Home Health A-Z Coping with Irritable Bowel Syndrome (IBS)

Coping with Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (or IBS), is a common intestinal disorder associated with myriad unpleasant symptoms.

IBS is a condition that causes myriad unpleasant digestive symptoms. If the IBS symptoms do not go away on their own, a doctor’s visit is in order to determine possible aggravating causes. IBS treatment might include diet changes, medication, and stress reduction. IBS symptoms can be managed by avoiding IBS triggers and irritants and using home remedies.

What is IBS?

Irritable Bowel Syndrome (IBS) is a common intestinal disorder associated with myriad unpleasant symptoms. IBS affects millions of people, but has no known cause and no effective remedy. It is probably the number one reason people see gastroenterologists.

Irritable Bowel Syndrome may well be the most challenging functional GI disorder for patients and doctors alike. Several studies have found that patients with IBS have a significantly lower quality of life than patients without the syndrome, and that the illness is seriously underdiagnosed.

Unless a person is truly miserable or worried about the possibility of more serious illness, there may be no reason to seek medical attention.

Symptoms of IBS

Common IBS symptoms include:

  • Pain or cramps in the lower abdomen
  • Frequent bowel movements
  • Loose, watery stools
  • Bloated feeling
  • Excess gas
  • Constipation

You will begin to suffer intermittent cramps in the lower abdomen and may have to move your bowels more often than usual. And, when you have to go, you have to get to a toilet right away. Your stools are loose and watery, possibly containing mucus. Sometimes, you feel bloated and full of gas.

After a while, the cramps return, but this time when you try to go to the bathroom, nothing happens. You’re constipated. And back and forth it goes — diarrhea, then constipation, and pain and bloating in between. Some people with IBS alternate between constipation and diarrhea, while others have one without the other. Irritable bowel syndrome is the catchall term for this mixed bag of symptoms.

It’s a common disorder, with no known cause. The most frequently reported symptom is pain or discomfort in the abdomen. People with IBS usually feel their pain subside after a bowel movement or passing gas. But they also may feel that they have not fully emptied their rectum after a movement.

While some patients have daily episodes or continuous symptoms, others experience long symptom-free periods. These patterns make it hard to know whether someone has IBS or some occasional complaint that’s part of the bowel’s normal response to stress. Whether it is IBS, usually depends on its frequency. The formal criterion for diagnosis is that symptoms have occurred for 3 of the preceding 12 months.

IBS is a disorder in the functioning of the intestinal tract. Some experts suspect that it involves disturbances in the nerves or muscles in the gut. Others believe that abnormal processing of gut sensations in the brain may hold the key, at least in some cases. In addition, IBS can be triggered by a bout of gastroenteritis (stomach or bowel inflammation). Low-grade bowel inflammation may persist in these patients indefinitely, thereby leading to IBS. Other possible causes of IBS include emotional upset, stress, or other psychological factors.

Diagnosing IBS

Because there are no tests for IBS, the illness must be diagnosed based on symptoms and by the process of elimination, often with the use of tests for other conditions. Fortunately, a diagnosis usually can be made on the first visit to a doctor.

The doctor takes a complete medical history including a careful description of your symptoms. A physical exam and laboratory tests are likely to be part of the exam, and a stool sample is useful for evidence of bleeding. In some cases, the doctor may also recommend diagnostic procedures that involve viewing the inside of the colon with a scope inserted through the anus, such as with sigmoidoscopy or colonoscopy. The physician may also order an X-ray.

The doctor will also ask whether your symptoms started after an episode of gastroenteritis, or if they seem to be triggered by specific foods or medications, particularly milk products (to rule out lactose intolerance) and foods and beverages that contain fructose or sorbitol. You may need to keep a food diary for a few weeks to help identify foods that provoke symptoms.

It is especially important to consider emotional and psychological triggers. Physicians may like to know what prompted the visit and will ask about the patient’s lifestyle and stress level. It is not unusual for traumatic life events such as divorce or the loss of a job to wreak havoc on the bowels and the psyche. The doctor must also try to establish whether the patient has a serious psychological disturbance. A referral to a mental health professional may be appropriate in some cases.

