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Irritable Bowel Syndrome (IBS)

What is Irritable Bowel Syndrome (IBS)?

IBS is a disorder that interferes with the normal function of the intestines. It is very common. It is found more often in women than men. Symptoms start before age 35 about 50 percent of the time.

What are the symptoms of IBS?

Abdominal pain
Bloating
Constipation (hard to pass or infrequent bowel movements)

Diarrhea (frequent, loose, watery stools)

Sometimes alternating between constipation and diarrhea

What causes IBS?

One theory is that people with IBS have intestines that are more sensitive and react to things that may not bother other people, such as stress, large meals, gas, medicines, certain foods, caffeine, or alcohol. The immune system, which fights infection, may also be involved.

A person who has IBS may not have normal movement in their GI tract. They may have spasms at times. During a spasm, the muscles contract strongly, and the person may feel pain.

The lining of the colon is affected by the immune and nervous systems which control the flow of fluids in and out of the colon. In IBS, the lining appears to work well. But, when the contents in the colon move too quickly, it isn’t able to absorb fluids. The result is too much fluid in the stool. Sometimes, the movement in the colon is too slow, which causes extra fluid to be absorbed. The result is constipation.

How is IBS diagnosed?

IBS is diagnosed by its signs and symptoms and by the absence of other diseases. The first step is to see your doctor for a complete physical. Your doctor will do a health history. You may be asked questions based on these symptoms which must be present to make the diagnosis of IBS.

Abdominal pain for at least 12 weeks out of the last 12 months.

It has two of these three features.

It is relieved by 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.

Certain other symptoms must also be present.

A change in the number of bowel movements and how often they happen.
A change in how bowel movements look.
Feeling an uncontrollable urge to have a bowel movement.
Problems passing stool.
Mucus in the stool.
Bloating.

Bleeding, fever, weight loss, and persistent severe pain are not symptoms of IBS and may point to other problems.

There is no one test for IBS but the tests listed below may be done to rule out other diseases. This does not apply to all patients.

Blood tests check for low red blood cell count, or high white blood cell count.
Stool sample checks for bleeding, infection, virus, parasites, or inflammation.
Colonoscopy or sigmoidoscopy checks the inside of the colon. A long flexible lighted tube connected to a computer and TV monitor (endoscope) is inserted into the anus. The doctor will be able to see any inflammation, bleeding, or ulcers on the colon wall. During this exam the doctor may do a biopsy (take a sample of tissue from the lining of the colon to view with a microscope).

What is the treatment?

No cure has been found for IBS, but there are many options to treat the symptoms. Most people can control their symptoms with diet, stress management, and prescribed medicines. For some people, however, IBS can be so disabling that they may be unable to work, attend social events, or even travel short distances.

Medicines

Medicines are an important part of easing symptoms.

Fiber supplements or laxatives are sometimes used to treat constipation but must be used with caution. Side effects can be bloating and gas.

Loperamide or diphenoxylate with atropine Lomotil® is used to decrease diarrhea.

Antispasmodics may help to control colon muscle spasms and reduce abdominal pain. Tricyclic agents or small doses of antidepressant medicines may relieve some symptoms.

Alosetron hydrochloride, (Lotronex^®) is approved for women under age 55 with severe IBS who have failed conventional treatment and whose main symptom is diarrhea. Its use is restricted because of occasional side effects such as constipation or decreased blood flow to the colon.

Each person with IBS is unique. You will need to work with your doctor to find the best combination of medicine, diet, counseling, and support to control your symptoms.

Can changes in diet help IBS?

For many people, careful eating reduces IBS symptoms. Fiber may lessen the IBS symptom of constipation. It may not help with the symptoms of diarrhea or pain. Whole grains, fruits and vegetables are good sources of fiber. High fiber diets may help prevent spasms. Some forms of fiber keep water in the stool which helps keep stools soft. High fiber diets may cause gas and bloating although some people report that these symptoms go away within a few weeks. A tip is to increase fiber intake slowly by 2-3 grams per day. This may help reduce the risk of increased gas and bloating.

Drinking 6-8 glasses of water a day is helpful especially if you have constipation. Beverages with bubbles like soda may cause gas pain. Chewing gum and eating too quickly can cause you to swallow air, which also leads to gas. Eating smaller meals more often may help IBS symptoms. Large meals can cause cramping and diarrhea. Eating meals that are low in fat and high in carbohydrates may help some patients and a low carbohydrate diet may help others.

Keeping a food record before changing your diet can help you be aware of the foods that cause distress. Discuss your findings with your doctor. You may want to see a nutritionist who can help you make changes to your diet.

How does stress affect IBS?

How to manage stress

What is stress? It is the “wear and tear” your body feels over time as it adjusts to feelings of anxiety, tension, and anger. Stress can trigger intestinal spasms in people with IBS since the GI tract has many nerves that connect it to the brain. Like the heart and lungs, the bowel is partly controlled by the autonomic nervous system, which responds to stress. These nerves control the way the bowel contracts and cause abdominal pain at stressful times. People often feel cramps or ‘butterflies” when they are nervous or upset. In people with IBS, the bowel can be very sensitive to even slight conflict or stress.

Learning to cope with stress is part of the treatment for IBS. Here is a list of some of the options to manage stress. This list is to give you ideas that are a fit for you. Some of these options require learning new skills.

Getting enough sleep.
Biofeedback.
Counseling and support groups.
Hypnosis and cognitive behavioral therapy (offered at UWHC).
Making lifestyle choices to decrease the stress you feel in your life.
Exercise such as walking or yoga.

Is IBS linked to other diseases?

As its name states, it is a disorder which causes a great deal of discomfort and distress, but does not harm the intestines, and does not lead to cancer. It is not related to Crohn’s disease or ulcerative colitis.

For More Information

International Foundation for Functional Gastrointestinal Disorders

P.O. BOX 170864

Milwaukee, WI 53217

Phone: 1-888-964-2001

Fax: 414-964-7176

Email: iffgd@iffgd.org

Internet: www.iffgd.org

National Digestive Diseases Information Clearinghouse

2 Information Way

Bethesda, MD 20892-3570

Phone: 1-800-891-5389

Fax: 703-738-4929

Email: nddic@info.niddk.nih.gov

Internet: www.digestive.niddk.nih.gov

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 07/01/2008

Copyright © 07/01/2008 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #6756

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