) it is associated with a change in the appearance or form of the stool.

For many years, IBS was considered a psychological rather than a physical problem; however, doctors now agree it is a real medical condition. Meanwhile, it is not an anatomical or structural problem or an identifiable physical or chemical disorder. It is not cancer and will not cause cancer. It will not cause other gastrointestinal diseases, either.

What are the symptoms of IBS?
Intestinal walls are lined with layers of muscle that squeeze and relax as they move food from your stomach through your intestines to the rectum. Normally, this is a smooth effort. But in IBS, the squeezes are longer and stronger than normal. Food is pushed through the intestines too quickly, which causes gas, bloating and diarrhea. In some cases, just the opposite occurs — food passage slows and patients become constipated with stools that are hard and dry.

Symptoms of IBS may include moderate-to-severe abdominal pain, bloating, gas, diarrhea or constipation. Although the exact symptoms and severity may differ, IBS can tremendously influence the daily life of people who suffer from the disease. A flare-up of symptoms can mean hours of misery.

What is the prevalence of IBS?
Fifty-eight million Americans suffer from irritable bowel syndrome (IBS) at some point in their lives. It is one of the most common disorders that doctors see.

What causes IBS?
No one knows the cause, but some researchers think IBS is caused by changes in the nerves that control contraction and sensation in the bowel. Women are two to three times more likely to have IBS, so researchers think hormones also are involved. Triggers for IBS can range from gas or pressure on your stomach to certain foods, medications or emotional stimuli. And the least bit of stress may cause the colon to spasm. Symptoms are often at their worst when people are stressed. However, though stress may aggravate symptoms, it doesn’t cause them.

How is IBS diagnosed?
To diagnose IBS, a doctor may order stool and blood tests, X-rays, endoscopy (viewing the colon through a flexible tube inserted through the anus). If all of these tests are negative, the doctor may diagnose IBS on the basis of symptoms.

To make sure that IBS is your diagnosis, you should see a physician.

How is IBS treated?
There is no cure, but many options are available to treat the symptoms. Your doctor will order the best treatments available for your symptoms and encourage you to manage stress and make changes in your diet.

Certain foods or situations may trigger a flare-up of symptoms. People with IBS may keep a symptom journal to figure out what triggers their illness and how best to avoid these triggers.

The key to managing IBS is to manage diet, lifestyle and stress so you don’t have these symptoms.

Here are some treatment options:

Diet

• Boost fiber. The American Dietetic Association (ADA) recommends 20 to 25 grams of fiber a day. You can usually find fiber in whole grain bread and cereal, fruit, vegetables and beans. However, don’t shock your system with a sudden increase of fiber or fiber supplements. Add a little each day to give your body some time to get used to it. Fiber helps 75 to 80 percent of people with IBS, but the remaining 20 percent often feel worse!

• Prunes and liquids. Some fruity foods that are higher in the sugar sorbitol — such as dried plums (prunes) and prune juice — also can loosen bowels. But people with IBS should take care not to take too much sorbitol. It can cause gas, bloating, cramping and diarrhea.

• Try ground flaxseed to ease symptoms. It can be sprinkled on salads, cooked veggies and even cereal. Another way to encourage bowel movements is to drink more liquids like water and juice. The ADA recommends eight 8-ounce glasses every day for good hydration.

• Avoid coffee, carbonated drinks and alcohol. These can make IBS constipation worse by dehydrating you.

• Limit highly refined foods. They fill you up without providing fiber and nutrients. Avoid eating too much white bread, white rice, certain cereal without fiber, chips and cookies.

• A high protein, low-carb diet can worsen your condition. You need protein, of course, but don’t cut out carbs like fruits and veggies. Constipation is a common side effect of some popular low-carb diets.

• While you’re eating, try not to do other things, such as drive or sit in front of a computer. The stress from traffic or other things can trigger symptoms. And the faster you eat, the more air you swallow — causing abdominal pain, gas and bloating.
  
  

Medication
Physicians usually prescribe a combination of therapies. Too many laxatives can cause problems and actually increase your symptoms. Also, some laxatives can be habit forming and harmful in the long run.

In stimulant laxatives, the ingredient senna triggers muscles in the bowels to contract, moving stool through the bowel. Over time, the chemical can damage nerves in the colon wall. Eventually, these laxatives may stop working in people who take them regularly. Stimulant laxatives include Dulcolax, Senokot, castor oil and the plant cascara sagrada.

Other laxatives, called osmotic laxatives, pull water back into the colon to soften stool, which makes the stool easier to pass. But research has found that these laxatives don't help relieve IBS symptoms other than constipation. In fact, they may actually worsen other symptoms. Side effects include diarrhea, dehydration and bloating.

Unlike stimulant laxatives, osmotics are considered fairly safe for long-term use. Osmotic laxatives include lactulose and MiraLax, which must be prescribed by a doctor.

Patients who need to stay on these types of medications must make sure they are correctly diagnosed. It's important to be certain that symptoms are not signs of another disease.

To make an appointment with a Washington University colorectal surgeon, please call (314) 454-7177.

Surgeons who treat irritable bowel syndrome:

Elisa H. Birnbaum, M.D.

James W. Fleshman, Jr., M.D.

Steven R. Hunt, M.D.

Ira J. Kodner, M.D.

Matthew G. Mutch, M.D.

Bashar Safar MBBS, MRCS