Other symptoms that accompany the pain may offer clues. If there is pain in the lower abdomen and a change in bowel movements, an abnormality in the large intestine may be present. A combination of abdominal pain and fever can signal inflammation (for example, diverticulitis), which requires immediate medical attention.

Another major diagnostic clue is bleeding from the digestive tract. IBS usually does not cause bleeding. Instead, bleeding reflects another cause, such as internal hemorrhoids. Bright red blood comes from the lower digestive tract, while black, tarry blood comes from the upper GI tract. If there is bleeding, more tests must be performed to determine the cause.

During the physical exam, the physician will look for tenderness in the abdomen. If the tenderness is located in the lower right part, it may signal ileitis or appendicitis, and in the upper right part, gallstones or inflammation of the gallbladder. The doctor will also check for masses caused by tumours, large cysts, or impacted stool. If the patient has IBS, the physical exam will usually not reveal anything other than perhaps a mildly tender abdomen. And, lab tests are generally normal in IBS patients. A digital rectal exam is also usually part of the evaluation to check for masses in the rectum and, in men, the prostate. If a serious disorder is suspected, more tests will be ordered immediately.

Treatment Options:

Medications

If you have symptoms that are troublesome enough to stop you from participating in normal activities, talk with your doctor about drug therapy. While medications can’t cure the condition, they may ease the symptoms.

Anticholinergics. These medications, including atropine and related agents, dicyclomine (Bentyl), or hyoscyamine (Levsin), may relieve mild abdominal pain by reducing bowel spasms. People who often experience cramps after eating may obtain some relief if they take one of these medications before meals.

Antidepressants. Medications such as amitriptyline (Elavil, Endep) and desipramine (Norpramin) may be prescribed for patients who have pain-predominant IBS. These tricyclic antidepressants should be used at low doses and only by patients who have diarrhea-related IBS because they can cause constipation. The selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), may be helpful in treating abdominal pain in patients who have either diarrhea- or constipation-related IBS, but the SSRIs have not been studied extensively in IBS yet.

Other medications. Current research is focusing more on the gut-brain connection, which appears to play a role in IBS, with serotonin-like medications among those being investigated. However, the first of these to be approved, alosetron (Lotronex), which works on the serotonin type III receptor, was temporarily taken off the market in 2000 because of colitis and severe constipation that resulted in 44 hospitalizations and 5 deaths. Lotronex is now available for women by prescription but only under a tightly controlled prescribing program. Another drug in this class, tegaserod (Zelnorm) improves symptoms in constipation-predominant IBS. Diarrhea is the most common side effect.

Loperamide (Imodium) and diphenoxylate (Lomotil) are generally recommended for patients whose main complaint is diarrhea. Loperamide, available over the counter, reduces the secretion of fluid by the intestine. Diphenoxylate, available by prescription only, helps to slow down intestinal contractions. It is related to codeine and contains atropine as well.

Managing IBS

As there is no cure for IBS, treatment is often aimed at controlling the individual symptoms. Therefore, the management of IBS needs great understanding between the doctor and patient. Individuals need to educate themselves about IBS and receive adequate information from their doctors so they can learn to manage the syndrome and regain control over their lives.

Eliminate triggers. What is known is that, something has disrupted the automatic functioning of the bowel in IBS patients. The task is to search for possible irritants. The natural place to start is with something consumed — foods, beverages, or drugs, for example.

You have to eliminate likely food triggers — caffeine, sorbitol-containing gum or beverages, dairy products, alcohol, apples and other raw fruits, fatty foods and gas-producing vegetables (for example, beans, cabbage, and broccoli) — to see if symptoms subside. You may eliminate the foods one at a time to see which make a noticeable difference

If you are lactose intolerant, you can take supplements of the enzyme lactase if you can’t always avoid milk. There are also a host of lactose-free dairy products on the market

Eat fiber. The most common dietary recommendation for IBS is adding fiber to increase the stool’s bulk and speed its movement through the GI tract. A high-fiber diet does not always improve bowel symptoms, but many clinical trials have shown that it does seem to relieve constipation and ease abdominal pain. And, sometimes it can even improve diarrhea.

Try heat. Individuals who experience IBS intermittently can use a home heating pad, a simple and inexpensive way of soothing abdominal pain. Heat can help relax cramping muscles.

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