Irritable bowel syndrome, or IBS, is a common disorder of the large intestine (colon) that causes cramping, abdominal pain, bloating/gas, diarrhea and/or constipation. Despite these annoying symptoms, IBS does not cause any damage to the intestines and does not lead to more serious conditions like ulcerative colitis, Crohn’s disease or colon cancer. Most people with IBS see their symptoms improve as they make lifestyle changes and learn to control their diet and stress. Only a small number will have disabling symptoms.

WHAT ARE THE SYMPTOMS?

Symptoms vary from person to person and can mimic those of other diseases. The most common symptoms are abdominal pain or cramping, bloating, flatulence, diarrhea and/or constipation, and mucus in the stool. Because the symptoms of IBS can also occur with more serious disorders of the gut, it is best to discuss the symptoms with a doctor. IRRITABLE

WHAT CAUSES IBS?

Unusually high sensitivity of the intestines to foods, gas and distention; changes in gut motility and intensity of intestinal contraction; and disturbed balance of bacteria in the intestines.

DOES DIET OR STRESS AFFECT IBS SYMPTOMS?

Symptoms are brought on or made worse by eating certain foods. Chocolate, milk and alcohol may cause constipation or diarrhea in some, while carbonated beverages and certain fruits and vegetables may result in bloating and abdominal discomfort in others. Lactose intolerance can mimic IBS symptoms, as can consuming too much fiber, both of which can cause bloating and discomfort. IRRITABLE

Stress often aggravates IBS symptoms. There is proof that stress management can help prevent or reduce IBS symptoms. Relaxation techniques, such as deep breathing or visualization, can help. Regular exercise, avoidance of alcohol and caffeine, and getting enough sleep all help manage IBS symptoms.

DO HORMONES, MEDICATIONS AND FAMILY HISTORY INFLUENCE IBS?

Hormonal changes can impact IBS symptoms, which tend to worsen during menstruation, for example. Some medications, such as antibiotics, may bring about symptoms as well by changing the balance of gut bacteria.

IS INFLAMMATORY BOWEL DISEASE (IBD) THE SAME AS IRRITABLE BOWEL SYNDROME (IBS)?

Fortunately, no. IBD comprises two predominant inflammatory conditions of the intestines—ulcerative colitis and Crohn’s disease—and is quite distinct from IBS. In IBS, there is no damage to the gut wall and there is no inflammation of the lining. IBD, on the other hand, is a serious condition that can have many complications including colon cancer. IBS, while quite annoying, is a benign disorder that does not result in serious complications or death. IRRITABLE

HOW DO I KNOW IF I HAVE IBS?

There is no test for IBS that can confirm the diagnosis. The condition is diagnosed by signs and symptoms and, when necessary, by excluding more serious disorders.

For a diagnosis of IBS, the Rome III Criteria require at least three months of recurrent abdominal pain or discomfort associated with two or more of the following, with onset at least six months previous:

  • Improvement with defecation
  • Onset associated with a change in frequency of stool
  • Onset associated with a change in form of stool

CAN IBS BE TREATED?

No single treatment for IBS works best for everyone. The patient and doctor need to work together to identify triggers and then it’s up to the patient to avoid them. Some common recommendations include the following:

  • Avoid excessive caffeine and alcohol;
  • Limit fatty food intake;
  • If diarrhea is predominant, limit dairy products, fruits and artificial sweeteners;
  • If constipation is predominant, increase dietary fiber;
  • Avoid high gas foods like beans and raw fruits and vegetables to help relieve bloating and gas;
  • Get regular exercise and good sleep.

Medications may be used along with dietary and lifestyle changes to manage the symptoms of IBS. Anticholinergics are used for cramping and are helpful in patients with bouts of diarrhea and spasms but can worsen constipation. Antidepressant medications, such as tricyclics (imipramine, amitriptyline)

S Murthy Badiga, MD, FACG

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